[Social disparities in morbidity and mortality: what are the causes?].
In Germany, as in many other western industrialized nations, a paradoxical trend can be observed: On the one hand, life expectancy continues to rise and both prevalence and incidence rates decrease for many groups of diagnoses. On the other hand, social disparities in morbidity and mortality are becoming more pronounced. This review's aim is to introduce a teaching framework concerning initial conditions and related factors of this "social gradient" on the basis of a critical synopsis of the current state of the relevant research and discussions, taking into account aspects of material inequality as well as social differences in the distribution of working and living conditions. In addition, the role of cultural capital and the relationship between social background and lifestyle will be described in detail. Finally, psychosocial and biological determining factors as well as potential selective processes are also considered in our model. The growing gap of social inequalities in health and life expectancy is a potential source of social conflicts. The "teaching framework model of the social gradient of morbidity and mortality" that is presented in this article helps to minimize explanatory deficits and will present clinicians with new ideas about the multifactorial origin of global and specific morbidity as well as important new perspectives for future preventative policies.
Schneider
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Mannheimer Institut für Public Health, Sozial- und Präventivmedizin, Medizinische Fakultät Mannheim der Universität Heidelberg, Ludolf-Krehl-Strasse 7 - 11, 68167 Mannheim. sven.schneider@medma.uni-heidelberg.de
D003695:Delivery of Health Care / Q000592:standards*; D005858:Germany / Q000453:epidemiology; D006304:Health Status; D006801:Humans; D008017:Life Expectancy / Q000639:trends; D008019:Life Style; D009017:Morbidity / Q000639:trends*; D009026:Mortality / Q000639:trends*; D009784:Occupational Diseases / Q000453:epidemiology; D011322:Primary Prevention; D011787:Quality of Health Care; D012307:Risk Factors; D012923:Social Class; D012959:Socioeconomic Factors