Social conditions as “fundamental causes” of health inequalities: New theoretical and empirical developments

We are pleased to invite you to:

The Institute of Health and Wellbeing Maurice Bloch Annual Lecture Series 2015/16

Title: Social conditions as 'fundamental causes' of health inequalities: New theoretical and empirical developments

Presenter: Professor Jo Phelan

Date: 6 June 2016

Time: 1pm lunch will be served 30mins beforehand

Venue: Yudowitz Lecture Theatre, Wolfson Medical School.

Chair: Professor Carol Tannahill

Abstract:

In 1995, Link and Phelan 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 seminar, I will briefly explicate the original theory, review key empirical findings from the US and Europe, and discuss two recent theoretical extensions. The first considers whether social conditions other than SES, such as racism and stigma, may also serve as fundamental causes of health inequalities. The second proposes an explanation of how mechanisms linking social factors to disease replace one another over time. Clouston and colleagues characterize diseases as having the potential to transition through four stages: 1) natural mortality, characterized by no knowledge about risk factors, preventions, or treatments for a disease in a population; 2) producing inequalities, characterized by unequal diffusion of innovations; 3) reducing inequalities, characterized by increased and broader access to health knowledge; and 4) reduced mortality/disease elimination, characterized by widely available prevention and effective treatment. It is proposed that the cycling of specific diseases through these stages results in the observed pattern of persistent socioeconomic inequalities in overall mortality over time that gave rise to fundamental cause theory.

Biography

Past Research: Professor Phelan has addressed inequalities in physical and mental health; particularly those based on socioeconomic status, gender, and stigmatized statuses such as homelessness and mental illness. Her work locates the creation and perpetuation of inequalities in the interplay between social structural, cultural and social psychological processes. Phelan's contributions include calling attention to the biases introduced by the 'point-prevalence' method of estimating the homeless population’s size and characteristics and, in an analysis published in the American Sociological Review, exploring the well established and longstanding association between level of formal education and political liberalism and tolerance. In that work, she provided empirical evidence to critique the dominant theory that education increases tolerance through a process of fundamental personality change, providing support for "socialization" theory-based explanations, in which educational institutions shape attitudes to conform to the prevailing "official" or "ideal" culture. Her work illuminates how education and, by extension, social environments in general, shape political attitudes—which is relevant not just to the issue of homelessness but more broadly to other social inequalities, including those based on socioeconomic status, race, ethnicity and gender.

Present Research: Phelan's current work focuses on 1) stigma and mental illness, 2) social consequences of the genetics revolution, and (with Bruce Link) 3) socioeconomic status as a "fundamental cause" of inequalities in mortality. Phelan’s scholarship (with Link) on attitudes toward mental illness, published in the Annual Review of Sociology, analyzes stigma as a process encompassing prejudice and discrimination, and fundamentally based in socially-structured power hierarchies. Her use of advances in understanding stigma and mental illness to inform our understanding of the social psychological aspects of other socially significant inequalities, including those based on race, ethnicity, gender and sexual orientation, has made Phelan internationally recognized as one of the leading scholars in the area of mental-illness stigma. Phelan is also one of the few scholars to explore the sociological implications of the Human Genome Project. Her NIH-funded program of research exploring the impact of the genetics revolution on the stigma attached to serious mental illnesses has found that genetic attributions increased the perceived seriousness and persistence of mental illness as well as the belief a mentally-ill individual’s siblings and children are likely to develop the same problem, suggesting that the Human Genome Project does bear with it the possibility of spreading stigma to biological relatives of stigmatized individuals. Phelan’s new NIH-funded study explores the information and ideas that the media are disseminating to the public and analyzes public understanding and response to that information, expanding her work to other stigmatized statuses that are also very likely to be influenced by changing knowledge and beliefs about genetics, such as obesity, cancers and minority racial status. The third area of Phelan’s work, supported by a prestigious Investigator Award from the Robert Wood Johnson Foundation, is her widely cited collaborative research (with Link) on fundamental causes of mortality, which has both conceptualized the paths through which socioeconomic inequality creates mortality differentials and developed a body of supporting empirical work to substantiate their arguments.

Future Research: Phelan's future work on the potential impact of the genetics revolution, social conditions as fundamental causes of inequalities in mortality, and stigma includes two specific projects already underway. With support from NIMH, her study on public understandings of 'genetic risk' combines qualitative and quantitative methods and a well-developed body of theory (expectation states theory) to explore in greater depth how people understand genetic risk and how accurate information about risk can best be communicated to people. Second, she and Link will continue their work on the mechanisms through which socioeconomic inequality creates mortality differentials, exploring the proposition that one key element of this relation is that advances in knowledge about the prevention and/or treatment of the disease create mortality advantage for high-SES individuals.