Understanding Health Determinants: Explanatory Theories for Social Epidemiology

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.

Preface

It is universally recognized that health and illness are unevenly distributed, both within and between countries. Studies across the world show a consistent gradient of improving health and longevity with increasing wealth. This consistency proves it is not a random occurrence, so it invites explanation. And, given the right to life, systematic health inequities also demand moral condemnation and corrective action. Innumerable empirical studies have described these realities, but many fewer offer theoretical reviews that explain how and why health inequalities arise; nor do they indicate the appropriate interventions [1–3]. In part this is due to a separation between researchers in the biological sciences who study the mechanisms of disease and those in the social sciences who study its context [4]. To some extent, epidemiologists have drawn these perspectives together, but too often without proposing interpretive explanations based on theory. Meanwhile, the social sciences have rich histories of theorizing, so it would seem a step forward to incorporate their insights into descriptive epidemiological studies, to enhance the interpretation of empirical findings and to guide interventions. This book accordingly reviews a selection of concepts and theories drawn from the social and biological sciences that have been, or at least could be, applied in interpreting epidemiological data on the social determinants of health. The major sources are sociology, psychology, economics, geography, and biology.

The presentation opens with an introductory chapter that outlines the evidence for social inequalities in health. This has long formed the core focus of social epidemiology [5], but here serves merely as a starting point, to outline the phenomenon to be explained. Chapter 2 then reviews concepts relevant to the process of explanation itself. Chapter 3 reviews theories and concepts drawn from sociology and economics that address the origins of health disparities between social groups. Chapter 4 steps sideways to review biological mechanisms through which social circumstances could plausibly influence disease processes – how circumstances ‘get under the skin.’ These mechanisms are frequently cited in the subsequent chapters. Chapter 5 reviews the life course perspective on health, illustrating the lasting impact of early life experiences on a person’s health through the remainder of their life. Chapter 6 reviews theories of health behaviors, as these form important pathways

between social circumstances and health. Chapter 7 surveys conceptual models of how the work environment influences health; this alludes to concepts of stress that are then covered in more detail in Chap. 8. The next four chapters change direction and address positive influences on health. Chapter 9 reviews explanations for how social networks and supports promote the health of individuals and groups, and Chap. 10 covers coping responses and personal resiliency. Chapter 11 draws some of these threads together through a review of the connections between mind and body, while Chap. 12 reviews theories concerning how personality may influence behaviors and health. Chapter 13 assembles concepts and theories from the preceding chapters into a set of conceptual models that illustrate overall mechanisms through which social circumstances may affect health.

The scope of such a review is clearly ambitious – perhaps naïvely so – but hopefully not pretentious. In a single volume, it is only possible to provide a brief overview of theories that merit more detailed discussion. And yet, it seems worthwhile to assemble in one place brief introductions to a broad range of explanatory concepts; I have included extensive references to primary sources to enable readers to review these in greater depth. Naturally, this is one person’s selection of the material to include, and I apologize in advance to readers whose favorite theory has been omitted. The manuscript had to be severely trimmed to complete this project and many interesting theories were set aside. I would be happy to receive suggestions for other worthy topics to include.

Table of contents :

