Main description:

This book assembles a wide range of explanatory perspectives on social inequalities in health. Everywhere in the world, those with less advantage die younger and suffer more illness than the wealthy. Decades of research have documented this reality and yet we lack a comprehensive understanding of the mechanisms through which social circumstances ultimately influence the biological processes that lead to disease. Explanations have been proposed from various disciplines - economics, psychology, behavioral science, geography, and neuroscience - and each sheds light on parts of the overall process. But very few texts assemble these insights into an overall explanatory paradigm.

Through a review of concepts and theories from a wide range of disciplines, the author outlines how these may be woven together to offer a more complete picture of how social influences 'get under the skin' to affect health and disease. As well as understanding individual health, the book assembles explanations for social disparities in health. It concludes with a proposal for a set of explanatory models that cross disciplinary boundaries. Topics explored include:

Social Inequalities in Health
Explanation and Causal Models for Social Epidemiology
Social and Economic Theories to Explain Patterns of Disease
Biological Pathways Linking Social Determinants to Health
Theoretical Models of Health Behavior
Work Environment and Health
Social Networks, Social Support and Health
Positive Influences on Health: Coping and Control
The Relationship Between Personality and Health

Understanding Health Determinants: Explanatory Theories for Social Epidemiology is a textbook for graduate students in epidemiology, health sciences, health policy, and psychology, as well as social science students who are studying health. It will also be of interest to general readers, and can serve as a reference for researchers in epidemiology and the health sciences who are planning studies of the social determinants of health. The book reviews theories that could be tested in such studies.

Contents:

