Psychosocial and neo-material dimensions of SES and health revisited: Predictors of self-rated health in a Canadian national survey

This study addresses questions concerning psychosocial processes of relative comparison in the production of socio-economic inequalities in health. Specifically, the importance for health of perceptions of status, different 'reference groups' and 'reference points' in such comparisons is problematized and investigated empirically. Using data from a cross-sectional telephone survey of the Canadian population in 2000 (n=1331), the paper investigates relationships between self-rated health status (SRHS) and: (1) 'actual' absolute socio-economic standing, (2) perceived relative socio-economic standing (relative to other Canadians and to Canadians of the previous generation), and (3) 'actual' relative socio-economic standing (relative to others in respondents' province of residence and neighbourhood of residence). Measures of actual absolute socio-economic status (SES) (household income, personal income and education) were strongly related to SRHS. Results for perceived relative SES were mixed. Perceived SES relative to all Canadians was a strong predictor of SRHS before and after controlling for age and gender while perceived SES relative to the previous generation was unrelated to SRHS. Actual relative income was strongly related to SRHS for all reference points (10th, 50th and 90th percentiles) in both reference groups analysed (neighbourhoods and provinces). Within neighbourhoods, however, comparisons with those at the top of the income ladder appeared to be somewhat more salient for SRHS than were comparisons to other levels. We conclude that there is some evidence of the importance of both psychosocial and neo-material aspects of SES for Canadians' self-rated health, but that further empirical research is needed that accounts for the numerous ways in which psychosocial processes of relative social comparison may take place.