National vital statistics in the United States are unique among those of advanced capitalist countries in reporting data only by race, sex, and age—not by class and income. This article reviews the limited U.S. data resources that may be used to document social class inequalities in health. Summarizing the strengths and weaknesses of the British approach to gathering data on social class and health, the authors discuss possible approaches to collecting data that could be feasible in the U.S. context. They argue that educational level is an insufficient marker for socioeconomic position and contend that appropriate measures must take into account not only individual but also household and neighborhood markers of social class. These additional types of social class data are especially important for accurately describing and understanding social class inequalities in health among women and across diverse racial/ethnic groups.
Get full access to this article
View all access options for this article.
References
1.
LiberatesP.LinkB. G.KelseyJ.The measurement of social class in epidemiology. Epidemiol. Rev.10: 87–121, 1988.
2.
SusserM.WatsonW.HopperK.Sociology in Medicine, Ed. 3. Oxford University Press, New York, 1985.
3.
NasarN.The 1980's: A very good time for the very rich. New York Times, March 5, 1992, pp. A1, C13.
4.
RisenJ.Middle class stagnated during Reagan era. Oakland Tribune, January 7, 1990, p. C1.
5.
PearR.Ranks of U.S. poor reach 35.7 million, the most since '64. New York Times, September 4, 1992, pp. A1, A10.
6.
NasarN.However you slice the data the richest did get richer. New York Times, May 11, 1992, pp. C1, C5.
7.
RichS.Poverty on rise among whites. Oakland Tribune, October 9, 1991, pp. A1, A17.
8.
SydenstrickerE.Health and the depression. Milbank Mem. Fund. Q.12: 273–280, 1934.
9.
National Cancer Institute, National Institutes of Health. Cancer Statistics Review, 1973–1989. NIH Publication No. 92-2879. U.S. Department of Health and Human Services, Bethesda, Md., 1992.
10.
ClappR. W.Occupation and Race Data in Cancer Incidence Registries. Paper presented at the American Public Health Association, 119th Annual Meeting, Atlanta, November 10–14, 1991.
MaysV. M.AIDS and Ethnic Minorities: How You Ask Is What You Know. Paper presented at the American Public Health Association, 119th Annual Meeting, Atlanta, November 10–14, 1991.
13.
Centers for Disease Control. Reporting of race and ethnicity in the National Notifiable Disease Surveillance System, 1990. MMWR Morb. Mortal. Wkly Rep. 41: 653–657, 1992.
14.
RiesP.Health Characteristics According to Family and Personal Income, United States. Vital Health Statistics10(147). DHHS Publication No. (PHS) 85-1575. National Center for Health Statistics, U.S. Public Health Service, Hyattsville, Md., 1985.
15.
RiesP.Educational Differences in Health Status and Health Care. Vital Health Statistics10(179). DHHS Publication No. (PHS) 91-1507. National Center for Health Statistics, U.S. Public Health Service, Hyattsville, Md., 1991.
16.
CollinsJ. G.Health Characteristics by Occupation and Industry: United States, 1983–85. Vital Health Statistics10(170). DHHS Publication No. (PHS) 90-1598. National Center for Health Statistics, U.S. Public Health Service, Hyattsville, Md., 1989.
17.
AmlerR. W.DullH. B. (eds.). Closing the Gap: The Burden of Unnecessary Illness. Oxford University Press, New York, 1986.
18.
IdlerE.KaslS.Health perceptions and mortality: Do global evaluations of health status really predict mortality?J. Gerontol.46: S55–S65, 1991.
19.
MarmotM. G.KogevinasM.ElstonM. A.Social/economic status and disease. Annu. Rev. Public Health8: 111–135, 1987.
20.
U.S. Bureau of the Census. Income, Poverty, and Wealth in the United States: A Chartbook. Current Population Reports, Series P-60, No. 179. U.S. Government Printing Office, Washington, D.C., 1992.
21.
RogotE.A Mortality Study of 1.3 Million Persons by Demographic, Social, and Economic Factors: 1979–1985 Follow-Up, U.S. National Longitudinal Mortality Study. NIH Publication No. 93-3297. National Institutes of Health, Washington, D.C., 1992.
22.
U.S. Department of Health and Human Services. Health Status of Minorities and Low-Income Groups, Ed. 3. U.S. Government Printing Office, Washington, D.C., 1991.
23.
U.S. Department of Health and Human Services. Report of the Secretary's Task Force on Black & Minority Health, Volume I: Executive Summary. 1985 0-487-673 (QL3). U.S. Government Printing Office, Washington, D.C., 1985.
24.
Office of Minority Health, U.S. Department of Health and Human Services. Toward Equality of Well-Being: Strategies for Improving Minority Health. Strategic Planning and Coordination Process. 93-50217. U.S. Government Printing Office, Washington, D.C., 1993.
25.
U.S. Bureau of the Census. A look at health insurance coverage. Census and You, September 1991, p. 8.
26.
National Center for Health Statistics. Health, United States, 1991. DHHS Publication No. (PHS) 92-1232. U.S. Public Health Service, Hyattsville, Md., 1992.
27.
KriegerN.The making of public health data: Paradigms, politics and policy. J. Public Health Policy13: 412–427, 1992.
28.
JonesI. G.CameronP.Social class analysis—an embarrassment to epidemiology. Community Med. 6: 37–46, 1984.
29.
BlackD.Inequalities in Health: The Black Report. Penguin, Harmondsworth, England, 1982.
