Reflection Paper

Posted: January 4th, 2023

Reflection Paper #2

Student’s Name

Institutional Affiliation

Reflection Paper #2

Class status is a significant predictor of health outcomes, although it is overlooked when discussing the social factors that determine health. Although healthcare professionals are trained to provide quality health services to all members of society regardless of their social category, low-class people face significant barriers in accessing these services. In the article “Class-The ignored determinant of the nation’s health”, Isaacs and Schroeder (2004) discuss the influence of class differences in health outcomes and criticizes the United States for not appreciating social class to inform health interventions. I selected this article because it captures social class as a health determinant that is often ignored in the United States. It also enlightens nurses about the difficulties in targeting health interventions when social class data is insufficient. In this regard, I hope to learn how well social class categorization is captured and addressed by medical practitioners and policymakers as a factor influencing the health outcomes.

Understanding how social class influences health outcomes can improve the targeting of health policies and interventions towards the lower class members of society. Isaacs and Schroeder (2004) purpose is to emphasize the need to develop health policies and interventions that consider social class above the race, gender, and age considerations. Isaacs and Schroeder (2004) argue that the widening gap in wealth and income among Americans was challenging the provision of equitable health services and advancing social injustice. Hence, the paper recommends that while the expansion of health insurance coverage was commendable, more attention should focus on social policies that address the underlying class differences (Isaacs & Schroeder, 2004).

In the United States, social class categorization is subsumed by other clasifications and therefore, is often ignored when formulating health policies and interventions. Isaacs and Schroeder (2004) noted that Americans were uncomfortable with social class categorization because it threatened the meritocracy foundation of society, which was founded on liberalism and fluidity of the socioeconomic status of Americans. In this regard, racial inequality dominated health-related discussions because it was deeply rooted in the country’s history and conscience. Therefore, the policies and intervention targeted the marginalized races and ethnic groups, thus missing many other Americans who did not fall into these categories.

People in the lower class were most exposed to adverse health outcomes. Therefore, policies and interventions that intend to improve clinical outcomes in a population must address the needs of this segment in society. Tan and Kraus (2015) appreciated that individuals from lower-class backgrounds that were deficient in social and economic resources were prone to adverse health outcomes. They also categorized lower-class b ased on educational attainment, income, occupation status and comparative material resources (Tan & Kraus, 2015). Similarly, Matthews (2015) associated socioeconomic status with materialism, which is a consequence of the capitalistic structure that stratified society, and subjected many working classes to unhealthy conditions. Therefore, social class categorizations could be captured using other measurable parameters, such as socioeconomic status.    

I agree that nursing professionals are not conditioned to address health disparities from a social class lens. They are not exposed to social class data during their training because it is unavailable. I am not surprised when Isaacs and Schroeder (2004) discusses the controversy surrounding the widening income and wealth disparities as a cause of poor health among the economically deprived Americans. However, Choi, Kim, and Park (2015, p. 1) used the term “subjective social class” as an unconventional measure of socioeconomic status describing the perception of one’s “position in the social hierarchy”, that could be used to predict health behavior and outcomes. Moreover, Pampel, Krueger, and Denney (2010) viewed socioeconomic status as a social stratification system akin to social class. This view fits the American context in which social status is measured by wealth, income, employment, occupation, and education (Pampel, Krueger, & Denney, 2010, p. 350). In this regard, nurses needed to expand their depiction of socioeconomic status as a measure of social class that influenced health behavior and outcomes.

I am convinced that social class and health outcomes are intimately related. Policymakers and health practitioners should consider the social hierarchy of individuals in society through socially-targeted initiatives. In this regard, Woolf, Johnson, Phillips Jr, and Philipsen (2007) suggest that it is the social change, rather than medical advances, that would deliver more significant health outcomes. Similarly, Cubbin, Egerter, Braveman, and Pedregon (2008) recommend that improving neighborhoods would improve the health of children, particularly. Here, social change includes educating the population and improving their communities to improve their health wellbeing of those in the lower class. Therefore, failing to view social class categorization from the contemporary American lens may hinder the development of interventions targeting members in the lower class and undermine social justice and equity.

Broadening the social class description and collection of class-specific data would advance the pursuit of favorable health outcomes and wellbeing. While nurses are not privileged with class data on the health wellbeing of Americans, they could use objective and subjective socioeconomic status to address the needs of Americans in the lower class. The article by Isaacs and Schroeder emphasized the need for healthcare practitioners to prioritize social class considerations when designing interventions that promote the health of lower-class Americans.   

References

Choi, Y., Kim, J. H., & Park, E. C. (2015). The effect of subjective and objective social class on health-related quality of life: new paradigm using longitudinal analysis. Health and quality of life outcomes, 13(1), 1-11. doi:10.1186/s12955-015-0319-0.

Cubbin, C., Egerter, S., Braveman, P., & Pedregon, V. (2008). Where we live matters for our health: Neighborhoods and health. Robert Wood Johnson Foundation. Retrieved from http://www.commissiononhealth.org/PDF/888f4a18-eb90-45be-a2f8-159e84a55a4c/Issue%20Brief%203%20Sept%2008%20-%20Neighborhoods%20and%20Health.pdf.

Isaacs, S. L., & Schroeder, S. A. (2004). Class-The ignored determinant of the nation’s health. The New England Journal of Medicine, 35(11), 1137-1142. doi:10.1056/nejmsb040329.

Matthews, D. (2015). Sociology in nursing 2: Social class and its influence on health. Nursing Times, 111(42), 20-21.

Pampel, F. C., Krueger, P. M., & Denney, J. T. (2010). Socioeconomic disparities in health behaviors. Annual Review of Sociology, 36, 349-370. doi:10.1146/annurev.soc.012809.102529.

Tan, J. J., & Kraus, M. W. (2015). Lay theories about social class buffer lower-class individuals against poor self-rated health and negative affect. Personality and Social Psychology Bulletin, 41(3), 446-461. doi:10.1177/0146167215569705.

Woolf, S. H., Johnson, R. E., Phillips Jr, R. L., & Philipsen, M. (2007). Giving everyone the health of the educated: An examination of whether social change would save more lives than medical advances. American Journal of Public Health, 97(4), 679-683. doi:10.2105/ajph.2005.084848.