1. Social Inequalities in Health. 23

Introduction: Background Concepts. 24

Conceptions of Health. 25

Concept Box: Health Capital 26

Population Health. 27

Conceptions of Social Position. 28

Concept Box: Max Weber and Social Class. 29

Concept Box: Health Inequalities and Inequities. 31

Concept Box: Moral Imperatives for Action on Inequalities. 32

Concept Box: Amartya Sen on Health Equity. 32

Concept Box: Gini Coefficient. 34

Scales of Analysis. 35

Social Mobility. 37

Global Patterns of Health (1): Rising Life Expectancy. 38

Historical Perspective: Epidemiologic Transitions. 42

Concept Box: The Evolution of Inequalities. 44

International Patterns of Health (2): Health Contrasts Between Nations. 46

The Uneven Gains in Life Expectancy. 47

Concept Box: Mortality Gini Curves. 48

National Patterns of Health (3): Health Inequalities Within Nations. 48

Social Class and Health. 49

Trends in Social Disparities in Health. 52

Socioeconomic Status and Health: The Whitehall Studies. 54

Income Inequality and Health. 55

Concept Box: Measuring Poverty, Relative and Absolute. 56

Further Investigations of the Income Inequality Hypothesis. 62

Critiques of the Income Inequality Hypothesis. 64

Conclusion. 65

Discussion Points. 66

References. 67

2. Explanation and Causal Models for Social Epidemiology. 78

The Challenge of Explanation. 79

Explanation and Understanding. 82

Concept Box: Erosion as a Metaphor. 83

Theories and Concepts. 84

Scales of Explanation. 86

Concept box: A Critique of Epidemiology. 87

Top-Down and Bottom-Up Explanations. 88

Idiographic and Nomothetic Science. 91

Concept Box: Structuralism.. 92

Systems Thinking. 92

Concept Box: Dissipative Structures. 94

Explanatory Models in Epidemiology. 95

The Epidemiologic Triad. 95

Explanation, Prediction and the Role of Time. 97

Binary Thinking. 99

Causality and Explanation. 100

Conceptions of Cause. 100

Causes and Determinants. 103

Concept Box: Functionalism.. 104

Concept Box: Fundamental Causes. 105

Counterfactuals, Potential Outcomes, and Causal Dilemmas. 105

Quantifying and Graphing Causal Influences. 107

Concept Box: Asymmetry in Causal Perceptions. 108

Concept Box: Determinants and Determinism.. 110

The Limits to Explanation: Entropy. 111

Concept Box: Income Entropy. 112

The Limits to Explanation: the Role of Chance. 112

Traditional Explanatory Approaches in Epidemiology. 114

Causal Chains. 114

Causal Webs. 115

INUS. 115

Rothman's Pies. 116

The Need for a Modified Conceptual Model 117

Potentially Useful Analytic Tools for Social Epidemiology. 118

Complexity and Emergent Phenomena. 118

Emergence. 119

Agent-Based Modeling. 119

Adaptive Systems. 120

Applying Complexity Thinking. 122

Autocatalytic Sets. 122

Chaos Theory. 125

Catastrophe Theory. 125

Sensitivity to Initial Conditions. 127

Fractals. 128

Attractors. 129

Interacting Causes. 130

Conclusion. 133

Discussion Points. 136

References. 137

3. Social and Economic Theories to Explain Patterns of Disease. 146

Explaining Patterns of Health and Longevity. 147

The Main Categories of Explanations for Social Disparities in Health. 149

Concept Box: Hard and Soft Explanations. 150

An Economic Perspective: Concavity and the Absolute Income Hypothesis. 151

Concept Box: Speed. 151

Historical Perspectives on the Interaction Between Wealth and Health. 154

Concept Box: The Origins of Inequalities. 154

The Links to Health. 156

Concept Box: Cumulative Advantage and the Matthew Effect. 157

Concept Box: Demographics and Economic Development. 157

The Scale of Analysis. 157

Social Mobility and Social Selection. 158

Concept Box: Status Passages. 159

Concept Box: Symbolic Violence. 161

Government Policies and Political Influences on Health. 165

Political Ideologies and Health. 165

Concept Box: Historicism.. 167

Neo-Materialism, Neo-Liberalism and Health Inequalities. 168

Concept Box: Post-Materialism.. 169

Neo-Liberalism.. 171

Globalization. 173

Critiques of Neo-Liberalism.. 174

Concept Box: Blaming the Victim.. 176

Poverty and Lack of Material Resources as Explanations for Social Inequalities in Health. 178

