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


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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    • "Moreover, Hayward's and Gorman's (2004) results suggested that the effects of adult socioeconomic factors on mortality are highly robust to controls for early life conditions, and that the association between educational attainment and adult mortality is potentially underestimated when childhood conditions are not controlled. Link et al. (2008) similarly observed in analyses of the Wisconsin Longitudinal Study and the Health and Retirement Study data sets that the associations between educational attainment, income, and adult mortality changed very little when intelligence was controlled and that there was no direct effect of intelligence. In addition, a very recent study by Montez and Hayward (2014) documented, using the Health and Retirement Study, that educational attainment's Valued information about, and support for, healthy lifestyles, and health care Access to good jobs and associated rewards in an information-based society Access to valuable networks/relationships, and perhaps increasingly so with technology advancements and ease of travel Sophisticated cognitive skills, greater sense of control and human agency Adult Mortality Educational Attainment Early Life Factors Adult Mechanisms Parental education and income Individual endowments (e.g., genetics and intelligence) Childhood physical and mental health Childhood social context Potential Confounders Fig. 1. "
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    ABSTRACT: Has the shape of the association between educational attainment and U.S. adult mortality changed in recent decades? If so, is it changing consistently across demographic groups? What can changes in the shape of the association tell us about the possible mechanisms in play for improving health and lowering mortality risk over the adult life course? This paper develops the argument that societal technological change may have had profound effects on the importance of educational attainment - particularly advanced education - in the U.S. adult population for garnering health advantages and that these changes should be reflected in changes in the functional form of the association between educational attainment and mortality. We review the historical evidence on the changing functional form of the association, drawing on studies based in the United States, to assess whether these changes are consistent with our argument about the role of technological change. We also provide an updated analysis of these functional form patterns and trends, contrasting data from the early 21st Century with data from the late 20th Century. This updated evidence suggests that the shape of the association between educational attainment and U.S. adult mortality appears to be reflecting lower and lower adult mortality for very highly educated Americans compared to their low-educated counterparts in the 21st Century. We draw on this review and updated evidence to reflect on the question whether education's association with adult mortality has become increasingly causal in recent decades, why, and the potential research, policy, and global implications of these changes. Copyright © 2014 Elsevier Ltd. All rights reserved.
    Social Science & Medicine 11/2014; 127. DOI:10.1016/j.socscimed.2014.11.024 · 2.89 Impact Factor
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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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    ABSTRACT: In general, well-educated people enjoy better mental health than those with less education. As a result, some wonder whether there are limits to the mental health benefits of education. Inspired by the literature on the expansion of tertiary education, this article explores marginal mental health returns to education and studies the mental health status of overeducated people. To enhance the validity of the findings we use two indicators of educational attainment - years of education and ISCED97 categories - and two objective indicators of overeducation (the realised matches method and the job analyst method) in a sample of the working population of 25 European countries (unweighted sample N = 19,089). Depression is measured using an eight-item version of the CES-D scale. We find diminishing mental health returns to education. In addition, overeducated people report more depression symptoms. Both findings hold irrespective of the indicators used. The results must be interpreted in the light of the enduring expansion of education, as our findings show that the discussion of the relevance of the human capital perspective, and the diploma disease view on the relationship between education and modern society, is not obsolete.
    Sociology of Health & Illness 08/2013; 35(8). DOI:10.1111/1467-9566.12039 · 1.88 Impact Factor
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    • "Low household SES, limited parental education , disorganization in family structure, traumatic experiences and health problems can stifle educational attainment (Duncan et al. 1998; Sandefur and Wells 1999). That being said, careful observational studies that include childhood measures still report a robust effect of education on adult health and mortality (Hayward and Gorman 2004; Link et al. 2008). This suggests that despite the nonrandomness of educational pathways, selection bias does not obscure an actual effect that educational attainment holds for health. "
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    ABSTRACT: College-educated adults are healthier than other people in the United States, but selection bias complicates our understanding of how education influences health. This article focuses on the possibility that the health benefits of college may vary according to childhood (mis)fortune and people's propensity to attain a college degree in the first place. Several perspectives from life course sociology offer competing hypotheses as to whether the most or the least advantaged see the greatest return of a college education. The authors use a national survey of middle-age American adults to assess risk of two cardiovascular health problems and mortality. Results from propensity score and hierarchical regression analysis indicate that the protective effect of college attainment is indeed heterogeneous. Further, the greatest returns are among those least likely to experience this life course transition (i.e., compensatory leveling). Explanations for this selection effect are offered, along with several directions for future research on the health benefits of completing college.
    Social Forces 02/2013; 91(3):1007-1034. DOI:10.2307/23361129 · 1.29 Impact Factor
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