30.
MacfarlaneA.Official statistics and women's health and illness. In Women's Health Counts, edited by RobertsII., pp. 18–62. Routledge, London, 1990.
31.
DaleA.GilbertG. N.ArberS.Integrating women into class theory. Sociology19: 384–409, 1985.
32.
CharlesN.Women and class—a problematic relationship. Social. Rev.38: 43–89, 1990.
33.
DukeV.EdgellS.The operationalisation of class in British sociology. Br. J. Sociol.38: 445–463, 1987.
34.
PughH.MoserK.Measuring women's mortality differences. In Women's Health Counts, edited by RobertsH., pp. 93–112. Routledge, London, 1990.
35.
MorganM.Measuring social inequality: Occupational classifications and their alternatives. Community Med. 5: 116–124, 1983.
36.
TolsonG. G.The 1989 Revision of the U.S. Standard Certificates and Reports. Vital Health Statistics4(28). DHHS Publication No. (PHS) 91-1465. National Center for Health Statistics, U.S. Public Health Service, Hyattsville, Md., 1991.
37.
RoseS. J.The American Profile Poster: Who Owns What, Who Makes How Much, Who Works Where, & Who Lives With Whom. Pantheon Books, New York, 1986.
38.
WrightE. O.The American class structure. Am. Sociol. Rev.47: 709–726, 1982.
39.
WrightE. O.Classes. Verso, London, 1985.
40.
KriegerN.Women and social class: A methodological study comparing individual, household, and census measures as predictors of black/white differences in reproductive history. J. Epidemiol. Community Health45: 35–42, 1991.
41.
KarasekR.TheorellT.Healthy Work: Stress, Productivity, and the Reconstruction of Working Life. Basic Books, New York, 1990.
42.
KriegerN.Overcoming the absence of socioeconomic data in medical records: Validation and application of a census-based methodology. Am. J. Public Health82: 703–710, 1992.
43.
U.S. Bureau of the Census. Income and poverty trends in 1991. Census and You, November 1992, pp. 7–8.
44.
BeeghlyL.Illusion and reality in the measurement of poverty. Soc. Problems31: 322–333, 1984.
45.
National Center for Health Statistics. The 1968 Revision of the Standard Certificate. Vital and Health Statistics, Series 4, No. 8. U.S. Government Printing Office, Washington, D.C., 1968.
46.
Education and income: Statistical portrait of the nation. New York Times, January 28, 1993, p. All.
47.
AndersonM. J.The American Census: A Social History. Yale University Press, New Haven, 1988.
48.
AlonsoW.StarrP. (eds.). The Politics of Numbers. Russell Sage Foundation, New York, 1987.
49.
NorwoodJ. L.KleinD. P.Developing statistics to meet society's needs. Monthly Labor Rev., October 1989, pp. 14–19.
50.
IrvineJ.MilesI.EvansJ. (eds.). Demystifying Social Statistics. Pluto Press, London, 1979.
51.
EssedP.Understanding Everyday Racism: An Interdisciplinary Theory. Sage Publications, Newbury Park, Calif., 1991.
52.
KriegerN.BassettM.The health of black folk: Disease, class, and ideology in science. Monthly Rev. 38: 74–85, 1986.
53.
HaanM.KaplanG.The contribution of socioeconomic position to minority health. In Report of the Secretary's Task Force on Black & Minority Health, Vol. II, Crosscutting Issues in Minority Health, pp. 67–103. U.S. Department of Health and Human Services, U.S. Government Printing Office, Washington, D.C., 1985.
54.
NavarroV.Race or class versus race and class: Mortality differentials in the United States. Lancet2:1238–1240, 1990.
55.
CooperR.DavidR.The biological concept of race and its application to epidemiology. J. Health Polit. Policy Law11: 97–116, 1986.
56.
GoldblattP. (ed.). Longitudinal Study: Mortality and Social Organisation. Her Majesty's Stationery Office, London, 1990.
57.
SymeS. L.Social determinants of disease. In Maxcy-Rosenau-Last Public Health & Preventive Medicine, Ed. 13, edited by LastJ. M.WallaceR. B., pp. 687–700. Appleton & Lange, Norwalk, 1992.
58.
WhiteheadM.The Health Divide. Penguin, Harmondsworth, England, 1987.
59.
HaanM.KaplanG.SymeS. L.Socioeconomic status and health: Old observations and new thoughts. In Pathways to Health: The Role of Social Factors, edited by BunkerJ. P.GombyD. S.KehrerB. H., pp. 76–135. Henry J. Kaiser Family Foundation, Menlo Park, Calif., 1989.
60.
EngelsF.The Condition of the Working Class in England, translated by HendersonW. O.ChalonesW. H., Stanford University Press, Stanford, Calif., 1958 [1848].
61.
RatherL. J. (ed.). Rudolf Virchow: Collected Essays on Public Health and Epidemiology. Science History Publications, Canton, Mass., 1988.
62.
AckerknechtE. H.Rudolf Virchow: Doctor, Statesman, Anthropologist. University of Wisconsin Press, Madison, 1951.
63.
VillerméL. R.Mémoire sur la mortalité en France dans la classe aisée et dans la classe indigente. Mémoires de l'Académie Royale de Médicin1: 51–48, 1828.
64.
ColemanW.Death Is a Social Disease: Public Health and Political Economy in Early Industrial France. University of Wisconsin Press, Madison, 1982.
