SES Scale

DR.V. XAVIER, MBBS, MBA,PGDHMAlumni , Stanley Medical College Chennai

Socioeconomic status (SES) Socioeconomic status (SES) is one of the most

important social determinants of health and disease, thus, a widely studied construct in the social sciences.1

SES influences the accessibility, affordability, acceptability and actual utilization of available health facilities2

Socioeconomic status (SES) is a combination of social and economic variables

• Ref: • 1.M Bairwa, M Rajput, S Sachdeva :Kuppuswamy’s Socioeconomic Scale: Social Researcher

Should Include Updated Income Criteria: Indian J Community Med. 2013 Jul-Sep; 38(3): 185–186

• Agarwal AK. Social classification: The need to update in the present scenario. 2008:33(1); 50-1

Definition A composite measure that typically

incorporates economic, social, and work status1 . Economic status is measured by income. Social status is measured by education, and work status is measured by occupation.

• Each status is considered an indicator. • These three indicators are related but do not

overlap

Ref:1.Adler, N.E., Socioeconomic status and health: The challenge of the gradient. American psychologist, 1994.

49(1): p. 15.

SES Scales and health Low SES population presenting more

commonly with nutritional deficiency and communicable diseases and

High SES showing more of obesity and noncommunicable diseases;

Access to healthcare with high SES showing a better access.

Ref: Sunil K. Raina: Use of Socioeconomic Status Scales in Medicine and Public Health :J Family Med Prim Care. 2015 Jan-Mar; 4(1): 156

Needed: methods for social classification

Status inequalities between individuals are common, so it becomes a quantitative issue to determine how much social inequality qualifies as stratification.

In general, the more complex the society, the more numerous the layers or strata of social differentiation1

• Ref:• 1.Grusky, David B. (2011). “Theories of Stratification and Inequality”. In Ritzer, George and J. Michael Ryan

(eds.). The Concise Encyclopedia of Sociology. Wiley-Blackwell. pp. 622–624. Retrieved 23 June 2014

Defintion SES Scale The position that an individual or

family occupies with reference to the prevailing average standards of cultural and material possessions, income, and participation in group activity of the community

Why SES scale? 1. Understand the distribution of population

based on SES1

2. To develop a uniform system of socioeconomic classification of the population universally based on the income with scientific basis

3. Resources are scarcea. Need to identify the most needyb. Difficulty in identifying the exact number of

people living below the poverty line (BPL families) in India1 Ref :

1. Tendulkar SD. New Delhi: Government of India; 2009. Report of the expert group to review the methodology for estimation of poverty. Planning commission; p. 29

International SES scale

Hollingshead scale, (The Hollingshead Four Factor Index of Socioeconomic Status is a survey designed to measure social status of an individual based on four domains: Marital status, retired/employed status, educational attainment, and occupational prestige.)

Mac Arthur scale (Domains: Education, income, occupational status and wealth)

Ref: Hollingshead, A. A. (1975). Four-factor index of social status. Unpublished manuscript, Yale University, New Haven, CT.

Standard of Living Index (SLI) scale

(NFHS - II) had used the Standard of Living Index (SLI) scale 1

Contains 11 items viz. house type, source of lighting, toilet facility, main fuel for cooking, source of drinking water, separate room for cooking, ownership of the house, ownership of agricultural land, ownership of irrigated land, ownership of livestock, ownership of durable goods

Used for measuring the SES both urban and rural areas for the entire country

Ref:NFHS-2, India, 1998-99

Wealth Index Variables

The NFHS-3 wealth index is based on the following 33 assets and housing characteristics:

NFHS-3, India, 2005-06

Wealth Index Variables Household

electrification Type of windows Drinking water

source Type of toilet

facility Type of flooring Material of

exterior walls Type of roofing Cooking fuel House ownership Number of

household members per sleeping room

Ref:NFHS-3, India, 2005-06

• Ownership of a bank

or post-office account • Ownership of a

mattress,• A pressure cooker, • A chair, a cot/bed, a

table, an electric fan, a radio/transistor,

• A black and white television, a color television,

• A sewing machine • A mobile telephone, • Any other telephone

• A computer,• A refrigerator, • A watch or clock, • A bicycle, • A motorcycle or

scooter, • An animal-drawn

cart, • A car,• A water pump,• A thresher, • A tractor

Socioeconomic Status Scales - India

Udai Pareek and G. Trivedi (1964)

Kuppuswamy scale 1962

B G Prasad classification proposed in the year 1961

Ref:• Prasad BG. Changes proposed in social classification of Indian families. J Indian Med

Assoc. 1970;55:98–9.• Pareekh U. Delhi: Mansayan; 1981. Mannual of socio economic status (rural)• Gupta MC, Mahajan BK. Social environment. In: Guptha MC, editor. Text book of

preventive and social medicine. 3rd ed. New Delhi: Jaypee Publications; 2005. p. 117.

