Theory Of Fundamental Causes Research Articles

Physical Activity in Underserved Preadolescents

Drawing insights from the theory of fundamental causes of disease, this study examined the relationships between socioeconomic status (SES) and selected risk factors in transitional urban China. Specifically, under China’s distinct institutional and sociocultural environment, we examined how contextualized SES (i.e., party membership, hukou status, housing ownership, and subjective social status) and conventional SES indicators (i.e., education, income, and occupation) were associated with physical inactivity and body mass index (BMI). Utilizing the urban subsample of the 2017 Chinese General Social Survey (CGSS), we found that individuals with higher education, income, Communist Party membership, and urban hukou status had lower risks of physical inactivity. However, higher SES with Community party membership, urban hukou, and government jobs also increased the risks of being overweight, which may be explained by potential countervailing mechanisms. These findings revealed intricate relationships among SES and risk factors in China. Our study helped contextualize the theory of fundamental causes, furnished new empirical evidence, and served as a useful reference for future health inequality research in non-Western societies.

A Holistic Evaluation of a Community Health Improvement Plan

ABSTRACT Guided by an integrated conceptual framework made up of social cognitive theory, the theory of fundamental causes, and community organizing theory, the author synthesizes quantitative and qualitative findings from process and outcomes evaluations in order to discern a holistic picture of the success and shortcomings of a Community Health Improvement Plan (CHIP), implemented in a Mid-Western region of the United States from 2016 to 2018. The aggregation and configuration of findings from a variety of data categories presented holistic meaning from evaluation results that would not be obvious in each method alone or each evaluation type alone. Findings from holistic analysis suggest a connection between social dimensions including partnership, participation, and community organizing strategy, and both plan implementation effectiveness and outcomes achievements. The results suggest that underlying contextual factors such as deficits in democratic participation, timid community organizing approaches, underlying socio-economic trends, and resource limitations might be hindering success in achieving plan outcomes and completing implementation activities. Community Health interventions should include strategies, goals, and activities that seek to build and/or improve partnerships and democratic participation related to the Community Health Improvement Plan. In addition, long-term and sustained efforts should be made to intensify collective efforts to build up resources related to capacity and poorly resourced social, economic, and health systems in the region.

Antisocial Behavior and Attitudes Towards Antisocial Behavior after a Five-Year Municipal Youth and Family Master Plan in Pomona, California, USA

ABSTRACT Within an integrated conceptual framework made up of social cognitive theory, theory of fundamental causes, and the risk and protective factor approach, we assess reported antisocial behavior and favorable attitudes toward antisocial behavior among youths and parents in a high-school sample after the implementation of a Youth and Family Master Plan in Pomona, California, USA from 2005 to 2009. We perform z tests for same students (8th grade 2005 and 12th grade 2009), same grade (8th,10th, and 12th grade), inter-grade, same year, and overall, 2005 to 2009 comparisons for Pomona, Los Angeles, and US national samples. It was hypothesized that after five years of implementation, Pomona Youth and Family Master Plan (PYFMP) activities will reduce antisocial behavior and favorable parental and youth attitudes toward antisocial behavior. Within a p-value of 05, z-test results show a decline in youth antisocial behavior among youths in the Pomona sample. Patterns in youth antisocial behavior were not consistent with youth favorable attitudes toward antisocial behavior but were consistent with perceived parental favorable attitudes toward antisocial behavior. Though youth favorable attitudes toward antisocial behavior were generally rising within the Pomona data, when compared to the rates of change in Los Angeles and US, Pomona rates of change were lower. Intra and inter jurisdictional patterns above could be attributed to the community multicomponent interventions of the PYFMP. They also align with assumptions and explanations offered in the integrated conceptual framework, which suggest a mediating role for environmental factors.

Health Power Resources Theory: A Relational Approach to the Study of Health Inequalities.

