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UBC Theses and Dissertations

Understanding pathways between social conditions and health : evaluating the "fundamental" nature of the relationship between socioeconomic status and health in Canada and the United States Buse, Christopher Gustav


Link and Phelan (1995) have written extensively on the pervasive and robust association between social conditions (i.e. social determinants) such as SES and health over the course of human history. In what they term "the fundamental cause perspective", they theorize that SES provides flexible resources of power, prestige, and beneficial social connections that create gradients in health which persist through time, even though more proximal determinants of health may change. This thesis investigates the fundamental cause perspective by testing four specific areas relating to the fundamental nature of the SES/health association. First, it seeks to answer whether or not this theory is contextually or culturally specific by comparing the United States with Canada. Second, it develops the idea that some social conditions (gender, race/ethnicity, and immigrant status) may be pre-fundamental to the SES/health association in an attempt to explain where SES disparities come from. Third, it seeks to test whether or not tangible resources (health behaviours and healthcare resources) mediate the SES/health association. Finally, it examines the interaction between each of gender, race/ethnicity and immigrant status with measures of SES to determine whether SES may be more or less meaningful to specific subsets of the population. Findings largely support the fundamental cause perspective in that SES is a significant predictor of self-rated health, asthma, and overweight/obesity in both countries and that the strength and direction of these associations are remarkably similar. Although some support exists for the pre-fundamental potential of racial/ethnic inequality to drive the SES/self-rated health association, gender, race/ethnicity, and immigrant status are not antecedent to the SES/health association. Health behaviours were found to mediate the SES/self-rated health association and healthcare resources suppressed the SES/self-rated health association. Little to no mediation occurred across other health indicators. Finally, significant interactions exist between gender and income, gender and education, and immigrant status and income leading to a discussion of the fundamental importance of considering intersections between SES and other social variables.

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