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„Subjektiver sozialer Status“

Stellenwert für die Untersuchung und Verringerung von gesundheitlicher Ungleichheit

“Subjective social status”

Importance for research and practice concerning the reduction of health inequalities

  • Forschungsmethoden und Evaluation
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Prävention und Gesundheitsförderung Aims and scope Submit manuscript

Zusammenfassung

Hintergrund

Zur Erfassung des sozialen Status werden in der Public-Health-Forschung fast immer „objektive“ Faktoren wie Bildung, Einkommen und berufliche Position verwendet. In englischsprachigen Publikationen wird seit einigen Jahren auch der „subjektive soziale Status“ erhoben („subjective social status“; SSS). Dieser Ansatz kann auch für die Praxis der Gesundheitsförderung und Prävention von erheblicher Bedeutung sein. In Deutschland ist er bisher jedoch kaum zur Kenntnis genommen worden.

Methoden

Auf Basis einer Suche in mehreren Datenbanken wurde ein systematischer Review über die empirischen Studien erstellt, in denen die Variable SSS verwendet wird. Im deutschsprachigen Raum ist ein derartiger Review u. W. noch nicht vorhanden. Einbezogen wurden dabei Zusammenhänge mit Morbidität, Mortalität und gesundheitlichen Risiken wie Rauchen oder Übergewicht. Auf Basis dieser Studien werden anschließend einige Handlungsempfehlungen für Forschung und Praxis in Deutschland abgeleitet.

Ergebnisse

Insgesamt konnten 53 empirische Studien gefunden werden. Die meisten Studien stammen aus den USA. Aus Deutschland, Österreich oder Schweiz ist keine Studie dabei. Von den 53 Publikationen sind 46 in den letzten 5 Jahren publiziert worden – die Diskussion ist also noch relativ neu. Der SSS wird fast immer über die MacArthur Scale erfasst. Dabei handelt es sich um eine Leiter, auf der die Befragten ankreuzen können, auf welcher Stufe sie sich zwischen oben (hoher Status) und unten (niedriger Status) einordnen. Inhaltlich weisen viele Studien darauf hin, dass ein niedriger SSS mit größeren gesundheitlichen Belastungen einhergeht, auch nach statistischer Kontrolle objektiver Statusmerkmale wie Bildung oder Einkommen.

Schlussfolgerung

Der SSS sollte auch in deutschsprachigen Studien erfasst werden, ergänzend zu den „objektiven“ Statusmerkmalen wie Bildung oder Einkommen. Wenn man Personen mit Gesundheitsförderungs- und Präventionsmaßnahmen erreichen will, dann muss man auch wissen, wie sie ihre eigene soziale Position wahrnehmen. Diese Wahrnehmung ist aber nicht nur von „objektiven“ Merkmalen wie Bildung oder Einkommen abhängig. Als Messinstrument zur Erfassung des SSS bietet sich v. a. die MacArthur Scale an. Das Bild der Stufenleiter kann die Wahrnehmung der eigenen sozialen Position offenbar intuitiv und gut nachvollziehbar abbilden.

Abstract

Background

Social 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.

Methods

Based 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.

Results

We 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.

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  1. Institut für Gesundheitsökonomie und Management im Gesundheitswesen, Helmholtz-Zentrum München, Ingolstädter Landstraße 1, 85764, Neuherberg, Deutschland

    R. Hegar & A. Mielck

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  2. A. Mielck
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Correspondence to R. Hegar.

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Hegar, R., Mielck, A. „Subjektiver sozialer Status“. Praev Gesundheitsf 5, 389–400 (2010). https://doi.org/10.1007/s11553-010-0261-2

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