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.
AdlerNBuchNRPantellMS.Rigor, vigor, and the study of health disparities. PNAS2012;109:17154–9.
2.
BravemanPACubbinCEgerterSet al. Socioeconomic disparities in health in the United States: what the patterns tell us. Am J Pub Hea2010;100:S186–96.
3.
BravemanPAEgerterSWilliamsDR.The social determinants of health: coming of age. Ann Rev Pub Hea2011;32:381–98.
4.
MatthewsKAGalloLC.Psychological perspectives on pathways linking socio-economic status and physical health. Ann Rev Psy2011;62:501–30.
5.
LinkBGPhelanJC.Social conditions as fundamental causes of disease. J Hea Soc Beh1995;35:80–94.
6.
LinkBGPhelanJC.McKeown and the idea that social conditions are fundamental causes of disease. Am J Pub Hea2002;92:730–2.
7.
PhelanJCLinkBGDiez-RouxAet al. “Fundamental causes” of social inequalities in mortality: a test of the theory. J Hea Soc Beh2004;45:265–85.
8.
PhelanJCLinkBGTehranifarP.Social conditions as fundamental causes of health inequalities: theory, evidence, and policy conditions. J Hea Soc Beh2010;51:S28–40.
9.
PhelanJCLinkBG.Fundamental cause theory. In: CockerhamW (ed) Medical sociology on the move: new directions in theory. Dordrecht: Springer Netherlands, 2013, pp.105–25.
10.
PhelanJCLinkBG.Controlling disease and creating disparities: a fundamental cause perspective. J Gerontol B Psychol Sci Soc Sci2005;60:S27–33.
11.
OlafsdottirS.Fundamental causes of health disparities: stratification, the welfare state, and health in the United States and Iceland. J Hea Soc Beh2007;48:239–53.
12.
ChangVWLauderdaleDS.Fundamental cause theory, technological innovation, and health disparities: the case of cholesterol in the era of statins. J Hea Soc Beh2009;50:245–60.
13.
RubinMSGolenCGLinkBG.Examination of inequalities in HIV/AIDS mortality in the United States from a fundamental cause perspective. Amer J Pub Hea2009;100:1053–9.
14.
WillsonA.‘Fundamental causes’ of health disparities: a comparative analysis of Canada and the United States. Int Soc2009;24:93–113.
15.
WangACloustonSRubinMSet al. Fundamental causes of colorectal cancer mortality: the implications of informational diffusion. Mil Quar2012;90:592–618.
16.
PolonijoANCarpianoRM.Social inequalities in adolescent human papillomavirus (HPV) vaccination: a test of fundamental cause theory. Soc Sci Med2013;82:115–25.
17.
Saldana-RuizNCloustonSRubinMSet al. Fundamental causes of colorectal cancer mortality in the United States: understanding the importance of socioeconomic status in creating inequality in mortality. Amer J Pub Hea2013;103:99–104.
18.
RubinMSCloustonSLinkBG.A fundamental cause approach to the study of disparities in lung cancer and pancreatic cancer mortality in the United States. Soc Sci Med2014;100:54–61.
19.
MackenbachJPKulhánováIBoppMet al. Variations in the relation between education and cause-specific mortality in 19 European populations: a test of the “fundamental causes” theory of social inequalities in health. Soc Sci Med2015;127:51–62.
20.
MastersRKLinkBGPhelanJC.Trends in education gradients of ‘preventable’ mortality: a test of fundamental cause theory. Soc Sci Med2015;127:19–28.
21.
CloustonSAPRubinMSChaeDHet al. Fundamental causes of accelerated declines in colorectal cancer mortality: modeling multiple ways that disadvantage influences mortality risk. Soc Sci Med2017;187:1–10.
22.
DeatonA.Policy implications of the gradient of health and wealth. Hea Aff2002;21:13–29.
23.
LahelmaEMartikainenPLaaksonenMet al. Pathways between socioeconomic determinants of health. J Epi Com Hea2004;58:327–32.
24.
BravemanPACubbinCEgerterSet al. Socioeconomic status in health research: one size does not fit all. JAMA2005;294:2879–88.
25.
FreeseJLutfeyK. Fundamental causality: challenges of an animating concept for medical sociology. In: PescosolidoBAMartinJKMcLeodJet al. (eds) Handbook of the sociology of health, illness, and healing. A blueprint for the 21st century. New York: Springer Science + Business Media, 2011, pp.67–84.
26.
OversveenERydlandHTBambraCet al. Rethinking the relationship between socio-economic status and health: making the case for sociological theory in health inequality research. Scan J Pub Hea2017;45:103–12.
27.
GiddensA.The class structure of the advanced societies. London: Hutchinson, 1973.
28.
WrightEO.Class, crisis, and the state. London: New Left Books/Verso UK, 1978.
29.
GoldthorpeJH.Revised class schema. London: Social and Community Planning Research, 1992.
30.
WeedenKAGruskyDB.The case for a new class map. Amer J Soc2005;111:141–212.
31.
BourdieuP.Outline of a logic of practice. Cambridge: Cambridge University Press, 1977.
32.
BourdieuP.Distinction. A social critique of the judgement of taste. Cambridge: Harvard University Press, 1984.
33.
BourdieuP.The forms of capital. In: RichardsonJG (ed) Handbook of theory and research for the sociology of education. New York: Greenwood Press, 1986, pp.241–58.
34.
BourdieuP.Practical reason. Stanford, CA: Stanford University Press, 1998.
35.
VeenstraGBurnettPJ.A relational approach to health practices: towards transcending the agency-structure divide. Soc Hea Ill2014;36:187–98.
36.
SavageMDevineFCunninghamNet al. A new model of social class? Findings from the Great British Class Survey Experiment. Sociol2013;47:219–50.
37.
BurnettPJVeenstraG.Margins of freedom: a field-theoretic approach to class-based health practices. Soc Hea Ill2017;39:1050–67.