Preface
References
Acknowledgments
Contents
List of Figures
List of Tables
About the Author
Chapter 1: Social Inequalities in Health
Introduction: Background Concepts
Conceptions of Health
Population Health
Conceptions of Social Position
Health Inequalities
Measuring Social Inequalities
Scales of Analysis
Social Mobility
Global Patterns of Health (1): Rising Life Expectancy
Historical Perspective: Epidemiologic Transitions
International Patterns of Health (2): Health Contrasts Between Nations
The Uneven Gains in Life Expectancy
National Patterns of Health (3): Health Inequalities Within Nations
Social Class and Health
Trends in Social Disparities in Health
Socioeconomic Status and Health: The Whitehall Studies
Income Inequality and Health
Further Investigations of the Income Inequality Hypothesis
Critiques of the Income Inequality Hypothesis
Conclusion
Discussion Points
References
Chapter 2: Explanation and Causal Models for Social Epidemiology
The Challenge of Explanation
Explanation and Understanding
Theories and Concepts
Scales of Explanation
Top-Down and Bottom-Up Explanations
Idiographic and Nomothetic Science
Systems Thinking
Explanatory Models in Epidemiology
The Epidemiologic Triad
Explanation, Prediction and the Role of Time
Binary Thinking
Causality and Explanation
Conceptions of Cause
Causes and Determinants
Counterfactuals, Potential Outcomes, and Causal Dilemmas
Quantifying and Graphing Causal Influences
Social Determinants
The Limits to Explanation: Entropy
The Limits to Explanation: The Role of Chance
Traditional Explanatory Approaches in Epidemiology
Causal Chains
Causal Webs
INUS
Rothman’s Pies
The Need for a Modified Conceptual Model
Potentially Useful Analytic Tools for Social Epidemiology
Complexity and Emergent Phenomena
Emergence
Agent-Based Modeling
Adaptive Systems
Applying Complexity Thinking
Autocatalytic Sets
Chaos Theory
Catastrophe Theory
Sensitivity to Initial Conditions
Fractals
Attractors
Interacting Causes
Conclusion
Discussion Points
References
Chapter 3: Social and Economic Theories to Explain Patterns of Disease
Explaining Patterns of Health and Longevity
The Main Categories of Explanations for Social Disparities in Health
An Economic Perspective: Concavity and the Absolute Income Hypothesis
Historical Perspectives on the Interaction Between Wealth and Health
The Links to Health
The Scale of Analysis
Social Mobility and Social Selection
Government Policies and Political Influences on Health
Political Ideologies and Health
Neo-materialism, Neoliberalism, and Health Inequalities
Neoliberalism
Globalization
Critiques of Neoliberalism
Poverty and Lack of Material Resources as Explanations for Social Inequalities in Health
Theories of Poverty
Structural Theories of Poverty
Poverty Traps
Culture of Poverty
Poverty and Family Structure
Migration
The Geography of Health
Methodological Problems in Geographic Analyses
The Modifiable Area Unit Problem
Context and Composition
Concepts of Space and Place
Access to Nature
Causal Direction and Interactions Between Health and Place
Access to Care and Socioeconomic Status
A Health Literacy Gradient
Relative Income and Psychosocial Explanations for Health Inequalities
Theories Concerning Community Structures and Health
Social Cohesion
Social Capital
Socioeconomic Status and Social Capital
Social Capital and Health
Critiques of Social Capital
Collective Efficacy
Community Empowerment
Community Resilience
Theories Relating to Psychosocial Processes Within the Community
Motivation and Self-Determination Theory
Person–Environment Fit
Variants of the P-E Fit Model
Relative Deprivation
Social Exclusion
Discrimination and Social Dominance Theory
Ethnic Diversity
Racial Inequalities
Critical Race Theory
Social Policy Interventions
How Effective Are Policies That Address Income Inequalities?
Discussion Points
References
Chapter 4: Biological Pathways Linking Social Determinants to Health
Introduction
Brain Structure
Limbic System
The Neocortex
The Nervous System
Polyvagal Theory
System Integrity
The Endocrine System
Types of Hormones
Steroid Hormones
Peptides and Oxytocin
Hormones and the Brain Reward System
Information Pathways
The Stress Response
The SAM and HPA Systems
The Immune System
Inflammation
The Microbiome and Immunity
Psychological States and Immune Function
Socioeconomic Status and Chronic Inflammation
Allostasis and Allostatic Load
Biphasic Reactions and Hormesis
Genetics and Epigenetics
Genes
Epigenetic Influences and Gene Regulation
Telomere Length
Conceptions of Environmental Influence
Plasticity
Multiple, Interacting Systems
Case Study: Differential Male and Female Longevity
Conclusion: Embodiment
Discussion Points
References
Chapter 5: Health Determinants Cumulate Over the Life Course
The Life Course Perspective
Socioeconomic Status and the Life Course
Barker’s Fetal Origins Hypothesis
Developmental Origins of Health and Disease (DOHaD)
Programming Mechanisms in Sensitive Periods
Adverse Childhood Experiences
Health Effects of Adverse Child Events
Prospective Evidence
Socioeconomic Status and Childhood Adversities
Mechanisms for the Influence of Life Course Experiences on Health
Pathway I: Cognitive Development
Pathway II: Psychological Reactions
Personality Reactions
Self-Confidence
Attachment Theory
Resilience
Successful Aging
Pathway III: Adverse Child Experiences and Social Relationships
The Role of Family Stability
Parenting
Delay of Gratification: The Experiments of Walter Mischel
Socioeconomic Status and Parenting Styles
Reproductive Strategies
Pathway IV: Behavioral Mechanisms
Pathway V: Biological Processes
Brain Development
Genetics and Epigenetic Processes
Endocrine Pathways
Immune Pathways
Telomere Length
Potential Life Course Interventions
Discussion Points
References
Chapter 6: Theoretical Models of Health Behavior
Health and Illness Behaviors
Lifestyle Patterns and Social Class
Risk Attributable to Behaviors
