Social class position is a powerful predictor of illness and death from many forms of both chronic and infectious disease. Those in the upper class live longer and are healthier while doing so. Those in lower classes die at a younger age and are considerably less healthy over their entire life course (Evans, 1994). Moreover, numerous studies have found that a "gradient" exists along the social class continuum - with increasingly higher class position, health improves, and with descending class position health deteriorates (Marmot et al, 1978, Lynch & Kaplan, 2000). Although there continues to be a considerable discussion as to what explains this class gradient, there is an emerging consensus that social class is a "fundamental determinant" of population health. (Link & Phalen, 1995) Together with race and gender, class constitutes a core social structure (House & Williams, 2003). SSocial class is more than a property of individuals, rather, , it is more than a 'position' one occupies -- it is also an expression of macro-societal forcessystem that "produces" stratified hierarchies within modern societies. As a societal structure social class is associated withpositions. It is a social structure that creates the enormous inequalities that we observe in nearly every aspect of human existence across the entire life course. Social class is also intimately bound up with work and the labor process (Johnson & Hall, 1995, Wright, 1988). It is through our work, and the work of our parents, that we enter into the life chances and circumstances of a particular social class.
Some of the pathways linking lower social class position to ill health include economic deprivation, lack of educational opportunities, and adverse exposures associated with differences in geographic and community environmental characteristics such as exposure to violence and to toxic substances like lead and carbon monoxide (Lynch & Kaplan, 2000, Evans & Kantrowitz, 2002). Other pathways involve class differences in consumption patterns including unhealthy foods, cigarettes, alcohol and illicit drug usage (Cockerham, 2000)usage. Social class position is also strongly associated with access (or lack there of) to social and public resources, informal social networks, institutional resources, and inter-generational resources. Still another pathway involves differences in the nature of the social and work environments, and includes the class differences in stress from adverse labor market experiences, including unemployment, underemployment and chronic exposure to stressful work organizations (House & Williams, 2003, Seigrist & Marmot, 2004). These specific pathways linking social class to health may change over time. New causal paths might emerge, others might be removed, yet as long as the society continues to have a social class structure it is almost certain there will continue to be health "disparities" (differences) between classes - this is what is meant when we say class is a "fundamental determinant" of health (Link & Phalen, 1995).
Social class position is frequently defined with respect to one's occupation. Until recently skill levels have been used to distinguish different occupational class groups. Frequently a 5 occupational class scheme is used: 1st Class: Upper Level Managers and Professionals; 2nd Class: Medium Level Managers and Professionals; 3rd Class: Lower Level Office and Service Workers; 4th Class: Skilled Manual Workers; 5th Class: Unskilled Manual Workers. Critics have pointed out a number of problems with this definition of social class. Some have suggested that the degree to which the work has become routine is a more meaningful distinguishing characteristic today than skill. Others argue that the degree of control over the work process is the most important underlying element of social class (Marmot & Bartley, 2002).
There are, in fact, marked differences in a number of work organization characteristics across the different social class groups (Kristensen, 2002). The degree of control at work is strongly associated with social class position (Johnson & Hall, 1995). Social support at work, by contrast is only weakly (but [but positively?)] associated with social class. Other exposures tend to be much more present in certain class groups than others. Hazardous work exposures and heavy physical job demands are often present in lower level service and manual groups while being almost non-existent in managerial/professional class groups (Johnson & Hall, 1992). When examining patterns of multiple exposures across social class groups it becomes evident that Social Class 3 (the lower level office and service workers) is much more like Social Classes 4 and 5 (manual workers) than they are like Social Classes 1 and 2 (managerial/professional workers). The managerial/professional class tends to have high psychological job demands, high levels of work control, and very low levels of physical demands and low levels of hazardous exposure. They work longer work hours and their jobs require considerable flexibility (Johnson & Hall, 1992). Working class jobs by contrast have much less control, are more routine, and have fewer psychological job demands and considerable monotony. Working class jobs also have much higher physical demands and more hazardous exposures (Johnson & Hall, 1992). In addition, recent research findings using the two most prominent conceptual models of work stress have shown that those in lower social class positions are more likely to be exposed to high demands and low control as well as experience jobs with high demands for effort coupled with low rewards (Seigrist & Marmot, 2004). WWork environment exposure comes bundled by social class, and the most meaningful distinction is between a managerial/professional class on the one hand and a working class on the other. (Johnson & Hall, 1992, 1995).
The impact of adverse work organization exposure also varies
markedly by social class. For example, a number of studies have
shown that the impact of Job Strain (high demand/low control jobs)
and Iso-Strain (high demand/low control/low social support jobs)
is significantly greater for individuals in working class occupations
compared to those in managerial/professional jobs (Johnson &
Hall, 1988; Johnson Hall & Theorell; 1989, Landsbergis et
al, 2003). Moreover, research findings also indicate that class
differences in adverse work organization exposure (particularly
in job control, or lack thereof) may be an important causal mechanism
that helps explain the relationship between social class position
and health (Marmot & Theorell, 1988, Marmot et al, 1997).
