Health 20 MC
rock n rollIntroduction to Health Sciences
Lecture 6: Health Disparities II
Instructor: Jen-Hao Chen, Ph.D
Social Factors and Health
Many social factors can cause diseases and health problems
Income
Education
Race/ethnicity
Neighborhood you live
Furthermore, these social factors can cause many diseases and health problems
Hypertension
Diabetes
Mental illness
Shorter life span
Social Factors and Health
We hear the term ”social causes of disease” throughout the documentary
The evidence seems convincing
Social factors matter for diseases and health conditions
But why people not think about social factors when they talk about the cause of a disease?
Any idea?
Thinking about Causes of A Disease
Let’s take type 2 diabetes as an example
If you go to ask a doctor or healthcare professional, ask him/her about causes of diabetes……what kinds of answer you will get?
Thinking about Causes of A Disease
Thinking about Causes of A Disease
Let’s now take a closer look at one key social cause of type 2 diabetes: income
Thinking about Causes of A Disease
So what are the differences between the “first types” of causes versus “second types” (like income) of causes of disease?
Thinking about Causes of A Disease
Why people talk about first types of causes instead of social causes?
Thinking about Causes of A Disease
Let’s now take a closer look at income and health again:
Thinking about Causes of A Disease
Why Income Matters?
The two health conditions are different
Diagnosed with diabetes: based on clinical diagnosis
Self-report health: based on the question “in general, would you say that your health is excellent, very good, good, fair, or poor?”
Question: take 2-3 minutes, think about WHY income is related to diabetes and self-report health. Write down your answer.
Fundamental Cause Theory
It’s seems that the two types of causes we discussed are very different
But they are so important causes of disease
How can we better understand the different types of causes of disease?
Medical sociologists Bruce Link & Jo Phelan (1995) propose a theory called “fundamental cause theory”
Fundamental Cause Theory
A theory of causes of disease
In principle, we can distinguish two types of causes of disease
First, we have Proximate Cause: cause that directly affect our body, human physiology, cells and organs…etc.
Fundamental Cause Theory
Second, we get another very different type of cause Fundamental Cause
Like a super cause
Cause of “causes”: fundamental cause ”causes” many proximate causes
Fundamental Cause Theory
Take the example of diabetes
All these are proximate causes, right?
Fundamental Cause Theory
Take the example of diabetes
All these are proximate causes, right?
Then, we get fundamental cause
Cause of all proximate causes
Obesity
Smoking
High blood pressure
High fat foods
Income
Fundamental Cause Theory
Because all proximate causes are fundamentally affected by “fundamental cause”, so our understanding of causes of disease is incomplete/partial without knowing the fundamental cause
Fundamental cause is the source, the place where we get sick in the first place!!!
Fundamental Cause Theory
So, from the fundamental cause theory, why people often ignore income, education, gender, race……these social causes?
Because
Not directly causes damage on body, cells, organs……
Not get mentioned in medical reports, news……
Implications of Fundamental Cause Theory
Despite the concept of social factors as fundamental causes of diseases often ignore by medical scientists and general public, the theory has great implications on our understanding of health disparities
The theory predicts that
Advantaged social positions are always related to good health (so health disparities persist) throughout the history and regardless the nature of disease
Medical advancements or public health interventions cannot eliminate health disparities
Why? Think about why by yourself for 2-3 minutes
Implications of Fundamental Cause Theory
For example, even causes of death change dramatically between 1990 and 2010, we will see the same health disparities by income
Implications of Fundamental Cause Theory
The proximate causes of the top 3 deadly diseases are different in 1990 and 2000
Proximate cause of infectious diseases: contact with patients, poor living environment, drink contaminated water (eat contaminated food)……
Proximate cause of chronic disease: stress, obesity, smoking/heavy drinking……
Proximate causes differ but socially advantaged positions enable people get away from the proximate causes throughout human history
Implications of Fundamental Cause Theory
Second Implication: It’s also predict that medical advancements public health interventions cannot eliminate health disparities
Implications of Fundamental Cause Theory
Diabetes
Obesity
Smoking
High blood pressure
High fat foods
Income
Implications of Fundamental Cause Theory
On the contrary, sometimes medical advancements can widen the gap of health disparities ! ! !
Why?
Implications of Fundamental Cause Theory
On the contrary, sometimes medical advancements can widen the gap of health disparities ! ! !
Why?
Because medical advancements may reveal new, previously unknown proximate causes of diseases.
Socially advanced people can mobilize their resources to block the newly discovered path, leaving that proximate cause disproportionally affect the disadvantaged populations!!!