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

Jo C. Phelan; Bruce G. Link; Parisa Tehranifar

doi:10.1177/0022146510383498

Social Conditions as Fundamental Causes of Health Inequalities

Theory, Evidence, and Policy Implications

¹Columbia University
²New York State Psychiatric Institute

Jo C. Phelan, Columbia University, Department of Sociomedical Sciences, 722 W. 168th Street, 16th floor, New York, NY 10032 E-mail: jcp13{at}columbia.edu

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.

Article Notes

Jo C. Phelan is professor of sociomedical sciences at the Mailman School of Public Health of Columbia University. Her research interests include social stigma, conceptions of mental illness, the impact of the “genetics revolution” on the stigma of mental illness, attitudes and beliefs relating to social inequality and its legitimation, and social inequalities in health and mortality. In collaboration with Bruce Link, she developed the argument that frames social conditions as fundamental causes of disease.
Bruce G. Link is professor of epidemiology and sociomedical sciences at the Mailman School of Public Health of Columbia University, and a Research Scientist at New York State Psychiatric Institute. His interests include the nature and consequences of stigma for people with mental illnesses, the connection between mental illnesses and violent behaviors, and explanations for associations between social conditions and morbidity and mortality.
Parisa Tehranifar is assistant professor of epidemiology at the Mailman School of Public Health of Columbia University. Her research combines social science and epidemiologic perspectives and methods to studies of social inequalities in cancer and other chronic disease risk.
This work was supported by a Young Investigator Award granted to Professor Tehranifar by the Lance Armstrong Foundation.