Contextualising indicators of socio-economic status: Chronic illness as lived experience of SES

Abstract

The concept of socio-economic status (SES) has been recognised as playing an important role in the incidence and experience of chronic illness (Taylor, 1983; Najman 1988; Syme, 1998; Marmot, 2000). Yet just how SES interacts with the experience of chronic illness has not been well researched. For example, researchers are unable to categorically state if living conditions and life opportunities associated with low SES lead to a greater propensity for developing a chronic illness, or if the experience and consequences of having a chronic illness lead to developing low SES characteristics, or both. Neither has research provided good data on the mediating roles of factors such as ethnic background and location of residence on the relationship between SES and chronic illness. Self-management programs for chronic disease require different capacities from participants to produce good outcomes. These capacities are to some degree dependent on level of education, type of job, and general level of socio-economic status. Therefore, the level of SES of people with a chronic disease is important to understanding how they will respond to self-management approaches. For example, people with a chronic disease from lower SES backgrounds can be expected in some instances to have a different set of coping capacities with their disease (partly a function of income, education, and work experience) compared to those from higher SES backgrounds. The socio-economic status of people with a chronic disease is an important area for investigation that has implications for the efficacy of self-management programs. This paper will argue that while SES is a vital concept in understanding the impact of chronic illness on people?s lived experiences for many conditions, current approaches oversimplify it by quarantining it from its context. Researchers tend to treat SES as a stable composite concept whose application illuminates the social basis of the illness experience. More frequently, we arrive at an explanation of simplified relationships rather than an explanation of the relationships between chronic ill health and SES as lived by members of real communities (Frank, 1990; Zola, 1991).