Socio-Economic Status, Dietary Habits and Health-Related Outcomes in Various Parts of the World: A Review
Vlismas, Konstantinos, Stavrinos, Vassilios, Panagiotakos, Demosthenes B., Central European Journal of Public Health
It is generally accepted that socio-economic status (SES) influences dietary habits as well as human health. Three main parameters have been most often used to define SES, i.e. occupation, education and income. These characteristics cover different aspects of the socio-economic structure of people. The aim of this review is to present the current knowledge regarding the relationships between SES, dietary habits and health-related outcomes in various parts of the world.
Key words: socio-economic status, diet, disease, health, education, occupation, income
Socio-economic status (SES) is a well-established term often included in dietary studies as an explanatory variable in the analysis of another dependent variable such as health status (1). The definition and measurement of SES with respect to diet and health research has been critically examined in recent years ( 1-5). In order to characterise SES, three variables have been used most often: occupation, education and income. Although these variables measure the same concept it has been suggested that they cover different aspects of the socio-economic structure contributing individually to the relationship between SES and diet (4, 5).
Education is considered to be related to health outcomes through its influence on lifestyle behaviours (e.g., exercise, diet), problem-solving capacity and values (e.g. importance of preventive health behaviours) (1). Moreover, education may facilitate the acquisition of positive psycho-social and economic skills and may provide protection from adverse influences (6). The main advantages of education are that it is relatively easy to assess in self-administered questionnaires and response rates to educational questions tend to be high as these can be obtained from everybody independently of age or working circumstances (3).
Occupation in developed societies measures prestige, responsibility, physical activity and work exposures (6). Occupation may also affect diet by creating environmental or social networks that can influence behavioural health habits (4). Finally, more advantaged occupational levels permit increased access to medical care, enable one to have the funds for better housing and better nutrition, to live in safer neighbourhoods and increase his/her opportunity to engage in health-promoting behaviours (7).
Income is likely to mirror the availability of economic and material resources, and therefore influences dietary quality by making healthy food more or less affordable and accessible (8). The choice of socio-economic indicator often reflects which data are obtainable. In the US, measures based upon education have been widely used, because such information is the main socio-economic indicator contained in various national data sets (9). The Registrar General's classification of social class based on occupational status has traditionally been used to describe 'inequalities' of health in Great Britain (10).
The relationship between SES and diet or disease has been investigated by studying mortality rates for chronic diseases, food and nutrient intake, dietary patterns and food behaviour. It seems that disadvantaged groups have dietary profiles that increase mortality and morbidity rates for chronic diseases and they do not comply with recommended daily nutrient intakes and dietary guidelines, thus increasing the risk for development of chronic diseases (11-18).
Analysis of dietary patterns, as an approach to investigating links between diet and disease or diet and SES in relation to health risks has received a lot of attention from researchers and is indeed important, since it recognizes that foods are consumed in many combinations that are likely to be complex, and that nutrient intakes are often highly correlated with certain nutrients having interactive and synergistic effects (19-22). Investigation of dietary patterns also provides advantages with respect to the development of public health nutrition messages (23). …