Abstract
Arguably, the most important problem at the intersection of sociology and epidemiology is how to understand the pervasive positive relationship between various indicators of social position (hereafter, socioeconomic status or SES) and health. The lower status people are, the sooner they die, and the worse health they have while alive. Negative associations between SES and health overall have been found in almost every place and time for which data permit adequate study, implying that the generalization has held even as the prevalence of particular causes of ill-health and death have varied (see reviews in Marmot 2004; Link and Phelan 1995; Deaton 2002; House et al. 1990). In addition, data suggest that the negative association between at least some indicators of SES and some indicators of health may be increasing in some populations, including the United States (Duncan 1996; Lauderdale 2001; Preston and Elo 1995; Steenland et al. 2004; Krieger et al. 2008). Meara et al. (2008) found that while life expectancy had increased 1.6 years between 1990 and 2000 among those who had attended college, it had not increased at all over this same period among those who had not. While various caveats can be raised, none should detract from appreciating that socioeconomic disparities in health in studied populations overwhelmingly are pervasive and profound.
Keywords
- Health Disparity
- Seat Belt
- Medical Sociology
- Purposive Action
- Enduring Character
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
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Notes
- 1.
Some have asserted that gender can also be considered a fundamental cause of health (Graham 2004, p. 112). Surely, it is easy to see many pathways between gender inequalities and health outcomes. However, the greater longevity of the socially disadvantaged group (women) makes us wish for a more detailed explication of the understanding of the fundamental cause concept that yields the assertion that, by simple analogy to SES or race, we can think of gender as a fundamental cause of health.
References
Adler NE, Newman K (2002) Socioeconomic disparities in health: pathways and policies. Health Aff 21(2):60–76
Arber S, McKinlay JB, Adams A, Marceau LD, Link CL, O’Donnell AB (2004) Influence of patient characteristics on doctors’ questioning and lifestyle advice for Coronary heart disease: a UK/US video experiment. Br J Gen Pract 54(506):673–678
Aronowitz R (2008) Framing disease: an underappreciated mechanism for the social patterning of health. Soc Sci Med 67:1–9
Beckfield J (2004) Does income inequality harm health? New cross-national evidence. J Soc Behav 45:231–248
Bourdieu P (1984) Distinction: a social critique of the judgment of taste. Harvard University Press, Cambridge, MA
Braveman P (2006) Health disparities and health equity: concepts and measurement. Annu Rev Public Health 27:167–194
Christakis NA, Fowler JH (2007) The spread of obesity in a large social network over 32 years. N Engl J Med 357:370–379
Christakis NA, Fowler JH (2008) The collective dynamics of smoking in a large social network. N Engl J Med 358:2249–2258
Cutler DM, Lleras-Muney A (Forth coming) Education and health: evaluating theories and evidence. In: House JS, Schoeni RF, Kaplan G, Pollack H (eds) The effects of social and economic policy on health. Russell Sage, New York
Cutler DM, Deaton A, Lleras-Muney A (2006) The determinants of mortality. J Econ Perspect 20(3):97–120
Deaton A (2002) Policy implications of the gradient of health and wealth. Health Aff 21(2):13–29
Duncan GJ (1996) Income dynamics and health. Int J Health Serv 26:419–444
Gehlert S, Sohmer D, Sacks T, Mininger C, McClintock M, Olopade O (2008) Targeted health disparities: a model linking upstream determinants to downstream interventions. Health Aff 27(2):339–349
Glied S, Lleras-Muney A (2008) Health inequality, education, and medical innovation. Demography 45:741–761
Goldman D, Lakdawalla DN (2005) A theory of health disparities and medical technology. Contrib Econ Anal Policy 4(1): Article 8 (http://www.bepress.com/bejeap).
Gottfredson L (2004) Intelligence: is it the epidemiologists’ elusive ‘fundamental cause’ of social class inequalities in health? J Pers Soc Psychol 86:174–199
Graham H (2004) Social determinants and their unequal distribution: clarifying policy understandings. Milbank Q 82(1):101–124
House JS, Kessler RC, Herzog AR, Mero RP, Kinney AM, Breslow MJ (1990) Age, socioeconomic status, and health. Milbank Q 68:383–411
Institute of Medicine (2003) Unequal treatment: confronting racial and ethnic disparities in healthcare. The National Academies Press, Washington, DC
Klinenberg E (2006) Blaming the Victims: Hearsay, Labeling, and the Hazards of Quick-Hit Disaster Ethnography. American Sociological Review 71:689–698
Kremer M, Glennerster R (2004) Strong medicine: creating incentives for pharmaceutical research on neglected diseases. Princeton University Press, Princeton, NJ
Krieger N, Rehkopf DH, Chen JT, Waterman PD, Marcelli E, Kennedy M (2008) The fall and rise of US inequities in premature mortality: 1960–2002. PLoS Med 5:e46
Lauderdale D (2001) Education and survival: birth cohort, period, and age effects. Demography 38:551–561
Lieberson S (1985) Making it count: the improvement of social research and theory. University of California Press, Berkeley, CA
Link BG (2008) Epidemiological sociology and the social shaping of population health. J Health Soc Behav 49:367–384
Link BG, Phelan JC (1995) Social conditions and fundamental causes of disease. J Health Soc Behav Extra Issue:80–94
Link BG, Phelan JC (1996) Understanding sociodemographic differences in health –The role off fundamental social causes. Am J Public Health 86:471–473
