Social epidemiology research has provided persuasive evidence of the link between the social environment—especially socioeconomic status—and health outcomes, but has failed to identify underlying mechanisms that might account for the association. The research may have been limited to date by its reliance on traditional epidemiological methods that emphasize a search for specific causal factor-disease relationships. It is time to take the research evidence and recast it to find practical solutions. We argue that the human development perspective supplies a framework for understanding the critical interaction between elements of social environment and health: Analyzing the social epidemiological research from this perspective can help to explain why and how the most potent factor, socioeconomic status, affects health outcomes. Equally important, this alternative perspective also presents health education practice implications.
Get full access to this article
View all access options for this article.
References
1.
Vandenbroucke JP: Epidemiology in transition: A historical hypothesis. Epidemiology1:164-167, 1990.
2.
Syme SL: Social determinants of health and disease, in Last JM (ed.): Public Health and Preventive Medicine (12 ed.). Norwark, CT : Appleton-Century Crofts, 1986 .
3.
Locke SE: Stress, adaptation, and immunity. Gen Hosp Psychiatry4:49-58, 1982.
4.
Hofer MA: Relationships as regulators: A psychobiologic perspective on bereavement . Psychosom Med46:183 -197, 1984.
5.
Hofer MA: Early social relationships: A psychobiologist's view. Child Dev58:633-647, 1987.
6.
Cohen S., Williamson GM: Stress and infectious disease in humans. Psychol Bull109:5-24, 1991.
7.
Coe CL, Lubach GR, Ershler WB, Klopp RG: Influence of early rearing on lymphocyte proliferation responses in juvenile rhesus monkeys. Brain Behav Immun3:47-60, 1989.
8.
Boyce WT, Jemerin JM: Psychobiological differences in childhood stress response. I. Patterns of illness and susceptibility. J Dev Behav Pediatr11:86-94, 1990.
9.
Kaplan HB: Social psychology of the immune system: A conceptual framework and review of the literature. Soc Sci Med33:909-923, 1991.
10.
Verbrugge LM : Gender and health: An update on hypotheses and evidence. J Health Soc Behav26:156-182, 1985.
11.
Hall EM: Gender, work control, and stress: A theoretical discussion and an empirical test. Int J Health Serv19:725-745, 1989.
12.
Roseman RH, Brand RJ, Sholtz R., Friedman M.: Multivariate prediction of coronary heart disease during 8.5 year follow-up in the Western Collaborative Group Study. Am J Cardiol37:903-910, 1976.
13.
Seeman TE: Personal control and coronary artery disease: How generalized expectancies about control may influence disease risk. J Psychosom Res35:661-669, 1991.
14.
Cooper R., David R.: The biological concept of race and its application to public health and epidemiology . J Health Polit Policy Law11:97-116, 1986.
15.
Otten MW, Teutsch SM, Williamson DF, Marks JS: The effect of known risk factors on the excess mortality of black adults in the United States. JAMA263:845-850, 1990.
16.
Krieger N.: Racial and gender discrimination: Risk factors for high blood pressure ? Soc Sci Med30:1273-1281, 1990 .
17.
House JS: Occupational stress and coronary heart disease: A review and theoretical integration , in Conrad P, Kern R (eds.): The Sociology of Health and Illness. New York, NY: St. Martin's Press, 1981.
18.
Baker DB: The study of stress at work. Annu Rev Public Health6:367-381, 1985.
19.
Winkleby MA , Ragland DR, Syme SL: Self-reported stressors and hypertension: Evidence of an inverse association. Am J Epidemiol127:124-134, 1988.
20.
Klitzman S. , Hourse JS, Israel BA, Mero RP: Work stress, nonwork stress, and health. J Behav Med13:221-243, 1990.
21.
Schnall PL, Pieper C., Schwartz JE, Karasek RA, Schlussel Y., Devereux RB: The relationship between 'job strain,' workplace diastolic blood pressure, and left ventricular mass index. JAMA263:1929-1935, 1990.
