Social Conditions as Fundamental Causes of Health Inequalities: Theory, Evidence, and Policy Implications

Journal of Health and Social Behavior - Tập 51 Số 1_suppl - Trang S28-S40 - 2010
Jo C. Phelan1, Bruce G. Link2, Parisa Tehranifar3
1Columbia University, [email protected]
2Columbia University/New York State Psychiatric Institute
3Columbia University

Tóm tắt

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.

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