SES at a glance Criterias Udai

pareek B. Kuppu swamy

B.G. Prasad

Income x Total family income

Per capita income

Education + Edu of family head

X

Occupation + Occ of family head

X

Caste + X XLand + X XSocial participation + X XFamily type + X XFamily size + X XType of house + X XFarm power + X XMaterial possession

+ X X

Composite score + + XRural or urban R U R & U

• .Ref• 1.Kuppuswamy B. Manual of Socioeconomic Status (Urban) 1st ed. Delhi: Manasayan; 1981. pp. 66–72 • 2.Prasad BG. Changes proposed in social classification of Indian families. J Indian Med Assoc. 1970;55:98–9.• 3.Pareekh U. Delhi: Mansayan; 1981. Mannual of socio economic status (rural

By Udai Pareek and G. Trivedi (1964)

Udai Pareek and G. Trivedi (1964) attempts to examine the socio-economic status for the rural or mixed population only

This scale consists of a manual and one information blank

This scale has nine factors which assess the socioeconomic status of the individual

Pareek & Trivedi’s Scale: Components

Caste Occupation Education Social participation Land House Farm powers Material possession Family

1.Caste 2.Occupation Scheduled caste 1 Labour 1Lower caste 2 Caste occupation 2Artisan caste 3 Business 3Agricultural caste 4 Independent

profession 4

Prestige caste 5 Cultivation 5Dominant caste 6 Service 6

3.Education 4.Social participation

Illiterate 0 Member of one organization

1

Can read only 1 Member of > 1 organization

2

Can read and write 2 Office holder 3Primary 3 Wider public leader 6Middle 4High school 5Graduate 6

• Ref: Holyachi S: Socio economic scales – An update: Annals of comm health V1:issue 1:p24

5. Land Score

7. Farm power Score

9.Family Score

No land 0 No drought animal 0 Type < 1 Acre 1 1-2 drought animals 2 Single 1 1- 5 Acres 2 3-4 drought animal 4 Joint 2 5-10 Acres 3 Or one prestige animal 4 Extended 310-15 Acres

4 5-6 drought animal or tractor

6 Upto 5 2

15-20 Acres

5 Distinct features

2

>20 Acres 6

6. House Score

8. Material possession Score

No home 0 Bullock -cart 1Hut 1 Cycle ,Radio , Chair 1Katcha house

2 Improved agri implements

Mixed house

3 Television 3

Pucca house

4 Mobile 4

Mansion 6 Refrigerators 8

Scoring:

After filling the information ,and scoring the individual items, the total score is summed up.

With the help of the key provided in the manual, total score is interpreteding terms of the class.

Limitations This scale does not emphasize the

income aspect and can only be used for rural subjects

Social class

Above 43 Upper Class (I) 33-42 Upper Middle Class (II) 24-32 Middle Class (III) 13-23 Lower Middle Class (IV) Below 13 Lower Class (V)

Modified BG Prasad socioeconomic scale

Modified BG Prasad socioeconomic scale is widely used to determine the socioeconomic status .

The Consumer Price Index (CPI) for industrial workers (IW) is used to calculate updated income categories

The need to update SES scale Income ranges in the scale lose their relevance

following the depreciation in the value of the rupee1 .

Steady inflation, lower interest rates, and country’s current account deficits are the main factors contributing to fall in the value of currency2.

Therefore, it is needed to update the scale regularly for socioeconomic classification of study populations. 3

1.Ref:Kuppuswamy B. Manual of Socioeconomic Status (Urban) 1st ed. Delhi: Manasayan; 1981. pp. 66–72.

2.Mishra D, Singh HP. Kuppuswamy’s socioeconomic status scale - A revision. Indian J Pediatr. 2003;70:273–4. 3.Kumar P. Social classification - Need for constant updating. Indian J Community Med. 1993;18:60–1.

