What does “occupation” represent as an indicator of socioeconomic status?: Exploring occupational prestige and health

Abstract

The association between socioeconomic status (SES) and health has been widely documented. However, the role of occupation in this association is not clear because occupation is less often used than income and education as an indicator of SES, especially in the United States. This may be caused by the ambiguity in what occupation represents: both health-enhancing resources (e.g., self-affirmation) and health-damaging hazards (e.g., job stress). SES has two aspects: resources and status. While income and education represent resources and imply status, occupational prestige is an explicit indicator of the social status afforded by one’s occupation. Using data from the US General Social Survey in 2002 and 2006 (n = 3151), we examine whether occupational prestige has a significant association with self-rated health independent from other SES indicators (income, education), occupational categories (e.g., managerial, professional, technical, service), and previously established work-related health determinants (job strain, work place social support, job satisfaction). After all covariates were included in the multiple logistic regression model, higher occupational prestige was associated with lower odds of reporting poor/fair self-rated health. We discuss potential mechanisms through which occupational prestige may impact health. Our findings not only suggest multiple ways that occupation is associated with health, but also highlight the utility of occupational prestige as an SES indicator that explicitly represents social standing.

Introduction

The impact of socioeconomic status (SES) on health has been an important topic for public health research in the last several decades (Adler and Rehkopf, 2008, Curtiss and Grahn, 1980, Kaplan and Keil, 1993, MacIntyre, 1997). By now it is well-established that those with higher SES have better health (Adler and Newman, 2002, Evans and Kantrowitz, 2002, Kivimäki et al., 2007, Lemelin et al., 2009). Various mechanisms linking SES and health have been proposed, such as material deprivation (Benach, Yasui, Borrell, Sáez, & Pasarin, 2001), a sense of personal control and mastery (Taylor & Seeman, 2006), stress (Dressler, Oths, & Gravlee, 2005), and the quality of healthcare (van Ryn & Burke, 2000). These mechanisms are not mutually exclusive and most likely work simultaneously.

SES is partly determined by individuals’ occupation (MacIntyre, 1997), which reflects their educational level, provides income, and signals their social standing. However, the association between health and occupation is complex because occupation can be a source of both health-enhancing factors (e.g., self-affirmation) and harmful exposure (e.g., stress) (Adler & Newman, 2002). To explore the role of occupation as a determinant of health, we examine occupational prestige, an aspect of occupation that has been rarely discussed in scholarship on health. Occupational prestige represents the perception of a job’s social status (MacKinnon & Langford, 1994). Unlike other SES measures (e.g., income, education), which represent individuals’ material and human resources and only imply their social status, occupational prestige directly measures the social standing of the job and job holder (Nakao & Treas, 1994). Using US national data, we investigate whether occupational prestige explains self-rated health status beyond the effects of other SES measures and job-related health determinants.

Occupation has been used, mainly in European countries, as a marker of social stratification (Krieger, Williams, & Moss, 1997). Most notably, the British Registrar General’s social schema, a five-level categorization system, was used in the Whitehall studies to show strong health gradients among British civil servants (Marmot et al., 1991). In contrast, researchers in the US have rarely used occupation as an SES indicator (Barbeau et al., 2004, Braveman et al., 2005, MacDonald et al., 2009). Some argue that occupation merely represents the education required for the job and earning potential (Nam & Boyd, 2004); thus, if information on income and education is available, occupation is not needed. However, some US studies have found occupational gradients in health beyond the effects of income and education (e.g.,Barbeau et al., 2004, Fujishiro et al., 2010).

A more common approach to occupation in the US is to link specific occupations to specific health conditions. For example, material handlers and car mechanics have a high likelihood of developing chronic obstructive pulmonary disease (COPD) (Hnizdo, Sullivan, Bang, & Wagner, 2002). The underlying assumption is that certain jobs expose individuals to specific health hazards. It is generally true that workers in hazardous jobs (e.g., construction workers, chemical plant workers) tend to have lower income and education levels, and therefore are classified lower in the socioeconomic hierarchy than those in less hazardous jobs (e.g., accountants, librarians). One could argue that high likelihood of occupational hazard exposure is part of low SES. This approach is useful in studying specific health conditions (e.g., COPD) with known causal factors (e.g., chemical fumes, dusts). However, to examine health and occupation as an SES indicator, researchers must consider occupation as more than simply a source of hazard exposure (Adler & Newman, 2002).