Link and Phelan's pioneering 1995 theory of fundamental causes urged health scholars to consider the macro-level contexts that "put people at risk of risks." Allied research on the political economy of health has since aptly demonstrated how institutions contextualize risk factors for health. Yet scant research has fully capitalized on either fundamental cause or political economy of health's allusion to power relations as a determinant of persistent inequalities in population health. I address this oversight by advancing a theory of health power resources that contends that power relations distribute and translate the meaning (i.e., necessity, value, and utility) of socioeconomic and health-relevant resources. This occurs through stratification, commodification, discrimination, and devitalization. Resurrecting historical sociological emphases on power relations provides an avenue through which scholars can more fully understand the patterning of population health and better connect the sociology of health and illness to the central tenets of the discipline.

Status of Prioritized Health Issues at Two- Year Follow up in a Community Health Improvement Plan

ABSTRACT Within an integrated conceptual framework made up of the social cognitive theory and the theory of fundamental causes, we assess the impact of 37 ecological strategies and 126 programs and action plans on three prioritized health issues in a community health improvement plan implemented in a Mid-Western Region of the United States from 2016 to 2018. We perform z tests comparing performance values to both baseline and established targets in 16 objectives which are tied to two priority health issues: healthy behavior; and healthcare capacity, access, and delivery. For three objectives tied to a third priority issue: changes in policy, system and environment, we conduct descriptive as well as thematic and interpretive analysis of responses to open-ended questions. Based on z-test results with statistically significant margins of 0.05 or less, performance values for 5 out of 16 quantitative outcome objectives met established targets and /or were better than baseline data including adult nutrition choices, adult physical activity, and capacity for both inpatient and outpatient mental health and addiction services for all ages. Qualitative data reveals an overall positive perception of performance in the changes in policies, systems, and environment priority issue area even as members desire an expansion of representation, and a strategic focus on leadership and media advocacy. Most unmet objectives are related to system capacity and resource needs. As predicted and explained in the theory of fundamental causes and the social cognitive theory, findings suggest that efforts to improve community health might have been slow or failing because of unfavorable socio-economic, resource, and structural factors that shape the micro, mezzo, and macro environments in which healthy behavior modification takes place. The results also underscore the difficulties in transforming individual risk and community health status without addressing socio-economic factors.

In Her Own Words

Previous research suggests that race, gender, and income impact health care access and outcomes for women. Based on the theory of fundamental causes, feminization of poverty, and systematic racism theory, this qualitative study examines the intersections of poverty and health concerns from the perspective of women (n=20) residing in areas of economic disadvantage. This qualitative study explored how minority female residents (N= 20) from an urban neighborhood of concentrated poverty perceived barriers to acquiring a healthy lifestyle. Thematic analysis of focus group transcripts revealed three themes impacting health care access and outcomes for participants: 1) underserved in the medical community, 2) under-resourced in the local community, and 3) under-represented in district policy-decision making. Implications include changing health care policies on both the local and state levels to improve women’s health care in low-income areas to address the structural barriers impeding their ability to seek health care and healthy behaviors.

Socioeconomic inequality in tobacco use in Kenya: a concentration analysis.

This paper aims at assessing and exploring socioeconomic inequalities in tobacco use in Kenya. Using the theory of fundamental causes, and concentration index, we investigate the determinants of tobacco use, and whether it disproportionately affects the poor. All data used in this study emanated from the 2014 Global Adult Tobacco Survey implemented in Kenya on a nationally representative sample of men and women aged 15years and older. Our results suggest a link between tobacco use and socioeconomic inequality. Overall, poorer households are more affected by tobacco use than richer households. This socioeconomic inequality is more evident among men and households living in urban areas. The decomposition of the concentration index indicates that the overall socioeconomic inequality for current tobacco smokers is explained by 69.11% of household wealth. To reduce the prevalence rate of smoking in Kenya, policymakers could design and implement tobacco control programs through the equity lens. Community health workers could be used to promote non-smoking behaviors among the poor.

Market Transition, Multidimensional Socioeconomic Status, and Health Disparities in Urban China

Synthesizing the theory of fundamental causes in the health literature with the stratification research on transitional economies, this paper investigates how the multidimensional socioeconomic status (SES), especially education and communist party membership, is associated with three self-rated health outcomes in urban China. Using data from the 2013 Chinese General Social Survey, we find that party membership is associated with better self-rated health, higher health-related quality of life and work, and lower levels of self-rated depression, whereas the effect of education is somewhat more elusive than it usually is in Western societies. Our findings suggest that the effects of socioeconomic indicators are better understood by being contextualized in a sociopolitical environment. It is also fruitful to include both global (education, income, employment status, and subjective SES) and local measures of SES (party membership and housing ownership) in exploring their associations with health in the world’s largest transitional society.