Recent findings from the European Science Foundation's Study
on Social Variation in Health Expectancy strongly suggest that
workers in lower social class positions are more vulnerable to
the impact of both Job Strain (high demands and low control) and
effort/reward imbalance (Seigrist & Marmot, 2004).
[If you could, please mention that several studies have shown
that the impact of job strain on health seems to be greater for
people in lower social classes. Latest reference:
Landsbergis P, Schnall P, Pickering T, Warren K, Schwartz J. Lower
socioeconomic status among men in relation to the association
between job strain and blood pressure. Scandinavian Journal of
Work, Environment and Health 2003;29(3):206-215.]
In addition to looking at differences in exposure between social
class groups, it is important to examine how and why these kinds
of disparities exist. Clearly there are great structural differences
between classes in terms of the ownership of wealth and control
over workplace institutions. The class structure of modern society
is an expression of dynamic political and economic forces operating
over time at macro-societal and increasingly global levels (Moody,
1997; Navarro, 2002). Although social classes have been present
since the agricultural revolution and early urban settlement,
their present form emerged with the industrial revolution and
the growing centrality of the market economy as the predominant
influence over the structure of society. It has been suggested
that market economies today have three fundamental social classes:
(1) a very small elite made up of the most wealthy and powerful
members of the society who own and control large corporations
and other powerful institutions, (2) an increasingly large working
class whose members provide and care for the human energy that
produces the goods and services that are bought and sold in the
marketplace and (3) a third class made up of managers and professionals
that share some of the characteristics of both the elite class
and the working class, and hence are said to occupy a "contradictory
class location" in that their work involves administering
bureaucratic organizations in the interests of the elite, yet
their personal history, work experience and professional training
and ethics may lead them to identify with the working class (Wright,
1988; Moody, 1997; Perrucci & Wysong, 1999; ).
In order to survive in dynamic and competitive environments, corporations must continue to grow by increasing the rate at which profits are generated. Historically, one important way in which this has occurred is through managerial and technological innovations focused on increasing productivity - often by changes in work organization designed to reduce labor costs. 'Scientific Management' or 'Taylorism' is perhaps the most well known example of how this process can lead to a transformation in how work is organized. (Braverman, 1974). In the late 19th and early 20th Century F.redrick W.inslow Taylor, advocated a radical program of removing planning and decision-making authority from skilled workers on the shop floor, while, at the same time centralizing mental and conceptual work in the hands of a new managerial class. By fragmenting the work process into its simplest possible components, the proponents of "scientific management" hoped to both reduce labor costs by employing fewer skilled workers and to increase productivity through their newly won control over the pace, speed and intensity of the production process itself. Work environments that have been designed in this way implicitly embody class relations. To the extent that work is fragmented and deskilled for the working class, it becomes more manageable by the employing class (Braverman, 1974, Moody, 1997). The control over pace and intensity of work performance has historically been transferred from workers to owners for the purpose of increasing the profitability of the enterprise. The technical aspects of this work transformation have been implemented by the managerial/professional class, indeed, "Scientific management" techniques became the bedrock of industrial engineering, and they continue to dominate the ways in which jobs are designed even today (Kanigel, 1997).
The work organizations created by "scientific management" are highly stressful jobs (Johnson, 1980). These workplaces produce high levels of "job strain" (see section 4A) because they have very high demands for performance and productivity and, at the same time, very low levels of control over meaningful decisions about how the work is to be performed. These principles of job design have also had an enormous influence over changes in work organizations in the health care and human service sector. Moreover, "lean production" methods (see section 2Biii) have led to an even more intensified form of Taylorism, referred to by some observers as a kind of "management by stress." (Moody, 1997).
Managerial and technological innovations, though seemingly class-neutral, represent a kind of 'social choice' (Noble, 1977). The nature of specific character of these choices that have been made in the United Statesour country suggests a deep suspicion of and a fear directed toward the working class. Researchers have pointed out that the degree to which workers have been stripped of skills and authority in the workplace has far exceeded that which would in reality have been the most rational and efficient approach (Noble, 1984). This 'irrationality' has also been the case with the intense waves of downsizing and restructuring that have swept through work organizations over the last two decades - the health of firms, and their capacity to creatively produce has often been harmed by these types of extreme measures.
The globalization of work and the labor process has also taken on a class character. The transfer of many jobs to low wage countries, and perhaps even more importantly, the threat that this transfer might occur, has severed much of the social contract that existed in the U.S. between classes in the post wworld wwar ttwo era. In many ways, we have returned to the starker realities of the 19th century social landscape with an increasing polarization between society's 'winners' and 'losers'. Third World Workers have also become victims of a "downward leveling" - a "race to the bottom" where we see the working conditions for most of the working class being pulled in the direction of the most desperate and least empowered (Brecher & Costello, 1994; Moody, 1997) Yet, if at the most only 20% of the society can be considered 'winners' in the process of economic globalization, what will become of the remaining 80%? In the past century, social movements (such as the labor movement) developed to challenge economic and political inequalities . The same kind of social movements are being mobilized today, only now on a global level. These movements for economic and global justice may transform the politics of the 21st century and could improve work organization and working conditions and reduce job stress in both developed and developing countries (Teivainen T, 2002) .
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