Link BG, Phelan JC (2000) Evaluating the fundamental cause explanation for social disparities in health. In: Bird CE, Conrad P, Fremont AM (eds) Handbook of medical sociology. Prentice Hall, Englewood Cliffs, NJ
Link BG, Phelan JC (2002) McKeown and the idea that social conditions are the fundamental causes of disease. Am J Public Health 92(5):730–732
Link BG, Phelan JC (2005) Fundamental sources of health inequalities. In: Mechanic D, Rogut LB, Colby DC, Knickman JR (eds) Policy challenges in modern health care. Rutgers University Press, New Brunswick, NJ, pp 71–84
Link BG, Northridge ME, Phelan JC, Ganz M (1998) Social epidemiology and the fundamental cause concept: on the structuring of effective cancer screens by socioeconomic status. Milbank Q 76(3):375–402
Link BG, Phelan Jo C, Miech R, Westin EL (2008) The resources that matter: fundamental social causes of health disparities and the challenge of intelligence. J Health Soc Behav 49:72–91
Lutfey K, Freese J (2005) Toward some fundamentals of fundamental causality: socioeconomic status and health in the routine clinic visit for diabetes. Am J Sociol 110(5):1326–1372
Mackenbach JP, Stirbu I, Roskam AJ, Schaap MM, Menvielle G, Leinsalu M, Kunst AE (2008) Socioeconomic inequalities in health in 22 European countries. N Engl J Med 358:2468–2481
Mackintosh M, Koivusalo M (eds) (2005) Commercialization of health care: global and local dynamics and policy responses. [Series on social policy in a development contextg, United Nations Research Institute for Social Development]. Macmillan, New York
Marmot M (2004) The status syndrome: how social standing affects our health and longevity. Holt, New York
Massoglia M (2008) Incarceration as exposure: the prison, infectious disease, and other stress-related illness. J Health Soc Behav 49(1):56–71
McKeown T (1976) The Role of Medicine: Dream, Mirage, or Nemesis. Nuffield Provincial Hospitals Trust, London
McKinlay JB (1975) A case for refocusing upstream: the political economy of illness. In: Enelow AJ, Henderson JB (eds) Behavioral aspects of prevention. American Heart Association, Dallas, TX, pp 9–25
McKinlay JB (1996) Some contributions from the social system to gender inequalities in heart disease. J Health Soc Behav 37(1):1–26
McKinlay JB, Marceau LD (2008) When there is no doctor: reasons for the disappearance of primary care physicians in the U.S. during the early 21st century. Soc Sci Med 67:1481–1491
McKinlay JB, McKinlay SM (1977) The questionable contribution of medical measures to the decline of mortality in the United States in the twentieth century. Milbank Q 55:405–428
McKinlay JB, Lin T, Freund K, Moskowitz M (2002) The unexpected influence of physician attributes on clinical decisions: results of an experiment. J Health Soc Behav 43(1):92–106
Meara ER, Richards S, Cutler DM (2008) The gap gets bigger: changes in mortality and life expectancy, by education, 1981-2000. Health Aff 27(2):350–360
Mechanic D (2007) Population health: challenges for science and society. Milbank Q 85(3):533–559
Mirowsky J, Ross CE (2003) Education, social status, and health. Aldine de Gruyter, New York
Olafsdottir S (2007) Fundamental causes of health disparities: stratification, the welfare state, and health in the United States and Iceland. J Health Soc Behav 48:239–253
Pager D (2007) Marked: race, crime, and finding work in an era of mass incarceration. University of Chicago Press, Chicago, IL
Phelan JC, Link B (2005) Controlling disease and creating disparities: a fundamental cause perspective. J Gerontol 60B(Special Issue II):27–33
Phelan JC, Link B, Diez-Roux A, Kawachi I, Levin B (2004) Fundamental causes of social inequalities in mortality: a test of the theory. J Health Soc Behav 45:265–285
Preston SH, Elo IT (1995) Are educational differences in adult mortality increasing in the United States? J Aging Health 7:476–496
Rose N (2007) The politics of life itself: biomedicine, power, and subjectivity in the twenty-first century. Princeton University Press, Princeton, NJ
Sallaz JJ, Zavisca J (2007) Bourdieu in American sociology, 1980–2004. Annu Rev Sociol 33:21–41
Sankar P, Cho MK, Condit CM, Hunt LM, Koenig B, Marshall P, Lee SS, Spicer P (2004) Genetic research and health disparities. JAMA 291(24):2985–2989
Schnittker J (2004) Education and the changing shape of the income gradient in health. J Health Soc Behav 45:286–305
Shinar D, Schechtmana E, Compton R (2001) Self-reports of safe driving behaviors in relationship to sex, age, education and income in the U.S. adult driving population. Accid Anal Prev 33(1):111–116
Smith JP (2007) The impact of socioeconomic status on health over the life-course. J Hum Resour 42(4):739–764
Steenland K, Hu S, Walker J (2004) All-cause and cause-specific mortality by socioeconomic status among employed persons in 27 U.S. states, 1984–1997. Am J Public Health 94:1037–1042
The Diabetes Control and Complications Trial Research Group (1993) The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 329:977–986
Timmermans S, Haas S (2008) Toward a sociology of disease. Sociol Health Illn 30:659–676
Warren JR, Hernandez EM (2007) Did socioeconomic inequalities in morbidity and mortality change in the united states over the course of the twentieth century? J Health Soc Behav 48:335–351
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Freese, J., Lutfey, K. (2011). Fundamental Causality: Challenges of an Animating Concept for Medical Sociology. In: Pescosolido, B., Martin, J., McLeod, J., Rogers, A. (eds) Handbook of the Sociology of Health, Illness, and Healing. Handbooks of Sociology and Social Research. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-7261-3_4
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