Social inequalities in health (SIH) are systematic differences in health status among population groups that are socially constructed and therefore considered preventable. They are not solely a matter of biology, but of social determinants, defined as the “social circumstances in which individuals are born, grow up, live, work, and age, as well as the systems put in place to address illness.”

This is a cross-cutting and priority issue for Santé publique France. Our latest research shows that socioeconomically disadvantaged populations bear a disproportionate burden and are in poorer general, physical, and mental health than socially advantaged individuals. The production and analysis of data that account for the social characteristics of populations enable more equitable action.

To accurately measure social health inequalities, it is essential to understand the impact of social position (gender, migrant background, education, employment status, and financial resources) on the health status of populations and to be able to objectively assess it systematically in health studies. With this in mind, Santé publique France is publishing today a methodological overview on social position, the result of a collective and transdisciplinary effort. Stéphanie Vandentorren, coordinator of social inequalities at the agency, sheds light on the importance of addressing this issue in public health work.

What does the concept of social position encompass?

Social position refers to the relative place a person occupies in the social hierarchy, compared to other members of their community. This position depends on the extent to which their social identities conform to the norms and culture of a society at a given time. An individual’s social position is thus a multifactorial concept that cannot be reduced to a single indicator and encompasses, at a minimum, sex/gender, migration background, as well as education, employment status, and resources. Social position also influences an individual’s rights, access to resources (including health services), and, more broadly, their living conditions and life experience.

Social position is not fixed: it can evolve depending on the cultural, geographic, or historical context, but also throughout an individual’s life, as a result of personal changes (career path, family circumstances, etc.) or contextual changes, particularly socio-economic ones.

Why is it important to consider social position when determining social inequalities? And why should it be integrated into public health work?

Measuring social position allows us to account for the various dimensions of social health inequalities: these are not limited to socioeconomic or territorial inequalities but also encompass inequalities related to gender, origin, and age.

Social position sheds light on how exposures, behaviors, and resources that impact health are distributed across the population. It helps highlight the social gradient of health: that is, the gradual improvement in an individual’s health status as their position rises in the social hierarchy.

Incorporating it into public health work is an essential tool for better guiding action. Taking social position into account allows us to go beyond “average” results in the population, to make health disparities and the mechanisms underlying them visible and understandable. In concrete terms, measuring indicators of social position makes it possible to determine who benefits from the public health measures put in place, to what extent, and what effects these have on social health inequalities.

What are the prospects for this research?

This research first opens up methodological prospects. It aims to propose benchmarks for describing social position in a standardized manner in our work (choice of indicators, comparability over time and across regions) and to move beyond a “siloed” approach organized by disease. In epidemiology, for example, we often analyze the association between sex/gender and health “at comparable socioeconomic status.” This approach is useful, but it does not allow us to show how socioeconomic status influences the health of men and women differently.

The perspective is therefore to examine more systematically whether associations vary across groups—in other words, whether the observed effect changes from one group to another. This allows for a better account of the interaction of social situations: understanding how multiple dimensions combine and influence one another, without reducing the analysis to a simple juxtaposition of categories.

The perspectives are then operational: applying conceptual models of social inequalities in health and analyzing data using social epidemiology methods to better guide public health actions. In practical terms, this can help inform the design of public health interventions to make them more equitable, particularly by assessing whether these interventions have a similar effect across the social gradient.