Theories of Poverty. 178

Structural Theories of Poverty. 179

Poverty Traps. 180

Culture of Poverty. 181

Poverty and Family Structure. 183

Migration. 184

Concept Box: Migration and Concentration of Disadvantage. 184

The Geography of Health. 186

Concept Box: Disease Ecology. 186

Concept Box: City Size. 187

Context and Composition. 189

The Modifiable Area Unit Problem.. 190

Concept Box: Relational Geography. 191

Concepts of Space and Place. 192

Concept Box: Therapeutic Landscapes. 193

Access to Nature. 194

Causal Direction and Interactions Between Health and Place. 195

Concept Box: Broken Windows. 196

Socioeconomic Status and Access to Care. 197

Concept Box: SES and the Differential Diffusion of Innovations. 197

A Health Literacy Gradient. 200

Relative Income and Psychosocial Explanations for Health Inequalities. 201

Concept Box: The Easterlin Paradox. 201

Theories Concerning Community Structures and Health. 202

Social Cohesion. 203

Social Capital 203

Concept Box: Bourdieu's Three Forms of Capital 204

Socioeconomic Status and Social Capital 205

Social Capital and Health. 206

Critiques of Social Capital 207

Concept Box: Membership Theory. 208

Collective Efficacy. 209

Community Empowerment. 210

Concept Box: Opportunity, Agency, and Empowerment. 211

Community Resilience. 212

Theories Relating to Psychosocial Processes Within the Community. 213

Motivation and Self-Determination Theory. 213

Variants of the P-E Fit model 215

Relative Deprivation. 217

Discrimination and Social Dominance Theory. 220

Ethnic Diversity. 221

Racial Inequalities. 223

Critical Race Theory. 224

Social Policy Interventions. 225

How Effective Are Policies that Address Income Inequalities?. 227

Discussion Points. 230

References. 232

4. Biological Pathways Linking Social Determinants to Health. 252

Introduction. 253

Brain Structure. 255

Limbic System.. 255

The Neocortex. 258

The Nervous System.. 259

Polyvagal Theory. 261

The Endocrine System.. 263

Types of Hormones. 264

Steroid Hormones. 264

Peptides and Oxytocin

Hormones and the Brain Reward System.. 267

Endocrine Pathways. 268

The Stress Response. 269

The SAM and HPA Systems. 269

The Immune System.. 271

Inflammation. 274

The Microbiome and Immunity. 274

Psychological States and Immune Function. 275

Socioeconomic Status and Chronic Inflammation. 277

Allostasis and Allostatic Load. 277

Biphasic Reactions and Hormesis. 279

Concept Box: The Yerkes-Dodson Law.. 280

Genetics and Epigenetics. 280

Genes. 281

Epigenetic Influences and Gene Regulation. 283

Concept Box: Fitness Landscapes. 287

Telomere Length. 287

Conceptions of Environmental Influence. 289

Plasticity. 290

Concept Box: Predictive Adaptation. 291

Concept Box: Kauffman's NK Model 293

Multiple, Interacting Systems. 296

Case Study: Differential Male and Female Longevity. 296

Conclusion: Embodiment. 299

Discussion Points. 302

References. 303

5. Health Determinants Cumulate over the Life Course. 318

The Life Course Perspective. 320

Concept Box: Slice of Life Studies. 321

Concept Box: The Exposome. 324

Socioeconomic Status and the Life Course. 326

Barker's Fetal Origins Hypothesis. 328

Developmental Origins of Health and Disease (DOHaD). 331

Programming Mechanisms in Sensitive Periods. 331

Concept Box: Experience Expectancy. 334

Concept Box: The Life Course Health Development Model 335

Adverse Childhood Experiences. 336

Concept Box: Developmental Analysis. 337

Health Effects of Adverse Child Events. 339

Prospective Evidence. 340

Socioeconomic Status and Childhood Adversities. 343

Mechanisms for the Influence of Life Course Experiences on Health. 345

Pathway I: Cognitive Development. 345

Pathway II: Psychological Reactions. 348

Concept Box: Ethnomethodology. 349

Concept Box: Intrinsic Motivation. 351

Personality Reactions. 352

Self-Confidence. 353

Attachment Theory. 353

Resilience. 355

Successful Aging. 356

Concept Box: Primary and Secondary Control 357

Pathway III: Adverse Child Experiences and Social Relationships. 358

The Role of Family Stability. 359

Parenting. 361

Concept Box: Parenting Styles. 361

Delay of Gratification: the Experiments of Walter Mischel 362

