This paper examines how social factors — including socioeconomic status, gender, race, and environmental conditions — shape health and illness outcomes. Drawing on the biopsychosocial model as an alternative to the purely biomedical approach, the paper reviews research on psychological distress and subjective health, racial and environmental health disparities, and the gendered dimensions of morbidity and mortality. It also considers how feminist theory has contributed to understanding health inequalities and why upstream social interventions may be more effective than treating illness after the fact. The paper argues that social conditions not only independently affect health but amplify the impact of biological risk factors.
Socioeconomic inequalities in health have been observed persistently over the course of human history. These differences are manifest across individuals, communities, and societies, and recent analyses suggest that for the most part they have increased over the past century, and even in the past few decades. The nature and size of these inequalities make them arguably the major problem of population and public health in America and many other societies. Socioeconomic inequalities in health have increasingly become a focus of health policy. It is still not fully understood why socioeconomic inequalities in health exist and persist, nor which policies are most likely and necessary to reduce them. In seeking this understanding, research has increasingly focused on socioeconomic differentials in health at the level of communities and societies as well as at the level of the individual (Albrecht, Fitzpatrick, and Scrimshaw, 2003).
In contrast to the biomedical model, the biopsychosocial model views health as being determined by biological, psychological, and social factors. Adopting the biopsychosocial model does not mean rejecting the biomedical model entirely; rather, it acknowledges that the biomedical model alone does not lead to a complete understanding of health and illness. Although the role of biology will always be important in explaining illness, the biopsychosocial model demands that we also pay attention to psychological and social influences (Schneider, Gruman, and Coutts, 2005).
Over the last several decades, epidemiological studies have been enormously successful in identifying risk factors for major diseases. However, most of this research has focused on risk factors that are relatively proximal causes of disease — such as diet, cholesterol level, and exercise. Social factors, which tend to be more distal causes of disease, have received far less attention. Epidemiology has nonetheless been greatly successful in heightening public awareness of risk factors for disease (Link and Phelan, 1995).
In a study conducted by Koopmans and Lamers (2005), the aim was to compare three indicators of psychological distress (PD) on the strength of their association with subjective, or perceived, health and to analyze the extent to which these associations change after adjusting for physical illness measures and other possible confounding variables. Data were drawn from a community-based sample of adults. Psychological distress was measured using three different instruments: the Negative Affect Scale of Bradburn, a nervousness scale, and a self-reported depressive complaint measure. Physical illness was measured by seven specific chronic conditions, a co-morbidity index of 17 conditions, and two disability measures. Subjective health was assessed by a single question. Ordinary least squares and logistic regression, as well as structural equation modeling, were used to analyze the data.
The relationship between subjective health and PD was strongest when nervousness or negative affect was used as the indicator of PD. The measure of depressive complaints was less strongly, but still substantially, related to subjective health. After correction for physical illness variables, the change in the strength of association was smallest for depressive complaints and greatest for nervousness. Only small differences between negative affect and nervousness were found. These measures, which were more contaminated by physical ill-health than depressive complaints, showed the strongest association with subjective health both before and after correction for physical illness components (Koopmans and Lamers, 2005).
Negative affect and nervousness are reliable and valid indicators of PD that can be used to predict subjective health. However, for this purpose, a correction for the confounding effects of physical illness variables is necessary. The depressive complaints measure is not only less predictive of subjective health but also less contaminated by physical illness variables, making it a better indicator of PD when correction for physical illness variables is not possible (Koopmans and Lamers, 2005).
Differences exist across many health outcomes, including cancer, cardiovascular disease, diabetes, and mortality. Although there was a national decrease in disparities between 1990 and 1998, some regions reported an increase in disparities during the same period. Environmental circumstances are thought to play a very important role in producing and maintaining health differences. Minority neighborhoods tend to have elevated rates of mortality, morbidity, and health risk factors compared with predominantly white neighborhoods, even after accounting for economic and other characteristics (Gee and Payne-Sturges, 2004).
"Race, residential environment, and community stress framework"
"Feminist theory and gendered roles in morbidity patterns"
"Social determinants research and upstream health policy"
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