'Subjektiver sozialer Status'. Stellenwert für die Untersuchung und Verringerung von gesundheitlicher Ungleichheit.

BackgroundSocial status is just about always assessed by ‘objective’ measures such as educational level, income or occupational status. In recent years, some studies have also included the assessment of ‘subjective social status’ (SSS). This new variable could be important for health promotion and prevention. In Germany, though, this discussion has hardly been recognized yet.MethodsBased on different databases, we conducted a systematic review of empirical studies which include an assessment of SSS. As far as we know, a similar review has not been published in German yet. We looked for associations with morbidity, mortality and health risks such as smoking or obesity. We finish with recommendations for further research and practice.ResultsWe were able to find 53 empirical studies. Most of them are from the USA; no study has been published from Germany, Austria or Switzerland. Most studies (46 of 53) were published in the last 5 years, clearly indicating that this discussion is still rather new. ‘Subjective social status’ is mostly assessed by the MacArthur Scale, i.e. a ladder where the respondents can mark their position between ‘low’ (low social status) and ‘high’ (high social status). The results of the studies often show increased health risks for people with low SSS, even if ‘objective’ measures such as educational level or income are controlled for statistically.Conclusion“Subjective social status” should also be included in German studies, in addition to ‘objective’ measures such as educational level or income. If people are to be reached in programmes for health promotion or prevention, it is important to know what social position they believe they have; and this subjective perception does not just depend on ‘objective’ measures such as educational level or income. We would recommend that ‘subjective social status’ be assessed with a German version of the MacArthur Scale. The picture of a ladder is apparently able to capture the meaning of ‘social status’ very well and it is very easy to understand