22.
Haynes SG , Eaker ED, Feinleib M.: The effect of employment, family, and job stress on coronary heart disease patterns in women, in Gold EB (ed.): The Changing Risk of Disease in Women. Lexington, MA: Collamore Press, 1984.
23.
Haynes SG, Feinleib M.: Women, work and coronary heart disease: Prospective findings from the Framingham heart study. Am J Public Health70:133-141, 1980.
24.
Hall EM, Johnson JV, Fredlund P., Theorell T.: Double exposure: The combined impact of the home and work environments on mental strain and physical illness (unpublished manuscript).
25.
Hinkle LE, Wolff HG: The nature of mann's adaptation to his total environment and the relation of this to illness. Arch Intern Med99: 442-460, 1957.
26.
Hinkle LE, Wolff HG: Ecologic investigations of the relationship between illness, life experiences and the social environment. Ann Intern Med49:1373-1388, 1958.
27.
Rabkin JG , Struening EL: Life events, stress, and illness. Science194:1013-1020, 1976.
28.
Klerman GL, Clayton P.: Epidemiologic perspectives on the health consequences of bereavement , in Osterweis M, Solomon F, Green M (eds.): Bereavement: Reactions, Consequences and Care. Washington, DC: National Academy Press, 1984 .
29.
Marmot M. , Syme SL: Acculturation and coronary heart disease in Japanese-Americans. Am J Epidemiol104:225 - 247, 1976 .
30.
Boyce WT, Boyce JC: Acculturation and changes in health among Navaho boarding school students . Soc Sci Med17:219-225, 1983.
31.
Cassel J.: The contributions of the social environment to host resistance. Am J Epidemiol104:107 - 123, 1976 .
32.
Berkman LR, Syme SL: Social networks, host resistance and mortality: A nine-year follow-up study of Alameda County residents. Am J Epidemiol109:186-204, 1979.
33.
Egeland B., Breitenbucher M., Rosenberg D.: Prospective study of the significance of life stress in the etiology of child abuse. J Consult Clin Psychol48:195-205, 1980.
34.
Cohen S, Syme SL (eds.): Issues in the study and application of social support, in Social Support and Health. Orlando, FL: Academic Press, 1985 .
35.
House JS, Landis KR, Umberson D.: Social relationships and health. Science241:540-545, 1988.
36.
Spiegel D., Bloom J., Kraemer HC, Gottheil E.: Effect of psychosocial treatment on survival of patients with metastatic breast cancer. Lancet October14: 888-891, 1989.
37.
Cohen S.: Social support and physical illness. Advances7:35-47, 1990.
38.
Kennell J., Klaus M., McGrath S., Robertson S., Hinkley C.: Continuous emotional support during labor in a US hospital. JAMA265:2197-2201, 1991.
39.
Lazarus RS: Four reasons why it is difficult to demonstrate psychosocial influences on health. Advances8:6-7, 1992.
40.
Antonovsky A.: Social class, life expectancy, and overall mortality. Milbank Q45:31-73, 1967.
41.
Marmot MG, Rose G., Shipley M., Hamilton Pjs: Employment grade and coronary heart disease in British civil servants . J Epidemiol Community Health32:244-249, 1978.
42.
Kitagawa EM , Hauser PM: Differential Mortality in the United States: A Study in Socioeconomic Epidemiology . Cambridge, MA: Harvard University Press, 1973.
43.
Starfield BH : Child health and socioeconomic status. Am J Public Health72:532-533, 1982.
44.
Starfield BH : Family income, ill health, and medical care of U.S. children. J Public Health Policy3:244-259, 1982.
45.
Mare RD: Socioeconomic effects on child mortality in the United States. Am J Public Health72:539-547, 1982.
46.
Lindheim R. , Syme SL: Environments, people, and health . Annu Rev Public Health4:335-359, 1983.
47.