Methods to update SES scale

Kumar had tried to update Prasad Scale’s income limits using consumer price index (CPI)

Kuppuswamy socioeconomic scale was revised with CPI .

Linking of the scale with price index makes it relevant and meaningful and also provides a opportunity for constant updation .

• Ref: • 1.M Bairwa, M Rajput, S Sachdeva :Kuppuswamy’s Socioeconomic Scale: Social Researcher

Should Include Updated Income Criteria: Indian J Community Med. 2013 Jul-Sep; 38(3): 185–186

Consumer Price Index (CPI) Definition: A comprehensive measure

used for estimation of price changes in a basket of goods and services representative of consumption expenditure in an economy is called consumer price index

• Ref: http://economictimes.indiatimes.com/definition/consumer-price-index

Updating Prasad’s Scale The BG Prasad scale was formulated in

1961Consumer Price Index (CPI) for 1960 as 100.

This was revised in 1982 by introducing a linking factor of 4.93 to convert CPI (1982) from the new base of 100 to the old base CPI (1960).

Again a need was felt in 2001 to revise the base, which was done by introducing the linking factor of 4.63.

Formula (CPI [IW]× 4.63) × 4.93 ÷ 100. [ 237 ]× 4.63) × 4.93 ÷ 100. = 54.09738

Class Prasad’s Classification (1961) In Rupees

New Starting classes before they are rounded off

Modified Prasad’s Classification after rounding off to the nearest Rs. 10/=

I 100 & above 5410 5410 & aboveII 50-99 2705 2710 – 5409III 30-49 1623 1620 – 2709IV 15-29 811 810V Below 15 811 Below 810

Limitation It is only income-based scale

Kuppuswamy’s socioeconomic scale

The most widely used scale for urban population was devised by Kuppuswamy in 1976.

Kuppuswamy scale is a composite score of education and occupation of the head of the family along with monthly income of the family, which yields a score of 3-29.

This scale classifies the study populations into high, middle, and low SES

To get current income group, a conversion factor calculated based on current All India Consumer Price Index (AICPI) is applied

Contents Manual Two information blanks (one for the person

concerned and second for the father or guardian) Score card

• The information is collected in the devised Information blanks and with the help of the score card the status score is obtained.

• On the basis of the total score, the respective class is found out.

Scoring:

Scoring

• Ref:Kuppuswamy B. Manual of Socioeconomic Status (Urban) 1st ed. Delhi: Manasayan; 1981. pp. 66–72.

Socioeconomic Class

26 –29 Upper (I) 16 –25 Upper Middle (II) 11 –15 Middle (III) 05 –10 Lower Middle (IV) < 4 Lower (V)

Limitations Steady inflation and consequent fall in

the value of currency make the economic criteria in the scale less relevant.

Ref:.Mishra D, Singh HP. Kuppuswamy’s socioeconomic status scale - A revision. Indian J Pediatr. 2003;70:273–4.Kumar P. Social classification - Need for constant updating. Indian J Community Med. 1993;18:60–1.

Summary

SES is a predictor of health status Socioeconomic status (SES) is a combination of social and

economic variables SES Scales help to develop a uniform system of

socioeconomic classification of the population universally based on the income with scientific basis

Udai Pareek and G. Trivedi scale, Kuppuswamy scale 1962, B G Prasad classification are some Indian SES scales .

Steady inflation, lower interest rates, and country’s current account deficits are the main factors contributing to fall in the value of currency, so, it is needed to update the scale regularly for socioeconomic classification of study populations

SES at a glance Criterias Udai

pareek B. Kuppu swamy

B.G. Prasad

Income x Total family income

Per capita income

Education + Edu of family head

X

Occupation + Occ of family head

X

Caste + X XLand + X XSocial participation + X XFamily type + X XFamily size + X XType of house + X XFarm power + X XMaterial possession

+ X X

Composite score + + XRural or urban R U R & U

• .Ref• 1.Kuppuswamy B. Manual of Socioeconomic Status (Urban) 1st ed. Delhi: Manasayan; 1981. pp. 66–72 • 2.Prasad BG. Changes proposed in social classification of Indian families. J Indian Med Assoc. 1970;55:98–9.• 3.Pareekh U. Delhi: Mansayan; 1981. Mannual of socio economic status (rural

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