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Background Many studies use dichotomous distinction between high and low SES and overall 'general total health' as outcome variable in studying Socio-Economic Status (SES) as determinant of health. In light of recent views on health and society, this study challenges this approach by proposing a more multidimensional view on both SES as well as health by analyzing four groups of SES and including six dimensions of positive health (PG) next to total general health. This study therefore addresses the impact of SES on the perception of total general health and the six domains distinguishing four instead two SES groups. Methods An online questionnaire on health perceptions was performed amongst 1000 respondents age 18 years and older in the Netherlands. Spearman correlations and regression analysis have been performed determining relationships and relative contributions of effects to the main outcome of perceived total general health using IBM SPSS Statistics 24. Results It appears that on average total general health is higher with increasing SES scores. Furthermore, distinguishing between four levels of SES instead of two revealed that low and mid low SES group evaluated total general health and all six health domains equal. However, mid low SES group evaluate their general health and 5 out of 6 domains lower than mid high SES group and mid high SES group scored lower on general health and all 6 domains than very high SES group. Variance in people's evaluation of their perceived health was explained for 10% of the impact of SES on total general health using simple regression analysis which remarkably disappeared using multiple regression including other socioeconomic and demographic variables. Discussion Results show that a more refined SES score and using the six health domains of positive health seems to give more insight into peoples' perceptions of their health. These findings suggest that health promoting interventions should be tailored to different SES-groups. Key messages Using more SES-groups and positive health domains gives more insight in peoples' perception on experienced health. Tailoring health promoting interventions to peoples' perspectives on health and SES might decrease health disparities.

Refining insights in SES and other determinants on perceived health; a Positive Health Perspective