Social inequalities in health disentangling the underlying mechanisms.

TLDR

Health and longevity disparities across socioeconomic status and social relationships are well documented, and researchers generally attribute them to complex causal mechanisms rather than selection or measurement error. This paper examines the arguments and strategies used to conclude that selection plays a minor role in the link between social factors and health. The authors evaluate the justification for minimal selection effects and highlight emerging research that elucidates causal pathways between social factors and health.

Abstract

Differentials in health and longevity by socioeconomic status and by the nature of social relationships have been found in innumerable studies in the social and medical sciences. Three categories of explanations for the observed patterns have been proposed: causal mechanisms through which the social environment affects health status or the risk of dying; selection or reverse causal pathways whereby a person's health status affects their social position; and artifactual mechanisms, such as measurement error. The general consensus among researchers is that the observed disparities in health are driven largely by a complex set of causal processes rather than by selection or by artifactual mechanisms. This paper explores the set of arguments and strategies that researchers have used to arrive at this conclusion. As part of this undertaking, we assess whether inferences regarding the minor contribution of selection to the overall association between social factors and health are justifiable. In addition, we identify current avenues of research that are providing new insights into the causal pathways linking social factors and health.