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Abstract
Link and Phelan (1995) developed the theory of fundamental causes to explain why the association between socioeconomic status (SES) and mortality has persisted despite radical changes in the diseases and risk factors that are presumed to explain it. They proposed that the enduring association results because SES embodies an array of resources, such as money, knowledge, prestige, power, and beneficial social connections that protect health no matter what mechanisms are relevant at any given time. In this article, we explicate the theory, review key findings, discuss refinements and limits to the theory, and discuss implications for health policies that might reduce health inequalities. We advocate policies that encourage medical and other health-promoting advances while at the same time breaking or weakening the link between these advances and socioeconomic resources. This can be accomplished either by reducing disparities in socioeconomic resources themselves or by developing interventions that, by their nature, are more equally distributed across SES groups.
Keywords:
health disparities, social stratification, fundamental causes, health, mortality
As we mark the fiftieth anniversary of the Medical Sociology Section of the American Sociological Association, one of the most basic and critical problems addressed by medical sociologists is a very old one: the fact that society's poorer and less privileged members live in worse health and die much younger than the rich and more privileged ones. Socioeconomic inequalities in health and mortality are very large, very robust, and very well documented. Typically, age-adjusted risk of death for those in the lowest socioeconomic level is double to triple that for the highest level (Antonovsky 1967; Sorlie, Backlund, and Keller 1995; Kunst, Feikje, and Mackenbach 1998). To illustrate, in 2005, all-cause, age-adjusted death rates for individuals between the ages of 25 and 64 were strongly related to education level for both men (at < 12 years, 821 per 100,000; at 12 years, 605; and at > 12 years, 249) and women (at < 12 years, 472; at 12 years, 352; and at >12 years, 165) (National Center for Health Statistics 2008). Similar levels of inequality are observed between income groups.
These inequalities in overall health and mortality are not only very common in modern times, but they have persisted at similar levels at least since the early nineteenth century...