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

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.

Sex and Race Differences in the Utilization and Outcomes of Coronary Artery Bypass Grafting Among Medicare Beneficiaries, 1999–2014

“…In contrast to sex differences, previous studies have suggested that biological differences between racial groups contribute little to the differences in outcomes, which are driven largely by differences in socioeconomic well‐being and quality of care at hospitals where black patients seek care 6, 26, 27, 28, 29, 30, 31, 32. The continued high post‐CABG mortality in black patients merits further investments in targeting hospital‐level quality improvement interventions, as well as in strengthening systems for transitions of care outside the hospital and developing community support interventions that support this unique sociocultural group.…”

Barriers to outdoor physical activity and unmet physical activity need in older adults

“…It has been argued that people who possess the most resources, such as knowledge, money and social connections, and have the best capacity to utilize them in a flexible manner, have the best prerequisites for preventing risks and thus avoiding adverse health outcomes, such as diseases or disabilities (Phelan, Link & Tehranifar 2010). People with more resources also have a wider range of choices they can select from in order to adapt to risks (Satariano 2006).…”

Exploring inequities in child welfare and child protection services: Explaining the ‘inverse intervention law’

“…These factors are seen as either having a direct material impact on the capacity of families to offer children a good developmental experience or as indirectly causing stresses that affect parents' ability to function effectively. Detrimental consequences of stress, such as excessive alcohol or substance use, exposure to intimate partner violence or poor mental health, can be seen as secondary to fundamental causes (Bywaters, 2015a;Phelan et al, 2010). In some cases such structural difficulties cross generations increasing the likelihood of a range of behavioural and health factors damaging to family life.…”