Conceptual Approaches to Explaining Health Behavior
Behavior as Choice
Psychological Models: The Role of Cognition
Subjective Expected Utility Theory
Behavioral Economics
Path Dependence and Health Behavior
Prospect Theory and Risk-Taking Behavior
Behavior as Constrained by Circumstance and Life Chances
Collective Behavior
Cognitive Models of Behavior: Continuum and Stage
Continuum Models of Health Behavior
Health Belief Model
Rogers Protection Motivation Theory
Theory of Reasoned Action
Theory of Planned Behavior
Albert Bandura: Social Cognitive Theory and Self-Efficacy
Limitations of the Cognitive Analyses of Behavior and Behavior Change
Heuristics and Judging Probabilities
A Dual Processing Behavioral Model
Stage Models of Health Behavior
Stages of Change and the Transtheoretical Model
Precaution Adoption Process Model
Health Action Process Approach (HAPA) Model
The Precede-Proceed Framework
Taxonomies of Intervention Models: Changing Health Behaviors
The Theoretical Domains Framework (TDF)
The Behavior Change Wheel
Discussion Points
References
Chapter 7: Work Environment and Health
Work as a Health Determinant
Evolving Patterns of Work Through Time
Job Security
The Benefits of Work
Work-Life Balance
Job Characteristics and Health
Job Demand and Control Model
The Employment Strain Model
Effort-Reward Imbalance
The Job Demands-Resources Model
The RIASEC Theory of Vocational Choice
Unemployment and Health
Who Will Suffer Adverse Effects of Unemployment?
Latent Deprivation Theory
Fryer’s Agency Restriction Model of Unemployment
Warr’s Vitamin Model of Unemployment
Paul and Moser’s Incongruence Theory
Ezzy’s Status Passage Model
Unemployment and Socioeconomic Status
Discussion Points
References
Chapter 8: Stress and Health
Introduction: Stress and Health
The Adverse Health Effects of Chronic Stress
Conceptual Models of Stress
Stimulus Models: Stressful Life Events
Critiques of the Stimulus Model
Response Models
Harold Wolff
Hans Selye
Antonovsky’s Resistance Resources
Critiques of the Response Model
Interactional and Systems Models of Stress
Lazarus and Folkman
Vulnerability, Resiliency, and Stress Diathesis
Toxic Stress
Modeling the Time Dimension
Weathering
Problems with the Interactional Model
Measurement Challenges
Applying Interactional Stress Models to Disease Risk
Stress and Socioeconomic Status
Interventions
Discussion Points
References
Chapter 9: Social Networks, Social Support, and Health
Introduction
Social Networks
Social Support
Evidence for the Impact of Social Relationships on Health
Marriage
Divorce
Bereavement
Paternal Absence
Loneliness and Health
Pets and Health
Mechanisms of Influence: Theories Relating to Social Networks
Network Analysis
Scale-Free Networks
Network Density and Redundancy
Information Networks
Network Reciprocity
Network Pressure
Space, Place, and Networks
Social Networks and Social Support
Social Supports: Conceptual Approaches
Mechanisms of Influence: Theories Relating to Social Supports
Perceived Versus Received Support
Attachment Theory
Disordered Attachment
Unconditional Benefits of Support
Interpersonal Theory
Appraisal Function of Support
Measuring Supportiveness
The Potential for Negative Influences of Social Relationships
Disrespect
Rejection
Mechanisms of Influence: Biological Mediators
Summary: The Benefits of Social Connections
Discussion Points
References
Chapter 10: Positive Influences on Health: Coping and Control
Conceptions of Coping
Physiological Responses and Allostasis
Taxonomies of Coping Responses
Personal Coping Repertoires
A Conceptual Model of the Coping Process
Two Major Coping Strategies and Their Effectiveness
Sense of Humor and Laughter
Physiological Effects of Laughter and Humor
Aphorisms
Religious and Spiritual Beliefs
The Impact of Religion on Health
Mechanisms of Influence
Physiological Pathways
Meaning and Purpose in Life
Theories to Explain Coping Capacity
Psychosocial Resources
Mastery and the Sense of Control
Conservation of Resources Theory
Salutogenesis and the Sense of Coherence
Positive Emotions: Broaden and Build Theory
Community Coping and Resiliency
Discussion Points
References
Chapter 11: Mental Processes and Health: The Mind-Body Connection
Introduction
Conceptions of Mind and of the Mind-Body Connection
Cognition and the Mind
Embodiment in Epidemiology
Cognitive Embodiment
Emotional Embodiment
Social Embodiment
The Placebo Response
How May Placebos Work?
How Powerful Is the Placebo Response?
Which Types of Person Respond to a Placebo?
Additional Theoretical Perspectives on the Mind-Body Link
Psychoneuroimmunology
Psychosomatics
Psychoanalysts
Intelligence
Discussion Points
References
Chapter 12: The Relationship Between Personality and Health
Personality
Personality and Health
Fundamental Attribution Error
Theories of Personality
The Big Five Model
Two and Three Trait Models
The HEXACO Personality Model
The Hot and Cool Framework of Emotions
The Alphabet Soup of Personality: Types A, B, C, and D
Type A Personality and Behavior
Anger, Hostility, and Aggression
Type C, or Cancer-Prone Personality
The Type D, Distressed Personality
Culture, or the Personality of Groups
Conceptual Links Between Personality and Health
Positive Personality Traits and Health
Happiness and Positive Well-Being
Hopefulness and Optimism
Personality and Coping Styles
Self-Concept, Self-Esteem, and Self-Efficacy
Locus of Control
Mastery
Resilience and Vulnerability
Hardiness
Mental Toughness
Reserve Capacity
Negative Personality Concepts Linked to Health
Powerlessness and Learned Helplessness
Denial
Personality and Socioeconomic Status
Discussion Points
References
Chapter 13: Overall Models for the Influence of Social Determinants on Health
Introduction
Models
Income Inequalities
Political Influences
The Work Environment
The Role of Education
Intergenerational Transmission of Adversity
Life Course Influences
Conclusion
References
Index