A Social History of Disease: Contextualizing the Rise and Fall of Social Inequalities in Cause-Specific Mortality
A Social History of Disease: Contextualizing the Rise and Fall of Social Inequalities in Cause-Specific Mortality
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DOI：
10.1007/s13524-016-0495-5
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发表时间：
2016-10-01
期刊：
影响因子：
3.5
通讯作者：
Link, Bruce G.
中科院分区：
文献类型：
--
作者：
Clouston, Sean A. P.;Rubin, Marcie S.;Link, Bruce G.
基本原因理论认为，健康方面的社会不平等是由于获得灵活资源的不平等而产生的，包括知识、金钱、权力、声望和有益的社会关系，这些资源使人们能够避免风险因素并采取与特定地点相关的保护性因素。在这项研究中，我们认为疾病也应该被置于时间背景中。我们将疾病描述为在给定时间经历四个阶段的转变：（1）自然死亡，其特征是对人群中某种疾病的危险因素、预防或治疗不了解； (2) 产生不平等，其特点是创新传播不平等； (3) 减少不平等，其特点是增加获得健康知识的机会； (4) 降低死亡率/消除疾病，其特点是广泛预防和有效治疗。为了说明这一点，我们将理想类型分析与死亡率数据配对，以探索假设的疾病发病率。尽管许多疾病的发病率存在社会不平等，但不平等的原因、程度和方向会随着人为干预而系统性地发生变化。本文强调了进一步发展的机会，特别强调了阶段持续时间在维持特定原因死亡率的社会不平等方面的作用。
Fundamental cause theory posits that social inequalities in health arise because of unequal access to flexible resources, including knowledge, money, power, prestige, and beneficial social connections, which allow people to avoid risk factors and adopt protective factors relevant in a particular place. In this study, we posit that diseases should also be put into temporal context. We characterize diseases as transitioning through four stages at a given time: (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 access to health knowledge; and (4) reduced mortality/disease elimination, characterized by widely available prevention and effective treatment. For illustration, we pair an ideal-types analysis with mortality data to explore hypothesized incidence rates of diseases. Although social inequalities exist in incidence rates of many diseases, the cause, extent, and direction of inequalities change systematically in relation to human intervention. This article highlights opportunities for further development, specifically highlighting the role of stage duration in maintaining social inequalities in cause-specific mortality.