Capturing complexity of a wicked problem: a comprehensive index for socioeconomic health inequality

Background

Socioeconomic status (SES) is a key but complex determinant in health research, commonly measured by educational attainment. However, societal changes such as diploma inflation have reduced the effectiveness of education as sole indicator for identifying groups at risk of poor health. Recent studies and policy applications stress the need for broader SES measures, incorporating both economic and social factors. This study explores additional SES indicators to improve the measurement and monitoring of health inequalities.

Methods

A literature review identified 32 potential SES indicators, including income, occupation, housing, social network, and skills. Indicators were scored on six criteria: interpretability, policy relevance, data availability, representativeness, and international and regional comparability. Using national health monitor data, we assessed the correlation and explanatory value of these indicators for health inequalities. Selected indicators covering broad SES domains were combined into an index measure.

Results

Analysis showed that the extent and patterns of health inequalities varied depending on the SES indicator or index measure, revealing more dynamics of health inequalities than education alone. This multidimensional approach offers a more detailed and nuanced understanding of at-risk groups and the scope of health inequalities. The results will be accessible for further exploration through an online tool.

Conclusions

Including social and cultural capital in SES measures enhances identification of vulnerable populations that may be overlooked by traditional SES-indicators. We recommend using multiple, complementary SES indicators in one measure, in addition to selected separate indicators, to enable more accurate identification, monitoring, and targeted interventions. This broader approach aligns with current perspectives on well-being and social security, and supports policies to reduce health inequalities.

Key messages

• A broader scope on socioeconomic health inequalities, including social and cultural factors offers a more nuanced understanding, in line with the wellbeing economy and social security.

• A multidimensional socioeconomic index measure enables identifying at-risk groups, monitoring health inequalities and guide policies to reduce them.