ill health (e.g., depression or alcoholism) is a major cause of downward occupational mobility, as well as a constraint on upward social mobility. An individual’s choice of occupation also may reflect unmeasured variables (such as ability) that simultaneously influence health status. Although the adverse health impact of job loss (e.g., through factory closure studies) is widely accepted (Kasl and Jones, 2000), fewer studies have convincingly demonstrated a causal effect of variables such as occupational prestige on health outcomes. As noted above, existing measures of occupational status such as the Duncan SEI combine measures of prestige with indicators of education and income that are thought to affect health independently. In addition, there are uncertainties regarding the optimal time point for measuring occupational status, especially since individuals change occupations over their life course. Job changes that occur earlier in people’s careers are often associated with upward social mobility, while late-career changes may be related to a diminished capacity to function within demanding occupations (Burgard et al., 2003). For this reason, the frequently used “final occupation”—that is the occupation of an individual at the time of death or at the onset of disease—may not be an optimal indicator of the occupational conditions experienced over the individual’s life course. Few studies have examined the health effects of occupational status over an individual’s entire life course (Burgard et al., 2003), although some evidence suggests that persistently low occupational status measured at multiple time points or downward status mobility over time may be associated with worse health outcomes (Williams, 1990).

The potential pathways linking occupational status to health outcomes are again distinct from those linking either education or income to health. First, higher status (and nonmanual) occupations are less likely to be associated with hazardous exposures to chemicals, toxins, and risks of physical injury. Higher status jobs also are more likely to be associated with a healthier psychosocial work environment (Karasek and Theorell, 1990), including higher levels of control (decision latitude) as well as a greater range of skill utilization (lack of monotony). A greater sense of control in turn implies improved ability to cope with daily stress, including a reduced likelihood of deleterious coping behaviors such as smoking or alcohol abuse. Undoubtedly, a major intervening pathway between occupational status and health is through the indirect effects of higher incomes and access to a wider range of resources such as powerful social connections.

In summary, there is good evidence linking each of the major indicators of SES to health outcomes. Together, education, income, and occupation mutually influence and interact with one another over the life course to shape the health outcomes of individuals at multiple levels of social organization (the family, neighborhoods, and beyond).



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