Susser M, Watson W, Hopper K (eds.): Social class and disorders of health, in Sociology in Medicine (3rd ed.). New York, NY: Oxford University Press, 1985.
48.
Dutton DB: Socioeconomic status and children's health. Med Care23:142-155, 1985.
49.
Kaplan GA , Haan MN, Syme SL, Minkler M., Winkleby M.: Socioeconomic status and health, in Amler R, Duhl H (eds.): Closing the Gap: The Burden of Unnecessary Illness. New York, NY : Oxford University Press, 1987.
50.
Esdaile JM, Sampalis JS, Lacaille D., Danoff D.: The relationship of socioeconomic status to subsequent health status in systemic lupus erythematosus. Arthritis Rheum31:423-427, 1988.
51.
Hay DI: Socioeconomic status and health status: A study of males in the Canada health survey. Soc Sci Med27:1317-1325, 1988 .
52.
Haan MN, Kaplan GA, Syme SL: Socioeconomic position and health: Old observations and new thoughts , in Bunker JP, Gromby DS, Kehrer BH (eds.): Pathways to Health: The Role of Social Factors. Palo Alto, CA: Stanford University Press , 1989 .
53.
Farley TA , Flannery JT: Late-stage diagnosis of breast cancer in women of lower socioeconomic status: Public health implications. Am J Public Health79:1508-1512, 1989 .
54.
House JS, Kessler RC, Herzog AR, Mero RP, Kinney AM, Breslow MJ: Age, socioeconomic status, and health. Milbank Q68:383-411, 1990.
55.
Kuh D., Maclean M.: Women's childhood experience of parental separation and their subsequent health and socioeconomic status in adulthood. J Biosoc Sci22:121-135, 1990.
56.
Carmichael A., Williams HE, Picot SG: Growth patterns, health and illness in preschool children from a multi-ethnic, poor socio-economic status municipality of Melbourne . J Paediatr Child Health26:136-141, 1990.
57.
Briones DF, Heller PL, Chalfant HP, Roberts AE, Aguirre-Hauchbaum SF, Farr WF: Socioeconomic status, ethnicity, psychological distress, and readiness to utilize a mental health facility. Am J Psychiatry147:1333-1340, 1990.
58.
Mutchler JE , Burr JA: Racial difference in health and health care service utilization in later life: The effect of socioeconomic status. J Health Soc Behav32:342-356, 1991.
59.
Hirdes JP, Forbes WF: The importance of social relationships, socioeconomic status and health practices with respect to mortality among healthy Ontario males. J Clin Epidemiol45:175 - 182, 1992 .
60.
Winkleby MA , Jatulis DE, Frank E., Fortmann SP: Socioeconomic status and health: How education, income, and occupation contribute to risk factors for cardiovascular disease . Am J Public Health82:816-820, 1992.
61.
Haan M., Kaplan G., Camacho T.: Poverty and health: Prospective evidence from the Alameda County study . Am J Epidemiol125:989-998, 1987.
62.
Werner E. , Smith R.: Vulnerable but Invincible: A Longitudinal Study of Resilient Children and Youth. New York, NY: McGraw-Hill , 1982.
63.
Marmot M., Theorell T.: Social class and cardiovascular disease: The contribution of work . Int J Health Serv18:659-674, 1988.
64.
North F., Syme SL, Feeney A., Head J., Shipley MJ, Marmot MG: Explaining socioeconomic differences in sickness absence: The Whitehall II study. Br Med J306:361-366, 1993.
65.
Forsdahl A. : Are poor living conditions in childhood and adolescence an important risk factor for arteriosclerotic heart disease ? Br J Prev Soc Med31:91-95, 1977.
Syme SL: Control and health: An epidemiological perspective, in Steptoe A, Appels A (eds.): Stress, Personal Control and Health. New York, NY: John Wiley and Sons, 1989.
68.
Syme SL: Control and health: A personal perspective. Advances7:16-27, 1991.
69.
