A Critical Appraisal of Kuppuswamy's Socioeconomic Status Scale in the Present Scenario.

The socioeconomic status (SES) is widely recognized as one of the important factors affecting the health condition of an individual or a family. One of the scales widely used and quoted even today is the one developed by Kuppuswamy. The Kuppuswamy scale in its various forms has held steady over three decades now and is still widely used as a measure of socioeconomic status in the urban population. However, it is important to discuss the applicability in the changed modern scenario.

The socioeconomic status (SES) is widely recognized as one of the important factors affecting the health condition of an individual or a family. The need for development of scales utilizing few selected criteria that would best indicate the SES of an individual/family has been a felt need since long. Several scales have been developed and reported in publications that seek to assess SES of families in specific circumstances, such as in urban population or in rural population.

One of the scales widely used and quoted even today is the one developed by Kuppuswamy. The original scale was published in the year 1981, and incorporated three characteristics to be assessed and scored: Education level of the head of family (HOF), occupation of the HOF, and income per month. A point to be noted is that the Kuppuswamy scale attempts to measure the SES of an individual in a urban community.[1] Revision of the original scale to bring the income subscale up to date and an online tool for real-time updating have been published.[23] This was necessitated as monetary inflation means the rupee does not retain the same value each year in terms of the goods/services that may be purchased with the same amount.[4] The revision is linked to the All India Average Consumer Price Index for Industrial Workers (CPI-IW).

The Kuppuswamy scale has now been around for more than 3 decades. However, there may be certain shortcomings in its use and application that need to be discussed. Improvement in these possible lacunae is a priority area considering the wide use of the scale in published literature and in family health advisory postings in urban areas of medical undergraduate students. The discussion is presented point-wise.

Education Status of Head of Family

(a) Identification of the HOF

In certain family situations it may be difficult to classify one individual as the HOF. Such difficulties arise if the family has one or more elderly members who may be retired or unemployed. Despite not being the eldest earning adult member in the family they may still wield considerable say in family matters, by virtue of their age, or it may be that despite not earning regular income they are the owners/holders of the shared family properties. It may be difficult for researchers in field settings to arrive at accurate identification of the HOF.

(b) HOF as representative for entire family

Second important point is that the education status of the identified HOF is being taken as a surrogate measure for the entire family's education level. While this may have been reliable enough in the times gone by, it is no more reliably applicable in today's scenario. India is in a time of dynamic demographic transitions. With increased opportunities and support, it is now common to find that in a family having an uneducated HOF, children or grandchildren have received tertiary level education or professional education. If the eldest member of the family is identified as HOF, the chances of low score in education subscale increase as the literacy rate in India earlier was much lower than what it is now.

Occupation of Head of Family

(a, b) The points mentioned earlier regarding the accurate identification of a HOF, and the error inherent in juxtaposing HOF's status to that of the entire family, hold relevance for occupation also.

(c) Grading the occupation

There has been a remarkable opening up of the Indian economy in the past years. If we study the sectors of employment, from a majority of working population being employed in the primary sector our occupational profile has seen a profound shift with more and more people finding work avenues in the tertiary or the ‘services’ sector.[5] Not only that but also the sheer variety and number of occupations available have increased manifold as the complexities of the modern civilization have grown. While it may still have been possible to grade the smaller number of possible occupational profiles as was true earlier, but now it is very difficult to accurately grade each and every occupation and especially difficult to slot it into one of the assigned scores in the Kuppuswamy classification for occupation.

(d) Scoring the occupation

The classes of score possible for occupation may now prove too limited considering the myriad varieties of occupations in the current society. The category 3 of the occupation subscale creates much confusion as it is not given a name and neither is it defined clearly. Only examples of the job profiles fitting the category are given which creates scope for ambiguity and subjectivity.

(e) Measure of success/standing in their chosen occupation not accounted for

The SES of the family may also be affected in a large part by how successful a person is in his/her job, or by how much social reputation(s) he has built with the gainful employment. An example may be an unskilled worker doing a simple occupation, but who may have lot of social standing owing to unpaid social work.

Assessing the Income

(a) Validity of directly asking for income

The Kuppuswamy scale requires directly asking the respondent about the income earned. In our experience, this proves to be a very tricky subject to elicit information about. Invariably it leads to nonresponses or responses that seem more likely to be underreported figures. Even Kuppuswamy had mentioned this as a possible shortcoming.[1] The practicality of asking for income directly is a point in question, and the problems of low validity are seen to persist even if the questionnaires are anonymous/self-filled.

(b) Only regular monthly/annual income being assessed

The regular monthly or annual income may not be a true reflection of the family's economic standing. There are innumerable examples where a one-off massive income addition may have occurred, for example, a family holding land tracts may have sold it and received a one-time monetary compensation in lieu thereof; or there may have been a financial compensation for an untimely death/injury of a family member in an accident, terrorist strike, or other such events.

(c) Only liquid income being assessed

The past economic conditions of the family can impact their present and future well-being too. The physical assets possessed by the family such as number of residential properties, number of commercial properties, extent of agricultural land holdings, investments such as gold or fixed deposits, and assets that may be regarded as investment such as vehicles, durable consumer goods, etc., are not assessed as part of the Kuppuswamy scale.

The Kuppuswamy scale in its various forms has held stead over 3 decades now and is still widely used as a measure of socioeconomic status in the urban population. However, it is important to discuss the applicability in the changed modern scenario. Despite best efforts, we could not find any recent study on validation of the Kuppuswamy scale in the present scenario. In the absence of a universally accepted available alternative, it may be perforce necessary to keep on using the Kuppuswamy scale; but discussion on its merits and demerits in the current scenario is important, especially for the health professionals and others new to the use of measures of socioeconomic conditions of a family.