Article Text

Download PDFPDF
Health selection operating between classes and across employment statuses
  1. Myung Ki1,
  2. Amanda Sacker2,
  3. Yvonne Kelly3,
  4. James Nazroo4
  1. 1Centre for Paediatric Epidemiology & Biostatistics, Institute of Child Health, University College London, London, UK
  2. 2Institute for Social and Economic Research (ISER), University of Essex, Colchester, UK
  3. 3Department of Epidemiology and Public Health, University College London, London, UK
  4. 4School of Social Science, The University of Manchester, Manchester, UK
  1. Correspondence to Dr Myung Ki, UCL Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK;{at}


Backgrounds The debate on health selection which describes the influence of health on subsequent social mobility is highly contested. The authors set out to examine the effect of health selection by looking at the effect of previous health status on changes in socio-economic position (SEP) over two time periods.

Method Data were pooled from 13 waves (1991–2003) of the British Household Panel Survey (BHPS). Using a multilevel multinomial approach, the presence of health selection between classes and into/out of employment was concurrently tested and compared.

Results In the descriptive analysis, poor health was consistently associated with moving downward, while the outcome was inverse for upward movement. After accounting for the data structure using multilevel analysis, health was a predictor for social mobility when leaving and entering employment, but the effect was minimal for transitions between classes for both men and women.

Conclusion The non-significant impact of health on mobility inside employment may reflect the presence of the significant impact of health on mobility between employment and non-employment. This implies that the effect of health was not evenly spread over all social mobility, but rather tends to concentrate on some types of mobility. The effect of each predictor on social mobility is more concentrated among specific transitions, and health and age were likely to be substantial in moving into/out of the labour force, whereas education was a relevant predictor for mobility into/out of upper classes, in particular, classes I/II.

  • Health selection
  • social mobility
  • health inequalities
  • panel data
  • multilevel modelling
  • longitudinal data analysis
  • self-rated health
  • social inequalities

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.