Week 2_1 SES and Fundamental Cause Theory

Question 1

SDOHs are…

Answer 1

value neutral

• can be either advantageous or
  deleterious
• Education both promotes better health for those who have high levels
  of attainment, and adversely affects health for those with low levels of
  attainment.

Question 2

Upstream vs downstream factors

Answer 2

Upstream = structural and operate at a macro level, such as policies
(e.g., free pre-K schooling), culture, political economies

Downstream = more proximate and individual-level, such as a job loss

Question 3

Socioeconomic Status (SES)

Answer 3

Summary measure of…
* Education
* Occupation
* Income

Question 4

What is the mechanism (pathway)?

Answer 4

Describes the why and how

influence–>mechanism–>outcome

Question 5

mechanism (pathway) for SES in the 21st century in Canada

Answer 5

I: SES
–> M: Diet, stress, smoking, drinking, job security,…
–> O: Mortality, morbidity

Question 6

Fundamental social causes

Link and Phelan (1995)

Answer 6

involve flexible resources such as knowledge, money, power, prestige and beneficial social connections that determine the extent to which people can
avoid risks and adopt protective strategies (and hence reduce mortality and morbidity). Because such resources can
be used in different ways in different situations, fundamental
causes have effects on disease even when the profile of risk and protective factors change. Their persistent effect on
health in the fact of drastic changes in mechanisms that makes them fundamental

Question 7

Fundamental Cause Theory - SES empirical goal

Answer 7

Explain the enduring association between SES and health despite changes in
diseases/risk

Question 8

Fundamental Cause Theory - SES theoretical goal

Answer 8

Shift away from a sole focus on intervening mechanisms (because they will change, and the association will persist) = shift to broader structures

Question 9

Social factors are fundamental causes if they… (4)

Fundamental Cause
Link and Phelan (1995)

Answer 9

(1) are related to important resource access
(2) Affect multiple disease outcomes
(3) Via multiple mechanisms
(4) Maintain an association with disease even when
intervening mechanisms change

Question 10

Fundamental Cause
Core ideas

Answer 10

• SES embodies flexible resources (money, knowledge, prestige, power and social connections)
• Resources protect health no matter what mechanisms are relevant at a given time
• Operates in the same direction (systematic
  (a)symmetry) and has a diverse set of causes
  (massively multiple mechanisms)

Question 11

Fundamental Cause Example

Cholesterol & HBP are two proximate risk factors for cardiovascular disease, a leading cause of death

What happened with statin?

Answer 11

CVD rates have gone
down since 1970s due to
discovery of statin in
1976 and pharmaceutical
release in 1987.

Overall levels of cholesterol decreased!
* The income gradient REVERSED

before: Higher SES had Greater Cholesterol Levels

then: lower income people now had higher cholesterol levels, without
changes to diets by income

Question 12

FCT – An extension (Freese & Luftey)

Ambiguity of “resources”

Answer 12

“SES” most immediately evokes income, but
education differences are more consequential for health in the United States; “resources” most
immediately evokes money, but nonmonetary differences are more important

Link and Pheland have used examples from health-promoting behaviors whose costs are minimal and for which information about benefits
have widely diffused

What about seat belt
wearing, living in
neighborhood with garbage
pick-up, children who bring
home health info.

Resources that are beyond
individual purposive action
(i.e., agency)?

Question 13

Stretching “resources” to 4 metamechanisms

Freese and Lutfey (2011) expand on “flexible
resources,” with 4 metamechanisms:

Answer 13

1. Means – purposeful use of resources to improve
   health (money, power, knowledge, capital)
2. Spillovers – Contextual resources (social network)
3. Habitus – Norms, dispositions, unintentional
   lifestyles
4. Institutions – Agentic action of institutions, family, school, government, healthcare (not an individual’s
   action)