Syme SL: Psychosocial factors and the health of women: Puzzles, dilemmas, opportunities (unpublished manuscript).
70.
Erikson E. : Childhood and Society. New York, NY: W.W. Norton and Company, 1963. 71.
71.
Salkind NJ: Theories of Human Development. New York, NY: John Wiley and Sons, 1981.
72.
Newman BM , Newman PR: Development Through Life: A Psychosocial Approach. Pacific Grove, CA: Brooks/Cole Publishing Company , 1987.
73.
Eccles JS, Midgley C., Wigfield A., Buchanan CM, Reuman D., Flanagan C., Maclver D.: Development during adolescence: The impact of stage-environment fit on young adolescents' experiences in schools and in families. Am Psychol48:90-101, 1993.
74.
Bronfenbrenner U.: The Ecology of Human Development: Experiments by Nature and Design . Cambridge, MA: Harvard University Press, 1979.
75.
Bronfenbrenner U.: Toward an experimental ecology of human development . Am Psychol32:513-531, 1977.
76.
Bronfenbrenner U.: Ecology of the family as a context for human development: Research perspectives. Dev Psychol22:723-742, 1986.
77.
Werner E., Smith R.: Overcoming the Odds: High-risk Children from Birth to Adulthood. New York, NY: Cornell University Press , 1992.
78.
Werner E. : Protective factors and individual resilience , in Meisels SJ, Shonkoff JP (eds.): Handbook of Early Childhood Inverventions . Cambridge, MA : Harvard University Press, 1990 .
79.
Antonovsky A. : Unraveling the Mystery of Health: How People Manage Stress and Stay Well. San Francisco, CA: Jossey-Bass, 1987.
80.
Baron RM, Kenny DA: The moderator-mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. J Pers Soc Psychol51:1173-1182, 1986 .
81.
Schweinhart LJ , Weikart DP: Young Children Grow Up: The Effects of the Perry Preschool Program on Youths Through Age 15. Ypsilanti, MI: The High/Scope Press, 1980 .
82.
Berrueta-Clement JR, Schweinhart LJ, Barnett WS, Epstein AS, Weikart DP: Changed Lives: The Effects of the Perry Preschool Program on Youths Through Age 19. Ypsilanti, MI: The High/Scope Press , 1984.
83.
Adler NE, Boyce T., Chesney MA, Cohen S., Folkman S., Kahn RL, Syme SL: Socioeconomic status and health: The challenge of the gradient. Am Psychol49:15-24, 1994.
84.
Hohmann M. , Banet B., Weikart DP: Young Children in Action. Ypsilanti, MI: The High/Scope Press, 1979.
85.
Miller LB, Dyer JL: Four preschool programs: Their dimensions and effects. Monogr Soc Res Child Dev40:1-170, 1975.
86.
Lazar I., Darlington R.: Lasting effects of early education: A report from the consortium for longitudinal studies. Monogr Soc Res Child Dev47:1-151, 1982.
87.
Zigler E., Taussig C., Black K.: Early childhood intervention: A promising preventative for juvenile delinquency . Am Psychol47:997-1006, 1992.
88.
Clark R.: Family Life and School Achievement: Why Poor Black Children Succeed or Fail . Chicago, IL: The University of Chicago Press, 1983.
89.
Comer JP: School Power: Implications of an Intervention Project. New York, NY: The Free Press, 1980 .
90.
Gritz ER, Berman BA, Bastani R., Wu M.: A randomized trial of a self-help smoking cessation intervention in a nonvolunteer female population: Testing the limits of the public health model. Health Psychol11:280-289, 1992.
91.
Kelly JA, Murphy DA, Sikkema KJ, Kalichman SC: Psychological interventions to prevent HIV infection are urgently needed: New priorities for behavioral research in the second decade of AIDS . Am Psychol48:1023-1034, 1993 .
92.
Goldman JA, Harlow LL: Self-perception variables that mediate AIDS preventive behavior in college students. Health Psychol12:489-498, 1993.
