Fundamental Causality: Challenges of an Animating Concept for Medical Sociology

Disparities in self-rated health across generations and through the life course

“…Third, as argued by fundamental cause theory resources of knowledge, money power, prestige and beneficial social connections dynamically shape health by allowing better positioned people to avoid risks and adopt protective strategies even as such factors change over time (Link and Phelan, 1995; Phelan et al, 2010). Finally and also consistent with fundamental cause theory (Link and Phelan, 2010; Freese and Lutfe, 2011), access to socioeconomic related resources confers potential advantage through contextual influences on health such as through neighborhood and work environments that are on average less noxious in better resourced contexts (Williams and Collins, 2001; Sharkey and Faber, 2014). With respect to racial disparities, socioeconomic pathways like these are expected to account for some but not all of the health differences between Blacks and Whites in the United States because of socioeconomic inequalities between the two groups (Phelan and Link, 2015).…”

“…When socioeconomic inequality is reproduced across generations and over the life course health inequalities are reproduced as well. Such a conclusion is consistent with explanations indicating that low SES confers adversity and stress that wears on individuals over time thereby influencing their health outcomes in adult life (Ben-Shlomo and Kuh, 2002; Hatch, 2005; Pearlin et al, 2005), with “health lifestyle” that posits strong social shaping of risk and protective factors (Cockerham, 2005) or with explanations that focus on SES-related “flexible” resources (knowledge, money, power, prestige and beneficial social connections) that either individually or collectively shape exposure to risks and influence the adoption of protective factors (Phelan et al, 2010; Freese and Lutfey, 2011). As such, the findings support the conclusion that SES and race inequalities in health are in some large part reproduced over the life course and across generations through the reproduction of SES inequalities and the differences in resources and adversity that such inequalities put in place.…”

Impact of area regeneration policies: performing integral interventions, changing opportunity structures and reducing health inequalities

“…The FCT scheme suggests four ‘meta-mechanism’ to differentiate between ways in which a set of specific mechanisms can emerge and contribute to reproducing the relationship between socioeconomic conditions and health. These four meta-mechanisms are: access to means , spill-overs , socially structured individual health preferences and institutional agency 29. The first one refers to systematic differences according to socioeconomic conditions in the access to means at individual and contextual level.…”

“…This meta-mechanism highlights the active and dynamic functions of institutions 29. For example, institutions such as the healthcare system, social services and the education system can also contribute to preserving (or mitigating) health inequalities through the way they interact with or treat individuals depending on their socioeconomic circumstances, gender, ethnicity, age, etc.…”

Network Effects and Social Inequality

“…In a review of research on health, Pampel, Krueger & Denney (2010) state "given that high--SES persons adopt healthy behaviors and associate with other high--SES persons, their networks of soc--ial support, influence and engagement promote health and widen disparities." Similarly, Freese & Lutfey (2011) suggest that network effects may contribute to the greater capacity of high--income people to exploit advances in medical science, causing such advances to widen rather than reduce inequality in health outcomes. Gamoran (2011:112) concludes from a review of the literature on school tracking (a form of induced homophily) that "tracking tends to have no effect on overall academic performance or productivity, but it tends to widen the dispersion of achievement, that is, it increases inequality…" Sociologists are not alone in these intuitions: In a review of work in economics on social interactions, Durlauf & Ioannides (2010:459) assert that "endogenous social interactions help amplify differences in the average group behavior.…”