When occupation is included in health research as an SES indicator, the US Census categories (e.g., managerial, professional, clerical, service, blue-collar) are commonly used (Kaplan & Keil, 1993). Braveman et al. (2005) point out that the census categories are “not intended—and do not appear to be meaningful—as SES measures” (p. 2883). In fact, using the National Longitudinal Mortality Study data, Gregorio, Walsh, and Paturzo (1997) demonstrated that there was no linear trend in all-cause mortality risk across the Census occupational categories (e.g., the relative risk of mortality for managerial/professional occupations did not differ from farming occupations). Because it is unclear as to what occupational categories represent, researchers have difficulty understanding what mechanisms cause differences in health status among these categories.

Since occupational categories have ambiguous meanings as an SES indicator (Adler and Newman, 2002, Braveman et al., 2005), a more precise conceptualization of occupation is needed as we investigate the association between SES and health. We propose that occupational prestige, an innate component of occupation, reflects a unique aspect of SES not directly represented by occupational categories, income, or education. Specifically, we argue that occupational prestige explicitly represents the social status afforded by a particular occupation.

SES is an individual’s position within the social structure, which determines his or her available resources (Lynch and Kaplan, 2000, Oakes and Rossi, 2003). Krieger et al. (1997) distinguish two aspects of SES: “(a) actual resources, and (b) status, meaning privilege- or rank-based characteristics” (p. 246). Actual resources are ones an individual already has, such as education, material wealth, and social support. Status, on the other hand, concerns potential availability of resources when needs arise. The higher the social status, the more access to potential resources. High status may be achieved through high income and education, but this status is only inferred but not explicitly measured. In contrast, occupational prestige is an explicit indicator of social status (Nakao & Treas, 1994).

Occupational prestige represents a collective, subjective consensus on occupational status (Xu & Leffler, 1992); that is, it indicates how members of a community collectively evaluate the social standing of a job. Occupational prestige is a measure of power, according to Donald Treiman, who observed a remarkable consistency in occupational prestige ranking across social contexts. To explain the consistency, Treiman (1976) reasons: “Since occupations are differentiated with respect to power, they will in turn be differentiated with respect to privilege and prestige” (p. 289). Being able to access and control resources is part of the definition of having power (Ibarra & Andrews, 1993). Thus, occupational prestige reflects the status aspect of SES, based on the differential distribution of power inherent in occupations, which then results in disparities in access to health-enhancing resources.

Holding a prestigious job may provide health benefits in various ways. First, high-prestige jobs may enhance the job holder’s self-esteem (Faunce, 1989), which is associated with high job satisfaction (Judge & Bono, 2001). High self-esteem and job satisfaction are both health-promoting factors (Faragher et al., 2005, Mann et al., 2004). In addition, high-prestige job holders may have more positive social interactions than low-prestige job holders (Matthews et al., 2000). Previous studies reported that prestige assessment reflects the raters’ deference to the job (Wegener, 1992), positive social sentiments (e.g., moral worthiness, usefulness) associated with the job (MacKinnon & Langford, 1994), and the job’s value to the society (Goyder, 2009). Because occupational prestige is how others see the job, the quality of social interaction the job holder experiences would be influenced by the prestige of the job. Large bodies of literature have documented that the quality of social interaction is an important determinant of health (e.g., Uchino et al., 1996, Williams et al., 2003).

Despite these suggestive associations, the current literature provides few direct investigations of the association between occupational prestige and health. To the best of our knowledge, only two studies have examined occupational prestige, but their findings are not consistent. One study (von dem Knesebeck, Luschen, Cockerham, & Siegrist, 2003) did not find any association between occupational prestige and self-rated health. The prestige score was trichotomized in the study, which might have contributed to the null result. The Framingham Offspring Study (Eaker, Sullivan, Kelly-Hayes, D’Agostino, & Benjamin, 2004) found a significant association between occupational prestige and coronary heart disease only among men, but not among women.

In this study, we investigate occupational prestige by distinguishing it from other aspects of occupation (i.e., occupational categories, and job characteristics) and other SES indicators. Using US national survey data, we examine the following research question: to what extent is occupational prestige associated with self-rated health independent from other SES indicators (education, income), occupational categories, and previously identified job-related health determinants (job stress, workplace social support, and job satisfaction)?