Social mobility and 21 year mortality in a cohort of Scottish men
Introduction
The role of inequalities in mortality across the socioeconomic spectrum has been of interest for many years, with the publication, in Britain, of the Black report stimulating fresh attempts to understand the processes lying behind these health differentials (DHSS, 1980). Researchers have considered the extent to which social mobility, either up or down the social class hierarchy, contributes to these inequalities (Stern, 1983; Illsley, 1986; Goldblatt, 1989; West, 1991; Blane et al., 1993; Power et al., 1996; Bartley and Plewis, 1997) and come to different conclusions about the importance of the contribution of health-related social mobility to mortality differentials. On the one side, it has been argued that health-related social mobility can explain socioeconomic differences in health and mortality since the healthier rise up the social spectrum and the less healthy go down (Stern, 1983; Illsley, 1986; West, 1991). Researchers on the other side have suggested that the role played by social mobility is small and socioeconomic gradients are constrained (Goldblatt, 1989; Blane et al., 1993; Power et al., 1996; Bartley and Plewis, 1997). This is because those moving upwards, although healthier than the group which they have left, are less healthy than the group which they join, and similarly the less healthy moving downwards are healthier than their destination group. The issue is of importance because if socioeconomic differentials in health are generated by health-related social mobility rather than by the effects of different social environments, then policies aimed at reducing health inequalities through equalising life chances will not succeed.
We have investigated the mortality experience of a large cohort of working men whose social class was known at three stages of their life. In a previous study of this cohort, we analyzed the cumulative effect on mortality of social class at these three stages (Davey Smith et al., 1997). We allocated men to one of four groups depending on the number of occasions their social class was non manual or manual (all three non manual, two non manual and one manual, one non manual and two manual and all three manual). A clear cumulative effect of socioeconomic circumstances over a lifetime was found, with mortality risk positively related to the number of occasions spent in manual social classes. In another study of this cohort, we analyzed mortality by social class at the three stages separately (Hart et al., 1998). We found that mortality risk was similar at each lifestage with men in social classes I and II having the lowest risk. A widening of inequalities in adulthood suggested the importance of the accumulation of poor socioeconomic circumstances throughout life.
In the current study, we have assessed whether the accumulation of socioeconomic risk could be due to health-related social mobility. We looked at three possible routes of social mobility — intergenerational mobility between childhood social class and later adult social class, intragenerational mobility between early adult and later adult social class, and intergenerational mobility between childhood social class and early adult social class. In addition, unlike other studies of social mobility, this cohort has information on individual behavioural and physiological measures, enabling us to see how they contribute to the mortality experience of socially mobile and socially stable groups.
Section snippets
Methods
This analysis was based on part of a cohort of employed people from 27 workplaces in Glasgow, Clydebank and Grangemouth, Scotland, who were screened between 1970 and 1973. The full sample consisted of 6022 men and 1006 women. Participants completed a questionnaire and attended a physical examination. Women have been excluded from this study due to the small number of deaths which have occurred. Full details have been described elsewhere (Blane et al., 1996; Davey Smith et al., 1997).
The
Father's social class and social class at screening
Taking mobility between father's social class and social class at screening, the largest group of men were the socially stable manual workers and the smallest group were the downwardly mobile, who were manual workers at screening but whose fathers had been non manual workers (Table 1). Statistically significant differences between non manual and manual social classes at screening were seen for all the characteristics except body mass index and ECG ischaemia. Differences between the four groups
Interpretation of mortality results
We have shown that overall, mortality experience was worse for the stable manual group, best for the stable non manual group and in between these two for the upwardly and downwardly mobile groups. This is compatible with results from the cumulative social class approach, analyzed in a previous study of mortality in this cohort where men were allocated to one of four groups depending on the number of occasions their social class was non manual or manual (Davey Smith et al., 1997). It was found
Conclusions
The major differentials in mortality were seen between the stable non manual and the stable manual groups, with mobility making only a minor contribution and constraining socioeconomic differentials in mortality. Apart from the intragenerational mobility findings, the mortality risks seen in this study were consistent with a cumulative lifecourse approach. Future studies should consider the importance of obtaining detailed information on socioeconomic position throughout the lifecourse. The
Acknowledgements
Funding was provided by a grant from the NHS Management Executive, Cardiovascular Disease and Stroke Research and Development Initiative. Victor M. Hawthorne was responsible for the original screening study and we thank him for his continuing interest. Charles Gillis, David Hole and Pauline MacKinnon are also thanked for their support.
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2019, Social Science and MedicineCitation Excerpt :It is well known that, in addition to individuals' own socio-economic status, their social origins are also related to the risk of developing depressive symptoms in adult life (Adler et al., 1994; Bjelland et al., 2008; Edwards et al., 2003; Hughes et al., 2017; Ross and Willigen, 1997; Schilling et al., 2007). Further, there is now growing research on the possible mechanisms – such as the role of individuals' life course trajectories, or the geography of health – that may underlay the complex relationships between social origins, socio-economic status and health outcomes (Chaparro and Koupil, 2014; Gugushvili et al., 2018b; Hart et al., 1998; Iveson and Deary, 2017; Palloni et al., 2009; Simandan, 2018). Still, we know very little about how far individuals' experience of intergenerational social mobility per se – i.e., the attainment of higher or lower socio-economic positions than their parents' – affects their psychological well-being, in addition to the effects of social origins and own socio-economic status.