THE INFLUENCE OF SOCIAL-CLASS ON HEALTH-STATUS - AMERICAN AND BRITISHRESEARCH ON HEALTH INEQUALITIES

PURPOSE: To summarize recent and past American and British studies on the relationship of social class and health status. DATA SOURCES: A sy stematic review of the pertinent British and American literature, incl uding references identified from bibliographies of books and recent ar ticles. STUDY SELECTION: Published English-language studies that repor t original or summary data describing socioeconomic status and mortali ty/morbidity are emphasized. DATA SYNTHESIS: Social class, whether mea sured by occupation, income, or education, has a marked effect on mort ality and morbidity. Use of British and American standardized mortalit y ratios (SMRs) shows that the gap between the advantaged upper socioe conomic classes and the disadvantaged lower classes has become wider f rom 1930 to 1980, Explanations for this inequality in health status by socioeconomic status point to four factors: artefact, social selectio n, culture/behavior. and material/structural conditions, A synthesis o f existing literature suggests that material deprivation and social de privation are the most important factors contributing to this associat ion, although data from longitudinal studies implicate social hierarch y. CONCLUSION: The reviewed studies point to growing inequalities in h ealth status between those of lower and those of higher socioeconomic status, Clinicians and teachers in internal medicine should incorporat e this knowledge in assessing patients and adopt a perspective that ta kes account of socioeconomic factors in diagnostic and management deci sions.