Does social class explain health inequalities?

The main research questions examined in this thesis concern the extent to which social class influence individuals' health, and how and whether individuals' occupation, education and lifestyles mediate between class and health. The conclusions drawn from the analysis of these empirical questions cast further light on the widening health inequalities seen in developed societies in recent decades. In particular, this research suggests that, employment conditions as well as educational levels are variables that need to be taken into account when planning policies aimed at tackling differences in health outcomes. Lifestyle variables, on the other hand, would appear to be almost irrelevant when explaining why the members of the more privileged social classes not only live longer than those in other classes, but also enjoy significantly better health over the course of their lives.
In trying to understand the association between class and health, I define a theoretical framework that specifies the mechanisms through which class is linked to health. Social structure influences health by distributing certain factors such as material resources or some health-related behaviour that ultimately result in individuals having different living conditions. Educational attainment also affects the way these resources are employed and, therefore, lifestyles. A fundamental element of a social class is occupation: individuals' employment and working conditions also affect their health. Furthermore, the nature of a social structure has an effect on health at the aggregate level of analysis since social policies are partly the result of the structure of class interests. Four mechanisms are specified in order to systematically test this theoretical framework. Mechanisms (2) and (3), those that relate class and health through education and lifestyle lie at the heart of the empirical analysis. This analysis employs individual-level data drawn from health surveys carried out during the first half of the 1990s in the two countries selected for the analysis, United Kingdom and Spain. These countries are treated as contexts in which to test the theoretical explanation.
The main results of the analysis reveal the importance of social class in determining health outcomes. Indeed, individuals from different classes enjoy distinct degrees of health. Specifically, individuals in the most privileged class categories have persistently better health than those in the other class categories. Differences exist in terms of both objective and subjective or self-perceived health. Moving on from observation to explanation, the analysis suggests that the distribution of certain resources across classes accounts for some of the variance in health outcomes. Hence, education is identified as a significant variable to comprehend part of the health inequalities in developed societies. Lifestyle, on the other hand, does not appear relevant in accounting for health outcomes. The small differences found between the United Kingdom and Spain in the mechanisms that link class and health suggest that the process through which class affects health is essentially similar in developed societies.

Advisor: Breen, R
Esping-Andersen, G