What is SES and why does it matter?

Authored by Stephanie Ferrera, M. S. W.

This was the question addressed by Professor Peter J. Gianaros of the University of Pittsburgh, the guest scientist at the CFC Midwest Symposium held on May 4-5.  The brief answer is:  SES is SocioEconomic Status and it matters because one’s place on the socioeconomic ladder is a major factor in one’s health and well-being in many ways.  Dr. Gianaros is a leading researcher on SES and the central role of the brain in mediating stress reactivity and adaptation.  He began his presentation with a review of older studies that established the “health/SES gradient.”  One chart told the story:  the lower one’s SES, the shorter one’s life expectancy and greater one’s risk for chronic stress-induced illnesses.

While the connection between socioeconomic disadvantage and greater risks to health has been known for decades, Dr. Gianaros and his colleagues are working toward a more specific understanding of the neurobiological pathways linking stress and health in the context of the socioeconomic environment.  A systems thinker par excellence, he described numerous recent studies that have explored the complex interaction between brain systems, stress physiology, stress psychology, cognition and behavior.

Going deeper into the meaning of the term, SES, he identified a complex of stressors associated with socioeconomic disadvantage.  In addition to material poverty, poorer social resources and health care, the individual may suffer from an ongoing sense of insecurity regarding future prosperity, and demoralizing feelings of social exclusion.  At the family level, there are the stressors of crowded, noisy, substandard housing, increased tensions in the home and harsh parenting.  At the community level, Gianaros cites crime, pollution, crowding, and poor employment opportunities as components of persistent economic hardship.  Newer research is investigating the cumulative impact of stress factors on people living in disadvantaged neighborhoods.

Dr. Gianaros introduced us to the MacArthur Ladder and the concept of sSES:  subjective SocioEconomic Status, an individual’s perception of her or his relative standing in the social hierarchy.  The MacArthur Scale of Subjective Social Status is a ten rung ladder on which the subject places an X on the rung that represents their sense of where they stand in their community.  Beyond the standard measures of SES—income, occupation, and education—this simple instrument captures the way people think and feel about their social status.  The striking finding from extensive research with this measure is that sSES has as much influence on health outcomes as objective SES.   As I understand this, it means that the sense of being a respected, important, contributing member in good standing in one’s community can to some extent offset the impact of low SES factors in terms of health outcomes.  On the other hand, the sense of being poor in a socially impoverished community, with low trust and sense of efficacy, would be likely to reinforce low SES health risks.

What can the perspective of Bowen theory bring to the study of SES and its impact on human health and overall functioning?  SES, both objective and subjective, is a highly influential part of the world in which families live.  Data on income, occupation, education, health, and longevity are important in evaluating family functioning and adaptability.  Families are highly sensitive to how they are doing socioeconomically, especially at times of heightened threat and uncertainty.  In my humble opinion, the study of SES and its multiple impacts, introduced so compellingly by Dr. Gianaros, is a great and relatively unexplored frontier in the study of family adaptability and variation.

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