Which rung are you on?

If you ask people in the UK which social class they belong to, nearly half are, as one British Social Attitudes report puts it, reticent to pick. But this survey data also shows that (after some prompting) about a third report being middle class and about 60 per cent report being working class. These percentages have not changed much over decades, despite a massive reduction in the number of typical 'working class' jobs in the UK. 

This is just one of the reasons why coming up with objective measures of 'class' isn't easy. So, when exploring links with mental and physical health, researchers often instead use objective measures of socioeconomic status (SES), which take into account income and level of education, as well as type of job. These studies have revealed all kinds of interplays between SES and health.

But over the past decade or so, research has also highlighted the importance of subjective measures of social status. Studies from a range of countries have found that objective SES doesn't always correspond to where people feel they sit on the social ladder. And these subjective ratings really matter: they too are linked to a number of differences in physical and mental health.  

Early impacts

The MacArthur Scale of Subjective Social Status is one of the most popular tools to measure people's own perception of their position in society. It's very simple: a person views a drawing of a ladder with ten rungs and is told that at the top are the 'people who are the best off, those who have the most money, most education, and best jobs', while those at the bottom have the least. With an X, they mark where they feel that they sit on this ladder. This scale has been used around the world. The wording has also been adapted to explore perceived social status in more specific environments, such as workplaces and schools. 

Using the MacArthur ladder, Margaret Sheridan at Boston Children's Hospital and colleagues found in a 2013 study that your mother's perceived social status might have affected your own development. The children of mothers who reported feeling that they were of a low social rank were more likely to have raised levels of the stress hormone cortisol, and to show reduced activity in the hippocampus (which is important in memory) during a learning task. The mother's actual level of education or family income had no bearing on these measures. 'We know that there are big disparities among people in income and education. Our results indicate that a mother's perception of her social status 'lives' biologically in her children,' commented Sheridan in a statement issued at the time. 

Why should perceptions matter, when the objective measures did not? The team suggest that how people adapt to their situation in life has a bigger impact on their children's development than the situation itself. If feeling that you sit relatively low on the social ladder is in itself stressful, this could have detrimental effects of its own. 

Social status in adolescence

Perceived social status matters for children as they grow up, too – but also in ways that go beyond their position in broader society. 

Evidence for this comes from a 2019 study in BMC Public Health on 705 Swedish teenagers, aged 17 and 18. The teens indicated their perceived social position within the school. To do this, they used a version of the MacArthur ladder, with terms such as 'respect' and 'standing' in place of jobs and income. The pupils also rated their own health. The researchers used their parents' level of education as an indicator of family SES. 

The team found no links between SES and self-rated health scores. However, kids who reported higher school social status also reported better health. 'Subjective social status in school seems to be a useful health-related measure of social position in adolescents,' the researchers concluded. This finding was important because, traditionally, family SES is the 'social rank' measure used in most studies of wellbeing among teenagers. This work suggested that perceptions of social rank within school has a bigger impact on how well teenagers feel, at least.  Still, there are a few different possible explanations for the findings. 

Variations in social skills and personality traits, including extraversion, are important in driving the 'pecking order' within a group of adolescents. It's certainly possible that kids with poorer social skills find themselves lower in this order, and experience stress as a result. But poorer social skills would also affect a child's ability to make friends – and social isolation is of course stressful, and linked to poorer health. It's also possible that kids with health problems fall down the social ladder. Untangling exactly how these factors influence each other will take more research. 

Adult subjective social status and health

For adults, studies have linked standard MacArthur ladder-type scores to all kinds of health outcomes. 

In a large study in the US led by Allyssa Allen, for example, when income was taken into account, lower subjective status scores were linked to a higher risk of heart disease – though this was the case only for White, not Black, people. The reason for the race-based difference is not clear. But research elsewhere – in Greece, for example, led by Antonios Charonis – has also found clear links between lower perceived social status and poorer health, when objective SES was taken into account. A 2018 study of almost 10,000 people in England even linked lower subjective scores to a higher risk of dying in the 10-year study period (the link was stronger for people aged 50-64 than for those who were 65-plus). 

Why might this be? It could relate back to the study on mothers in Boston – feeling that you're not doing as well as others around you is stressful, and chronic stress is linked to mental as well as physical health problems. A separate study on older adults supports this idea…

How old do you feel? 

Older adults who perceive themselves to be less successful and well-off than others within their own community report feeling older, and also think more negatively about ageing, according to a 2018 study published in the European Journal of Aging. This effect held when objective SES, age, physical health, sex and race were all taken into account. 'These findings suggest that perceptions of doing better than one's neighbors (i.e., "the Joneses") may matter more for understanding subjective perceptions of aging than objective indicators of social status,' concluded the team (led by Alaina English).

These studies all show that how people feel about their social position is at least, if not more, important for their health and wellbeing than objective measures of how they rank. Exactly what causes mismatches between perceptions of status and objective SES isn't yet clear. There are other potential explanations; perhaps, for example, people with a pessimistic view of their position in society are more pessimistic generally; pessimism is known to link to poorer physical health as well as psychological wellbeing. But the most common explanation for why perceptions matter more is that feeling that you're not doing well, or well enough, is stressful – and chronic stress is linked to all kinds of poorer physical and mental health outcomes.

- Emma Young writes for our Research Digest. 

Illustration: Eliza Southwood