SES Flashcards
Link & Phelan. (1995). Social conditions as fundamental causes of disease.
Gist: Most research has examined proximal causes of disease (e.g., diet, exercise). Instead, these individually-based risk factors are contextualized meaning the question is what puts people at risk of risks. Second, social factors such as SES and social support are “fundamental causes” of disease because they embody access to resources, affect multiple disease outcomes through multiple mechanisms, and maintain an association with disease even when intervening mechanisms change.
Definition of fundamental cause of disease:
1) Social condition has a persistent association with disease.
2) Differential access to resources explains link between social condition & risk(s). Resources include knowledge, wealth, power, prestige, social connectedness, etc.
3) vulnerability to multiple disease outcomes.
4) Social conditions affect health outcomes through multiple pathways or risk factors.
Phelan, Link, & Teranifar. (2010). Social conditions as fundamental causes of health inequalities: Theory, evidence, and policy implications.
Gist: Based on Link & Phelan’s (1995) original theory of fundamental causes, this article explicates the theory, reviews key findings, discusses refinements and limits to the theory, & discusses implications for health policies to reduce health inequalities.
1) Theory - 4 criteria (see 1995 article); individuals & groups deploy resources to avoid risks & adopt protective strategies;
2) Flexible resources - knowledge, money, power, prestige, & beneficial social connections; they have capacity to be used flexibly (center of theory); they operate at individual & contextual levels; conceptualized as “cause of causes” or “risk of risks”.
3) Key empirical findings: consistent evidence for 4 components of the theory.
4) Refinements: (a) knowing association btw risk factors or diseases and SES prior to new knowledge or technology; (b) understanding demise & death of mechanisms linking flexible resources to disease (different temporal patterns).
5) Limitations: (a) countervailing mechanisms - competing mechanisms (e.g., desire for beauty) that compete with SES mechanisms to explain health outcomes.
6) Health policy implications: (a) reduce resource inequalities (upstream factors); (b) contextualize risk factors (identify factors that place people at risk of risks); (c) prioritize interventions that don’t entail use of resources or minimize relevance of resources.
Geruso. (2012). Black-white disparities in life expectancy: How much can the standard SES variables explain?
Gist: Quantifies the extent to which socioeconomic & demographic characteristics account for black-white disparities in life expectancy in the U.S. using decomposition technique. SES & demographics explain 70-80% of the gap in life expectancy. Labor force participation, occupation, and marital status (for women only) add no additional explanatory power.
Elo. (2009). Social class differentials in health and mortality: Patterns and explanations in comparative perspective.
Gist: Review of various measures used to define social class in studies of health inequalities in developed countries. Focuses on patterns of inequalities and potential explanations.
1) Measures of social class & SES: (a) Europe historically uses occupation to assign social class; (b) U.S. typically includes multiple measures, including education, income, and wealth in addition to or instead of occupation; (c) U.S. also uses race/ethnicity to capture added aspects of social & economic position that are not well summarized by standard measures of social class; (d) overall, single measure of SES is insufficient of capture multiple dimensions of social class that influence health outcomes.
2) Educational attainment - not influenced by subsequent health impairments; may not be free of poor childhood health.
3) Occupational rankings - Difficulty assigning social class to people that aren’t members of the labor force (e.g., homemakers, retirees, students).
4) Income & wealth - represent access to economic resources available to purchase health-related goods and services; when absent, can use proxies of housing quality, housing tenure, car ownership for household wealth.
5) General findings:
(a) Educational attainment - single SES indicator most consistently associated with health & mortality; associated with length of life & timing of disease onset; maternal education sig. predictor of child health; potential role of education in production of learned effectiveness, improved decision-making & problem-solving skills, augmenting one’s ability to acquire information about health-producing technologies; role in adoption of positive health behaviors & healthy lifestyles, timely use of health care services.
(b) Income/wealth - protect from chronic financial stress & facilitate access to health-generating resources (superior housing in safe neighborhoods & leisure activities) & help cope with ill health; continued debate over whether association btw income & health is curvilinear (more pronounced at lower end of income) or linear; absolute vs. relative income.
c) Occupation - higher status positions protect individuals from stress associated with alienating working conditions.
6) Role of early life conditions: cumulative effects of social origins on health outcomes throughout the life course, indirectly via attained adult characteristics (SES, lifestyle) & directly affecting childhood health.
Link & Phelan. (2002). McKeown and the idea that social conditions are fundamental causes of disease.
Gist: McKeown’s thesis was that dramatic reductions in mortality over past 2 centuries were due to improved socioeconomic conditions rather than to medical or public health interventions; this has been overturned and discredited. However, antithesis that the role of social conditions is insignificant is also not true (by authors). Resources directly shape individuals health behaviors and shape access to broad context such as neighborhoods, occupations, and social networks. Overall, McKeown’s thesis discussed the overall trend, but the fundamental cause theory describes subgroups differences. Basically, while improvements in SES may have been made, it doesn’t necessarily change the gap between low- and high-SES groups.
Bond Huie et al. (2003). Wealth, race, and mortality.
Gist: Explore whether wealth is related to mortality risk independent of education & income, and whether wealth closes the black-white gap in U.S. adult mortality while controlling for other sociodemographic factors. Lower asset holdings by blacks (compared to whites) affects their financial well-being and survival. Cannot ignore impact of wealth on premature adult mortality. It attenuates the black-white gap in mortality independent of other factors.
