, Volume 53, Issue 5, pp 1631–1656 | Cite as

A Social History of Disease: Contextualizing the Rise and Fall of Social Inequalities in Cause-Specific Mortality

  • Sean A. P. CloustonEmail author
  • Marcie S. Rubin
  • Jo C. Phelan
  • Bruce G. Link


Fundamental cause theory posits that social inequalities in health arise because of unequal access to flexible resources, including knowledge, money, power, prestige, and beneficial social connections, which allow people to avoid risk factors and adopt protective factors relevant in a particular place. In this study, we posit that diseases should also be put into temporal context. We characterize diseases as transitioning through four stages at a given time: (1) natural mortality, characterized by no knowledge about risk factors, preventions, or treatments for a disease in a population; (2) producing inequalities, characterized by unequal diffusion of innovations; (3) reducing inequalities, characterized by increased access to health knowledge; and (4) reduced mortality/disease elimination, characterized by widely available prevention and effective treatment. For illustration, we pair an ideal-types analysis with mortality data to explore hypothesized incidence rates of diseases. Although social inequalities exist in incidence rates of many diseases, the cause, extent, and direction of inequalities change systematically in relation to human intervention. This article highlights opportunities for further development, specifically highlighting the role of stage duration in maintaining social inequalities in cause-specific mortality.


Fundamental causes Social inequalities Cause-specific mortality Informational diffusion Mortality trends 



The authors thank the Centers for Disease Control and Prevention (CDC) for its financial support of this article through Public Health Dissertation Research funding (Grant R36SH000004). The contents of this manuscript are solely the responsibility of the authors and do not necessarily represent the official views of CDC.


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Copyright information

© Population Association of America 2016

Authors and Affiliations

  • Sean A. P. Clouston
    • 1
    Email author
  • Marcie S. Rubin
    • 2
  • Jo C. Phelan
    • 3
  • Bruce G. Link
    • 4
  1. 1.Program in Public Health and Department of Family, Population and Preventive MedicineStony Brook University, Health Sciences CenterStony BrookUSA
  2. 2.Section of Social and Behavioral Sciences, College of Dental MedicineColumbia UniversityNew YorkUSA
  3. 3.Department of Sociomedical Sciences, Mailman School of Public HealthColumbia UniversityNew YorkUSA
  4. 4.Department of Sociology, and School of Public PolicyUniversity of CaliforniaRiversideUSA

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