Technologies and Health Inequities

Health technologies aim to improve individual and population health, but they may also exacerbate health disparities. Focusing on the specific design features of technologies, their availability, and their use, we present a conceptual framework to examine how health technologies may benefit some groups more than others by combining the theory of fundamental causes with a technology-in-practice approach. We examine three classes of technologies that have been associated with health inequities: once-advanced technologies such as kidney dialysis and transplantation for end-stage renal disease, which have been plagued by issues of scarcity and fair distribution, generating racial disparities; the highly anticipated precision medicine promising to change the focus from population to individualized medicine; and digital technologies, which may herald a democratization of health care.

Using an Integrated Conceptual Framework to Clarify Health Problems and Assess A Community Health Planning Process: A Mid-Western USA Case Study

ABSTRACT Within a case study design, this paper clarifies community problems, and assesses a Community Health Improvement Plan development process using a framework of explanatory models and change theories that links the macro social model, the materialistic model, social cognitive theory, theory of fundamental causes, and community organizing theory. Properties of demographic and health status artifacts are consistent with the core constructs in both the macro social and the materialistic models. The constructs in social cognitive theory and the theory of fundamental causes seem to influence program strategies even as socio-economic factors were only minimally addressed. At the organizing level, the Plan excelled in locality development and social planning but was short on social action. The findings suggest a need for social action as a model of practice in solving persistent social and health problems, and for research that investigates if social action practice can predict success in resolving these problems.

Socioeconomic Status and Racism as Fundamental Causes of Street Criminality

The theory of fundamental causes in medical sociology identifies socioeconomic status and racism as fundamental causes of disease and health disparities. We draw on this theory to argue that socioeconomic status and racism are also fundamental causes of violent and property crime. In line with the theory, we argue that criminology should pay increased attention to socioeconomic status and racism for the most far-reaching reductions in street criminality to be achieved.

Infusing fundamental cause theory with features of Pierre Bourdieu's theory of symbolic power.

The theory of fundamental causes is one of the more influential attempts to provide a theoretical infrastructure for the strong associations between indicators of socioeconomic status (education, income, occupation) and health. It maintains that people of higher socioeconomic status have greater access to flexible resources such as money, knowledge, prestige, power, and beneficial social connections that they can use to reduce their risks of morbidity and mortality and minimize the consequences of disease once it occurs. However, several key aspects of the theory remain underspecified, compromising its ability to provide truly compelling explanations for socioeconomic health inequalities. In particular, socioeconomic status is an assembly of indicators that do not necessarily cohere in a straightforward way, the flexible resources that disproportionately accrue to higher status people are not clearly defined, and the distinction between socioeconomic status and resources is ambiguous. I attempt to address these definitional issues by infusing fundamental cause theory with features of a well-known theory of socioeconomic stratification in the sociological literature-Pierre Bourdieu's theory of symbolic power.

Multifactorial discrimination as a fundamental cause of mental health inequities

BackgroundThe theory of fundamental causes explains why health disparities persist over time, even as risk factors, mechanisms, and diseases change. Using an intersectional framework, we evaluated multifactorial discrimination as a fundamental cause of mental health disparities.MethodsUsing baseline data from the Project STRIDE: Stress, Identity, and Mental Health study, we examined the health effects of discrimination among individuals who self-identified as lesbian, gay, or bisexual. We used logistic and linear regression to assess whether multifactorial discrimination met the four criteria designating a fundamental cause, namely that the cause: 1) influences multiple health outcomes, 2) affects multiple risk factors, 3) involves access to resources that can be leveraged to reduce consequences of disease, and 4) reproduces itself in varied contexts through changing mechanisms.ResultsMultifactorial discrimination predicted high depression scores, psychological well-being, and substance use disorder diagnosis. Discrimination was positively associated with risk factors for high depression scores: chronic strain and total number of stressful life events. Discrimination was associated with significantly lower levels of mastery and self-esteem, protective factors for depressive symptomatology. Even after controlling for risk factors, discrimination remained a significant predictor for high depression scores. Among subjects with low depression scores, multifactorial discrimination also predicted anxiety and aggregate mental health scores.ConclusionsMultifactorial discrimination should be considered a fundamental cause of mental health inequities and may be an important cause of broad health disparities among populations with intersecting social identities.