Concept Box: Socioeconomic Status and Vocabulary. 365

Stress Proliferation. 367

Reproductive Strategies. 368

Concept Box: r and K Reproductive Strategies. 369

Pathway IV: Behavioral Mechanisms. 370

Pathway V: Biological Processes. 371

Concept Box: Biological Embedding. 371

Brain Development. 372

Genetics and Epigenetic Processes. 374

Concept Box: Molecular Conduit Model 375

Endocrine Pathways. 376

Immune Pathways. 377

Telomere Length. 378

Potential Life Course Interventions. 378

Discussion Points. 381

References. 384

6. Theoretical Models of Health Behavior. 400

Health and Illness Behaviors. 401

Lifestyle Patterns and Social Class. 401

Risk Attributable to Behaviors. 402

Conceptual Approaches to Explaining Health Behavior. 403

Behavior as Choice. 404

Psychological Models: The Role of Cognition. 404

Subjective Expected Utility Theory. 406

Concept Box: Uncertainty and Belief. 406

Behavioral Economics. 407

Path Dependence and Health Behavior. 408

Concept Box: The Polya Urn Process. 408

Prospect Theory and Risk-Taking Behavior. 409

Behavior as Constrained by Circumstance and Life Chances. 411

Collective Behavior. 412

Cognitive Models of Behavior: Continuum and Stage. 413

Concept Box: Competence-Environment Press. 414

Continuum Models of Health Behavior. 414

Health Belief Model 414

Rogers Protection Motivation Theory. 417

Theory of Reasoned Action. 418

Theory of Planned Behavior. 420

Bandura Social Cognitive Theory and Self-Efficacy. 422

Limitations of the Cognitive Analyses of Behavior and Behavior Change. 424

Concept Box: Cognitive Biases and Health Behaviors. 424

Heuristics and Judging Probabilities. 425

A Dual Processing Behavioral Model 426

Stage Models of Health Behavior. 427

Stages of Change and the Transtheoretical Model 428

Precaution Adoption Process Model 432

Health Action Process Approach (HAPA) model 434

The Precede-Proceed Framework. 435

Taxonomies of Intervention Models: Changing Health Behaviors. 436

Concept Box: Intervention Mapping. 436

The Theoretical Domains Framework (TDF). 437

The Behavior Change Wheel 439

Discussion Points. 440

References. 442

7. Work Environment and Health. 457

Work as a Health Determinant. 458

Evolving Patterns of Work Through Time. 458

Job Security. 459

Concept Box: The Worksome. 459

The Benefits of Work. 460

Work-Life Balance. 461

Job Characteristics and Health. 462

Job Demand and Control Model 463

The Employment Strain Model 466

Effort-Reward Imbalance. 467

Concept Box: Procedural and Relational Injustice. 467

Concept Box: Status Control 469

The Job Demands-Resources Model 470

The RIASEC Theory of Vocational Choice. 473

Unemployment and Health. 475

Who Will Suffer Adverse Effects of Unemployment?. 477

Latent Deprivation Theory. 478

Fryer's Agency Restriction Model of Unemployment. 479

Warr's Vitamin Model of Unemployment. 479

Ezzy's Status Passage Model 482

Unemployment and Socioeconomic Status. 482

Discussion Points. 483

References. 484

8. Stress and Health. 494

Introduction: Stress and Health. 495

The Adverse Health Effects of Stress. 495

Concept Box: Enriched Environments. 497

Conceptual Models of Stress. 497

Stimulus Models: Stressful Life Events. 498

Critiques of the Stimulus Model 499

Response Models. 500

Harold Wolff. 501

Concept Box: Meaning Making. 501

Hans Selye. 502

Antonovsky's Resistance Resources. 503

Critiques of the Response Model 504

Interactional and Systems Models of Stress. 505

Lazarus & Folkman. 505

Toxic Stress. 509

Modeling the Time Dimension. 510

Weathering. 511

Problems with the Interactional Model 511

Measurement Challenges. 512

Concept Box: Measuring Life Events. 513

Applying Interactional Stress Models to Disease Risk. 514

Stress and Socioeconomic Status. 515

Interventions. 517

Discussion Points. 518

References. 521

9. Social Networks, Social Support and Health. 530

Introduction. 531

Concept Box: Social Baseline Theory. 531

Social Networks. 532

Social Support. 532

Evidence for the Impact of Social Relationships on Health. 533

Meta-Analyses. 533

Marriage. 535

Divorce. 535

Bereavement. 535

Paternal Absence. 536

Loneliness and Health. 537

Pets and Health. 537

Mechanisms of Influence: Theories Relating to Social Networks. 538

