1. Exploring the potential of the ESEC for describing class differences in health in European populations Anton Kunst on behalf of the Dutch team January 2006

2. Why look at occupational class in relation to health?  Large socioeconomic inequalities in health are observed in all European countries  We need measures that can help to accurately identify social groups with most health problems  Educational level and income level are often used in European research  Occupational class is much less often used

3. Applying the ESEC to health  Potential advantages  Theoretical basis & criterion validation  Internationally applicable and comparable  Emphasis on intrinsic characteristics of job  Uncertainties  construct validity? does it predict health?  applicability? no practical problems?

4. Objectives of the study  General aim: to the assess the construct validity and the practical applicability of the ESEC scheme in the field of health  Specific aim: to describe health differences according to ESEC class among male and female populations in Europe

5. Material and methods  The European Community Household Panel, first wave, 1994.  11 countries in the northern and southern part  ESEC derivation matrix “V3” of June 2005  Health measure is derived from the survey question “How rate do you rate your general health: very good, good, fair, poor, to very poor”  Standardized prevalence rates and loglinear regression, with control for age and country

6. Results (1) Proportion of respondents with “poor” health according to ESEC Class. Men, all countries.

7. Results (2) Prevalence of “poor” health by ESEC Class. Northern compared to southern countries. Men.

8. Results (3) Prevalence of “poor” health by ESEC Class. The role of education and income. Men.

9. Results (4) Prevalence of “poor” health by ESEC Class. Women compared to men. All countries.

10. Results (5) Prevalence of “poor” health by ESEC Class. Women: household vs. individual assignment

11. Summary of results  We observed health differences along the entire occupational hierarchy, from the most to the least advantaged classes;  The health differences were generalised, i.e. found among both men and women, within different age groups, and within different countries.  The health differences could in part, but not entirely, be attributed to differences between ESEC classes in education and income level

12. Further work (1) The prevalence of obesity by ESEC class. Women, nine countries, 1998 (wave 5)

13. Further work (2) The prevalence of obesity in class 9 compared to class 1. Women, per country.

14. Conclusions  Do the results support the construct validity of the ESEC?  yes; at least no strange results  southern countries warrant closer attention  Is the ESEC useful for monitoring of health inequalities in Europe?  yes, no practical problems  important advantages (e.g. international applicability)

15. Using the ESEC to describe social inequalities in health and similar outcomes: remaining issues  Economically inactive persons: assign them to the “known” ESEC classes 1-9, where possible  Education and income level: focus on the added value and complementary nature of occupational class  Hierarchical component: specify how outcomes can be presented from “low” to “high” class (except self employed)  Women: develop rules for choosing between the individual level and/or the household level when assigning ESEC classes

16. End  Thank you