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“Fundamental Causes” of Social Inequalities in Mortality: A Test of the Theory
Journal article   Open access   Peer reviewed

“Fundamental Causes” of Social Inequalities in Mortality: A Test of the Theory

Jo C. Phelan, Bruce G. Link, Ana Diez-Roux, Ichiro Kawachi and Bruce Levin
Journal of health and social behavior, v 45(3)
Sep 2004
DOI: https://doi.org/10.1177/002214650404500303
PMID: 15595507
Featured in Collection :   UN Sustainable Development Goals @ Drexel
url
http://nrs.harvard.edu/urn-3:HUL.InstRepos:41288128View
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Abstract

Medicine and epidemiology currently dominate the study of the strong association between socioeconomic status and mortality. Socioeconomic status typically is viewed as a causally irrelevant “confounding variable” or as a less critical variable marking only the beginning of a causal chain in which intervening risk factors are given prominence. Yet the association between socioeconomic status and mortality has persisted despite radical changes in the diseases and risk factors that are presumed to explain it. This suggests that the effect of socioeconomic status on mortality essentially cannot be understood by reductive explanations that focus on current mechanisms. Accordingly, Link and Phelan (1995) proposed that socioeconomic status is a “fundamental cause” of mortality disparities—that socioeconomic disparities endure despite changing mechanisms because socioeconomic status 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. We identified a situation in which resources should be less helpful in prolonging life, and derived the following prediction from the theory: For less preventable causes of death (for which we know little about prevention or treatment), socioeconomic status will be less strongly associated with mortality than for more preventable causes. We tested this hypothesis with the National Longitudinal Mortality Study, which followed Current Population Survey respondents (N = 370,930) for mortality for nine years. Our hypothesis was supported, lending support to the theory of fundamental causes and more generally to the importance of a sociological approach to the study of socio-economic disparities in mortality.

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566 citations in Web of Science
632 citations in Scopus

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UN Sustainable Development Goals (SDGs)

This publication has contributed to the advancement of the following goals:

#3 Good Health and Well-Being
#10 Reduced Inequalities

InCites Highlights

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Collaboration types
Domestic collaboration
Web of Science research areas
Psychology, Social
Public, Environmental & Occupational Health
Social Sciences, Biomedical
Sociology
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