Article

The Resources That Matter: Fundamental Social Causes of Health Disparities and the Challenge of Intelligence

Mailman School of Public Health, Columbia University, New York, NY 10032, USA.
Journal of Health and Social Behavior (Impact Factor: 2.72). 04/2008; 49(1):72-91. DOI: 10.1177/002214650804900106
Source: PubMed

ABSTRACT A robust and very persistent association between indicators of socioeconomic status (SES) and the onset of life-threatening disease is a prominent concern of medical sociology. The persistence of the association over time and its generality across very different places suggests that no fixed set of intervening risk and protective factors can account for the connection. Instead, fundamental-cause theory views SES-related resources of knowledge, money, power prestige, and beneficial social connections as flexible resources that allow people to avoid risks and adopt protective strategies no matter what the risk and protective factors are in a given place or time. Recently, however, intelligence has been proposed as an alternative flexible resource that could fully account for the association between SES and health and thereby find its place as the epidemiologists' "elusive fundamental cause" (Gottfredson 2004). We examine the direct effects of intelligence test scores and adult SES in two data sets containing measures of intelligence, SES, and health. In analyses of prospective data from both the Wisconsin Longitudinal Study and the Health and Retirement Survey, we find little evidence of a direct effect of intelligence on health once adult education and income are held constant. In contrast, the significant effects of education and income on health change very little when intelligence is controlled. Although data limitations do not allow a definitive resolution of the issue, this evidence is inconsistent with the claim that intelligence is the elusive fundamental cause of health disparities, and instead supports the idea that the flexible resources people actively use to gain a health advantage are the SES-related resources of knowledge, money, power, prestige, and beneficial social connections.

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    • "Furthermore, with regard to the frequency of depression and anxiety-related complaints, diminishing mental health returns to education were found among older adults in the USA (Goesling 2007). Smaller mental health returns among highly educated people were also observable in the data provided by Feinstein (2002), Alonso et al. (2004) and Link et al. (2008). Finally, the most straightforward test of the non-linear effect of education on depression was provided by Chevalier and Feinstein (2006), who demonstrated a decrease in returns to education among well-educated people, particularly among women. "
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    • "For example, persons who experience poor health during childhood and adolescence, who have lower levels of intelligence, and/or whose parents were not highly educated may complete fewer years of schooling and die earlier than their counterparts , thus creating a statistical association between educational attainment and mortality risk that is actually caused by those other underlying factors (Batty and Deary 2005; Gottfredson 2004; Hoffmann 2008; Palloni 2006). Recent research that has begun to take into account some of these underlying factors—such as intelligence scores and childhood health and socioeconomic conditions—generally finds that the relationship between educational attainment and mortality risk is modestly weaker than without such controls, but still strong (Hayward and Gorman 2004; Link et al. 2008; but also see Batty et al. 2006). Clearly, this line of research remains important, perhaps most so because answers to critical policy questions will rely on a better understanding of the true causal impacts of educational attainment than most observational studies to date have been able to demonstrate. "
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