Network Analysis. 538

Scale-Free Networks. 540

Network Density and Redundancy. 540

Concept Box: Homophily. 541

Information Networks. 542

Network Reciprocity. 542

Concept Box: The Helper-Therapy Principle. 543

Concept Box: Identity Accumulation. 543

Network Pressure. 543

Concept Box: Social Control Theory. 544

Space, Place and Networks. 544

Social Networks, and Social Support. 545

Social Supports: Conceptual Approaches. 545

Mechanisms of Influence: Theories Relating to Social Supports. 546

Perceived Versus Received Support. 546

Concept Box: What Makes an Interaction Supportive?. 548

Attachment Theory. 548

Disordered Attachment. 548

Unconditional Benefits of Support. 549

Interpersonal Theory. 549

Appraisal Function of Support. 550

Measuring Supportiveness. 550

The Potential for Negative Influences of Social Relationships. 550

Disrespect. 551

Rejection. 552

Mechanisms of Influence: Biological Mediators. 552

Summary: The Benefits of Social Connections. 554

Discussion Points. 556

References. 557

10. Positive Influences on Health: Coping and Control 566

Conceptions of Coping. 567

Physiological Responses and Allostasis. 569

Taxonomies of Coping Responses. 570

Coping Repertoires. 573

Concept Box: Ashby and the Variety of Responses. 573

A Conceptual Model of the Coping Process. 574

Two Major Coping Strategies and their Effectiveness. 578

Sense of Humor and Laughter. 578

Physiological Effects of Laughter and Humor. 580

Aphorisms. 582

Concept Box: Empiricism and Transcendentalism.. 583

The Impact of Religion on Health. 584

Mechanisms of Influence. 587

Concept Box: Uncertainty-Identity Theory. 588

Theories to Explain Coping Capacity. 590

Psychosocial Resources. 590

Mastery and the Sense of Control 591

Conservation of Resources Theory. 592

Salutogenesis and the Sense of Coherence. 593

Positive Emotions: the Broaden and Build Theory. 595

Community Coping and Resiliency. 596

Discussion Points. 597

References. 599

11. Mental Processes and Health: the Mind-Body Connection. 614

Introduction. 615

Conceptions of Mind and the Mind-Body Connection. 615

Cognition and the Mind. 617

Concept Box: Groundlessness. 617

Embodiment in Epidemiology. 618

Cognitive Embodiment. 618

Emotional Embodiment. 619

Social Embodiment. 620

The Placebo Response. 620

How May Placebos Work?. 622

How Powerful Is the Placebo Response?. 623

Which Types of People Respond to a Placebo?. 624

Other Theoretical Perspectives on the Mind-Body Link. 625

Psychoneuroimmunology. 625

Psychosomatics. 625

Psychoanalysts. 626

Concept Box: Meaning in Life. 626

Intelligence. 627

Discussion Points. 628

References. 630

12. The Relationship Between Personality and Health. 636

Personality. 637

Personality and Health. 637

Fundamental Attribution Error. 638

Theories of Personality. 639

The Big Five Model 639

Concept Box: The Healthy Adherer Effect. 641

Two and Three Trait Models. 641

The HEXACO Personality Model 641

The Hot and Cool Framework of Emotions. 642

The Alphabet Soup of Personality: Types A, B, C, and D.. 643

Type A Personality and Behavior. 643

Anger, Hostility and Aggression. 644

Type C, or Cancer-Prone Personality. 646

The Type D, Distressed Personality. 647

Culture, the Personality of Groups. 647

Conceptual Links Between Personality and Health. 650

Positive Personality Traits and Health. 650

Happiness and Positive Well-Being. 650

Hopefulness and Optimism.. 651

Personality and Coping Styles. 652

Locus of Control 653

Mastery. 654

Resilience and Vulnerability. 654

Concept Box: Emotional and Social Intelligence. 655

Concept Box: Stress Inoculation. 655

Hardiness. 656

Mental Toughness. 657

Reserve Capacity. 657

Negative Personality Concepts Linked to Health. 658

Powerlessness and Learned Helplessness. 658

Denial 659

Personality and Socioeconomic Status. 660

Discussion Points. 662

References. 665

13. Overall Model for Social Determinants and Health. 677

Models. 679

Income Inequalities. 679

Political Influences. 680

The Work Environment. 681

The Role of Education. 683

Intergenerational Transmission of Adversity. 684

Life Course Influences. 687

Conclusion. 689

References 692