Class matters: U.S. versus U.K. measures of occupational disparities in access to health services and health status in the 2000 U.S. National Health Interview Survey.
To inform current debates over whether occupational class is causally linked to health inequities, the authors used data from the 2000 U.S. National Health Interview Survey to compare occupational disparities in access to health services, socioeconomic resources, and health status, using (1) the United Kingdom's new National Statistics Socio-Economic Classification (NS-SEC), premised on type of labor contract (salaried vs. hourly wage) and class position (employer, self-employed, supervisory and non-supervisory employee), and (2) the conventional U.S. occupational categories, premised on status and skill. Analyses included all working-age adults (age 25 to 64) for whom data on occupation and race/ethnicity were available (N = 22,500). Risk of inadequate access to health services, poverty, and low education were two times greater for persons in NS-SEC class 5 versus class 1, compared with blue-collar versus white-collar, and for both measures persons with the worst health status were in jobs that afforded the least access to health care. Controlling for earned income and workplace health insurance markedly reduced health service disparities, especially for the NS-SEC measure, thereby implying structural characteristics of jobs are causally relevant for resources and benefits necessary to address health inequities in the United States.
Krieger
Nancy
N
Department of Society, Human Development and Health, Harvard School of Public Health, Boston, MA 02115, USA. nkrieger@hsph.harvard.edu
Barbeau
Elizabeth M
EM
Soobader
Mah-Jabeen
MJ
D000328:Adult; D005006:Ethnicity; D005260:Female; D006297:Health Services Accessibility / Q000191:economics*; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D009790:Occupations / Q000145:classification* / Q000592:standards*; D012015:Reference Standards; D012959:Socioeconomic Factors; D006113:United Kingdom; D014481:United States