Study Finds Childhood Health Is Directly Related to Social Class

A recent study from the Johns Hopkins Bloomberg School of Public Health found that children in higher social class groupings have better health than children in lower social classes. Results showed that health is better at each successively higher level of social position. "Social Class Gradients and Health in Childhood" is the first known study to use the same conceptual framework to examine the extent and nature of social gradients in childhood and in adolescence. The study was published in the July-August 2002 issue of the journal Ambulatory Pediatrics.

Barbara Starfield, MD, MPH, a study co-author and professor of health policy and management at the Johns Hopkins Bloomberg School of Public Health, said, "Our findings are in agreement with similar studies recently published on social gradients. Understanding which pathways are most important for which health outcomes may facilitate development of more informed health and social polices."

The study included 673 racially and ethnically diverse children ages 6 to 11 living in five areas of the United States, and 1,018 parents in the same geographical areas. They were assessed according to the Child Health and Illness Profile – Child Edition (CHIP-CE), which is a self-report questionnaire designed to assess the health of children. Children completed a 45-question survey. Parents completed a Comprehensive Parent Report Form, which included the same 45 questions in the CHIP-CE, as well as additional items. The responses were examined and scored by the researchers. The scores gave the researchers a comprehensive assessment of the children in four areas: satisfaction with health, comfort, resilience, and risk avoidance.

The researchers then compared these findings to the child’s social class, which was based on the parents’ job status and education level. Education levels and parental employment were combined to form three distinct and ordered categories (high, middle, and low).

Of the four areas measured, social class gradients were found in all but one area in the parent report form. The exception was satisfaction with health, where scores did not differ significantly by class level. The most notable gradient was in risk-avoidance behavior, which was better the higher the child’s social class. The reporting of symptoms of physical and mental ill health was also greater the lower the social class.

In parent-reported scores, the researchers also found a clear and significant gradient in threats to achievement, which represents disruptive behavior in children. Scores in this area progressively improved with increasing social class.

"The study shows the potential for CHIP, which can be used to examine life course changes in health and explore the influence of social and other conditions on health in developmental periods of life. The potential for understanding the complex influences on the development of various health profiles is large, especially in longitudinal research following youth from early school ages through adolescence," said Dr. Starfield.

Judy Robertson, BS, research associate, and Anne W. Riley, PhD , associate professor in the School’s Department of Health Policy and Management, co-authored the study.

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