Socioeconomic status and health are linked. But what does that really mean?

When reporters talk about socioeconomic status, it’s rarely defined. Usually, we’re thinking of a broad category of measures related to this nebulous idea: income, education, percent of federal poverty level, housing status and others.

But all these little pieces that we stitch together into the broader notion of socioeconomic status are not equivalent. For example, while there is a relationship between income and education, most journalists can attest to the fact that that relationship is not perfectly linear. When we throw in additional variables, like race or gender, the relationship becomes even hazier.

Reporters consider clarity and evidence our bread and butter, so failing to address what we really mean when we talk about socioeconomic status and its relationship to health is problematic.

So how do we unpack the complexities of this connection without losing our audience?

Here are some researchers’ tips for avoiding common challenges that come with covering the effect of socioeconomic status on health.

1) Break down the index.

Tina Sacks, a UC Berkeley social welfare professor, explains that socioeconomic status isn’t a measure or variable itself. It’s an index, comprised of several components — and it matters which of those components researchers focus on.

For example, a study that measures the association between socioeconomic status and obesity will have different results if it defines socioeconomic status by education or by income. That study’s results will vary more depending on how it measures its chosen variable: Education measured in increments of a single grade rather than degrees may not show a significant impact — graduating high school may improve the health outcome more than advancing from 10th to 11th grade does. And the association between one socioeconomic measure and obesity may vary depending on whether obesity is defined by BMI or body fat percentage.

Sacks and other researchers say that journalists should understand these nuances. If a researcher said they controlled for socioeconomic status, ask them what they mean. Did they control for income, education, both, or neither? How did they measure it? Spelling that out for your readers might not be necessary, but understanding it yourself can only strengthen your reporting.

2) Consider how socioeconomic status might affect health.

Sacks added that public health researchers are finding more and more that education has a stronger association with some health outcomes than income. She pointed out that there are some professions that are highly educated but not well-paid (I’m sure we can all think of an example here). Such professionals may not have the disposable income to pay for excellent health care or coverage, but they may have the “health literacy” to navigate the system and access care, Sacks said. They might also have the knowledge, skills or social supports to prioritize healthier choices in their daily lives.

At best, failing to address how socioeconomic status affects health is missing an important part of the story. At worst, it can result in harmful and victim-blaming narratives about the populations who are affected, researchers say. Explanations that emerge without this understanding of socioeconomic status often rely instead on assumptions about culture and behavior.

For example, if a community is suffering from an epidemic of sexually transmitted diseases, the first question might be why community members are engaging in sexually risky behavior. That explanation would not consider the role of potentially inadequate educational resources in providing sexual education and preventing such risky behavior.

3) Consider the issue in light of policies.

Sacks raised the example of universal basic income as a policy intervention. If we are viewing a lack of income as the most important metric affecting health, then that policy makes sense, but if education is, the policy solutions might be different.

4) Talk about class.

Journalists aren’t the only people who struggle to discuss socioeconomic class — in fact acknowledging that class exists in the U.S. puts reporters ahead of the curve. “The ruse is that it’s a classless society,” Sacks said.

It’s this pretense about class in America that keeps not just journalists, but public health researchers and our audiences, from unpacking how exactly socioeconomic status is measured or affects health.

“We’re just not that careful about the way we think about class, and that’s one of the reasons why we devolve to the simplistic idea that everyone who is poor has poor health outcomes.”

5) Think about the social, political, historical, and economic environment, rather than the individual.

Anoop Jain researches sanitation in India. Poverty is a commonly accepted explanation for poor sanitation. As a graduate student who is about to complete his doctorate in public health, Jain doesn’t earn much income, yet his health doesn’t suffer from poor sanitation. Why?

“You can argue that I’m certainly not getting paid enough, but I’m still able to engage in certain lifestyle habits,” Jain said. “We think about a person who is not being paid enough. That doesn’t say anything about the place or the context.”

Jain suggested comparing public health crises affecting poorer communities, such as the clean water crisis in Flint, Michigan, to crises affecting wealthier ones, like the wildfires in Southern California. How does the reporting differ?

Sacks pointed out that without that context, it’s easy to the view the impacts of low income, education, or other socioeconomic factors as the result of some kind of innate culture of poverty.

“Journalists prefer to tell stories through the eyes of an individual, which is reasonable since they want their audiences to have an emotional connection to the story; showing what happened to a person is often the easiest or quickest way to do that,” said Lori Dorfman, a professor at UC Berkeley School of Public Health, who runs the Berkeley Media Studies Group. “The trouble is that, research shows, when audiences see stories that focus narrowly on individuals or events then audiences tend to attribute responsibility for both the cause and solution of the problem being depicted to individuals.”

That doesn’t mean journalists should abandon individual stories, but such anecdotes need to be contextualized.

“The good news is that the alternative, a story that includes even just a bit of context around the individual or event, leaves audiences with different ideas about how to solve problems,” she added.