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Link and Phelan; Social Conditions as a Cause of Disease

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Western University
Sociology 3308F/G
Kim Shuey

Bruce, Phelan; "Social Conditions as a Cause of Disease" Monday, January 20, 2014 6:46 PM Abstract: Analysis of the factors associated with Low Socio Economic Status (power, prestige, knowledge, money) and how they correlate with poor health • Society's poor live in worse health and die much younger than more privileged people •Typically, age-adjusted risk of death for those in the lowest socioeconmic level is double to triple that for the highest level •Death rates strongly related to education levels, similar findings for income levels •SES inequalities in mortality persisted through industrialisation and developed phase, reflect cancers and cardiovascular illness fueled by poor diet, poor exercise, and smoking, that are more common in low SES groups •Link and phelan argue we cant explain why health inequalities exist if we cant explain why they persist after efforts have been made to eliminate them, referring to britains massive transformation and support of public health The Theory •Theory of fundamental causes rooted in Lieberson's concept of basic causes •Fundamental social cause of health inequalities has four essential features o Influences multiple disease outcomes - not limited to one or a few diseases o Affects these diseases through multiple risk factors o Involves access to resources that can be used to avoid riskm, minimize consequence of disease o Association is reproduced over time through the replacement of intervening mechanisms Central Role of Flexible Resources for SES inequalities in Health •SES related to multiple diseases through multiple pathways because individuals and groups deploy resources to avoid risks, and adopt protective strategies •Key resources; money, knowledge, power, prestige, benficial social connections •They are flexible because they can be used in different ways in different situations •Resources must come from somewhere •Deployment of resources changes over time; prior to cancer screening, didn’t matter how much resources you had, you couldn’t screen for cancer o Now that screening exists, those with resources can screen for cancer and take measures to better their health •Screening rates are indeed associated with education and income •Flexible resources shape whether people know about, have access to, can afford, and receive social support for their efforts to engage in health-protective behaviours •People with money live in neighborhoods with people with money where effort and money goes toward reducing crime, pollution, noise, violence and vermin o Best health care facilities, parks, grocery stores, located nearby o People with educational status often have jobs that include health benefits o Less likely to work in dangerous conditions •Person benefits in numerous ways that do not depend on their ability or initiative •"add-on" benefit at contextual level • Clearest example of fundamental cause theory is when groups push for better healthcare for all involved • Less explicitly, members of higher SES form better health lifestyles around food, working out, etc. o Reinforced through social normativity • Meetings of these people usually provide snacks of a healthier caliber, however meetings and get togethers of lower SES people usually incorporate high-fat high-sugar snacks • Conventional for higher SES meetings to incorporate healthy fare Key Empirical Findings • Empirical tests are not obvious or straightforward • It is difficult to single out anyone of these fundamental causes • Empirical support relies on evaluating the four essential features laid out prior o That SES influences multiple disease outcomes o That SES is related to multiple risk factors for disease and death o Deployment of resources plays a critical role between SES and health/mortality o Association between SES and health/mortality is reproduced over time via replacement of intervening mechanisms Evidence that SES is related to multiple disease outcomes via multiple Risk Factors • Low ses related to multiplicity of diseases and other causes of death o Chronic diseases, communicable diseases, injuries o Related to each of 14 major causes of death in international classification of diseases • Clear evidence that SES is related to smoking, sedentariness, being overweight, stressful life conditions, social isolation, crowded and unsanitary living conditions, unsanitary water supply, malnutrition • This theory is a "massive multiplicity of mechanisms" • Should be found in all or most particular instances when SES and health are connected • Higher SES patients encounter fewer costs of complying to treatment regimens, have more knowledge about disease Evidence that deployment of resources plays a critical role in the association between SES and health • Resources of money, knowledge, power, prestige, and beneficial social connections are critical to maintaining a health advantage • Difficult to test importance of resources • Requires identification of situations where using SES resources is benefical vs SES resources themselves • In situations where use of resources does not confer any benefit, usual association between high SES and health or mortality should be greatly reduced • Situation occurs when causes and cures of fatal diseases are unknown • There should be strong differences in which causes of death are highly preventable, and similarities where causes of death are not preventable3 • Consistent with prediction, above conditions were met • SES-mortality association stronger for preventable causes of death •Other situations possible for testing include when prevailing medical recommendations are discovered to be harmful, or when frailty of old bodies place limits on the effectiveness of interventions Evidence that the association between SES and health/mortality is reproduced over time via the replacement of intervening mechanisms •SES-mortality association persisted over time despite decline of mechanisms that formerly provided important links between SES and mortality (poor sanitation, widespread death from infectious disease) •New, previously weak or absent mechanisms currently link SES and mortality (smoking, diet, exercise, cardiovascular disease) •Socioeconomic inequalities in health are reproduced via replacemnt of intervening mechanisms •Higher SES individuals are better equipped to take advantage of new knowledge •Does SES-health gradient shift in favor of higher SES individuals following development of new knowledge •Persuasive when health outcome directly related to new knowledge •Just as important, if in absence of new knowledge, SES gradient remains fairly steady •Studied new health treatments - higher SES had better health after new treatments released for certain diseases •When no treatment advances- SES-health association remained steady •Womens breast cancer o When found that hormone therapy increased risk of breast cancer, those using hormone therapy (white, upper SES) stopped, a
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