The relationship between social class and health: Their "social-psychological-physiological" mechanism

Abstract

Health disparities between different classes are important social problems faced by all countries in the world. China is no exception. Since the reform and opening up of China, the health status of residents has improved rapidly with the development of society and the economy. However, the health gap between different social classes has grown at the same time. In order to achieve the goal of eliminating health disparities, we need to have a thorough understanding of the main factors that cause health disparities among different social classes. Therefore, this paper focuses on the mechanisms that may explain the relationship between social class and health. A comprehensive mechanistic analysis should include macro-social factors, such as community and family environment, as well as individual psychological and biological factors. That is, there are multi-level paths by which social class affects health. Firstly, the community provides a context in which various social risks are experienced by the residents. Community violence can significantly affect the health of members of the community, and a series of studies indicates that it is a social mechanism that leads to social class disparities in health. In addition to community violence, conflicts between family members are also an important cause of the health gap between different classes. Meanwhile, factors such as the social capital of the community and the parenting style of the family have also been proved to play a mediating role in the effects of social class on all-cause mortality and cardiovascular mortality. Secondly, the community and family environment eventually affect individuals psychological characteristics and behavior, which in turn affect health. Lots of studies indicate that individual psychological characteristics, such as anxiety, depression, pessimism, and hostility, play a mediating role between social class and health. Poor health behaviors have also been shown to be the mechanisms underlying the relationship between lower class and higher morbidity and mortality. Thirdly, the most direct factors affecting health are biological factors, or pathophysiological factors of disease. Asthma has been used as an example to demonstrate the influence of social class on number of immune cells and the level of activity of molecular signaling pathways that regulate cytokine production. Based on the toxic pressure model, another group of researchers have suggested that the HPA system is over-activated by toxic stress, which distorts the normal balance of steady-state components, resulting in too much or too little cortisol, adrenaline, cytokines, metabolic hormones or neurotransmitters, which in turn leads to disease. In sum, we reviewed the social-psychological- physiological mechanisms of health disparities among social classes. We focused on the multi-level paths to illustrate the relationship between social class and health, which include community and family environmental factors (community violence, social capital, family conflict, and parenting style) as well as individual psychological and behavioral factors (hostility and health behavior) and biological factors (cells, molecular, and HPA). Future studies should strengthen theory integration and construction concerning the relation between social class and health, carrying out multi-faceted and multi-disciplinary empirical research at the distal, middle and proximal levels within a social-psychological-physical framework so as to reveal more deeply the core mechanisms underlying the influence of social class on health and lay a solid foundation for proposing more effective intervention programs.