title: A Social History of Disease: Contextualizing the Rise and Fall of Social Inequalities in Cause-Specific Mortality.
abstract: 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.
authors.affiliation: Program in Public Health and Department of Family, Population and Preventive Medicine, Stony Brook University, Health Sciences Center, #3-071, Stony Brook, NY, 11794, USA. Sean.Clouston@stonybrookmedicine.edu.
authors.forename: Sean A P
authors.initials: SA
authors.lastname: Clouston
authors.affiliation: Section of Social and Behavioral Sciences, College of Dental Medicine, Columbia University, New York, NY, 10032, USA.
authors.forename: Marcie S
authors.initials: MS
authors.lastname: Rubin
authors.affiliation: Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, 10032, USA.
authors.forename: Jo C
authors.initials: JC
authors.lastname: Phelan
authors.affiliation: Department of Sociology, and School of Public Policy, University of California, Riverside, CA, 92521, USA.
authors.forename: Bruce G
authors.initials: BG
authors.lastname: Link
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D042241:Early Diagnosis; D005260:Female; D054624:Health Status Disparities; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D009026:Mortality / Q000639:trends*; D012111:Residence Characteristics; D012307:Risk Factors; D012737:Sex Factors; D012959:Socioeconomic Factors; D044465:White People / Q000706:statistics & numerical data
keywords: Cause-specific mortality; Fundamental causes; Informational diffusion; Mortality trends; Social inequalities