Co-occurring epidemics, syndemics, and population health

As originally theorised, three concepts underlie the notion of a syndemic: disease concentration, disease interaction, and the large-scale social forces that give rise to them.1,2 The concept of disease concentration holds that two or more epidemics co-occur in particular temporal or geographical contexts due to harmful social conditions. This aspect of the theory of syndemics is not necessarily what makes its contribution distinctive. For example, anthropologists have long called attention to the manner in which large-scale political, economic, and cultural forces have given rise to clustered epidemics of various infectious diseases, most prominently HIV and tuberculosis;3–5 and the theory of fundamental causes highlights the roles of these forces in driving concentrated health disadvantage.

The Counterfactual Implications of Fundamental Cause Theory

Causal inference lies at the center of epidemiologic research. In social epidemiology, two separate approaches to framing cause-effect relations have been considered: the counterfactual (or potential outcomes) framework and the theory of fundamental causes. The relations between these two frameworks have not yet been articulated. In this paper, I review the counterfactual and fundamental cause frameworks, and show how they capture different notions of cause-effect relations. Additionally, I show how the counterfactual and fundamental cause frameworks can be integrated to provide a more rigorous treatment of causality in social epidemiology. In particular, I show how counterfactual quantities can be used to evaluate predictions that follow from fundamental cause theory, assess the relations between and roles of various social resources in a given health disparity, and generate evidence on the potential interventions to mitigate health disparities.

Social Conditions as Fundamental Causes of Health Inequalities: Theory, Evidence, and Policy Implications

Link and Phelan (1995) developed the theory of fundamental causes to explain why the association between socioeconomic status (SES) and mortality has persisted despite radical changes in the diseases and risk factors that are presumed to explain it. They proposed that the enduring association results because SES embodies an array of resources, such as money, knowledge, prestige, power, and beneficial social connections that protect health no matter what mechanisms are relevant at any given time. In this article, we explicate the theory, review key findings, discuss refinements and limits to the theory, and discuss implications for health policies that might reduce health inequalities. We advocate policies that encourage medical and other health-promoting advances while at the same time breaking or weakening the link between these advances and socioeconomic resources. This can be accomplished either by reducing disparities in socioeconomic resources themselves or by developing interventions that, by their nature, are more equally distributed across SES groups.

“Fundamental Causes” of Social Inequalities in Mortality: A Test of the Theory

Medicine and epidemiology currently dominate the study of the strong association between socioeconomic status and mortality. Socioeconomic status typically is viewed as a causally irrelevant "confounding variable" or as a less critical variable marking only the beginning of a causal chain in which intervening risk factors are given prominence. Yet the association between socioeconomic status and mortality has persisted despite radical changes in the diseases and risk factors that are presumed to explain it. This suggests that the effect of socioeconomic status on mortality essentially cannot be understood by reductive explanations that focus on current mechanisms. Accordingly, Link and Phelan (1995) proposed that socioeconomic status is a "fundamental cause" of mortality disparities-that socioeconomic disparities endure despite changing mechanisms because socioeconomic status embodies an array of resources, such as money, knowledge, prestige, power, and beneficial social connections, that protect health no matter what mechanisms are relevant at any given time. We identified a situation in which resources should be less helpful in prolonging life, and derived the following prediction from the theory: For less preventable causes of death (for which we know little about prevention or treatment), socioeconomic status will be less strongly associated with mortality than for more preventable causes. We tested this hypothesis with the National Longitudinal Mortality Study, which followed Current Population Survey respondents (N = 370,930) for mortality for nine years. Our hypothesis was supported, lending support to the theory of fundamental causes and more generally to the importance of a sociological approach to the study of socioeconomic disparities in mortality.