Social Inequality, Stress and Health
Joseph E. Schwartz
Schwartz, J. E. (2001): Social inequality, stress,
and health. In Blau, J. R. (Ed.) The Blackwell Companion to Sociology.
Malden: Blackwell Publishers Inc.
Research into the determinants of disease morbidity
and mortality during most of the 20th century has been dominated
by a biological model of disease as has the practice of medicine
itself. Illnesses and other physical disorders were thought to
be caused by harmful agents (e.g., bacteria or viruses causing
infectious diseases, toxic chemicals, tobacco smoke, cholesterol,
etc.) and/or a breakdown in one or more of the body's organ systems.
Consistent with this biomedical model, primary prevention of
disease has focused on reducing the population's exposure to toxic
substances and procedures to control the spread of infections
- for example, ensuring a clean water supply, quarantining infected
individuals, and vaccinating individuals to make them immune to
specific diseases.
It was not until 1977 that Engel published his seminal article
setting forth the now widely accepted biopsychosocial model of
disease. This article urged physicians and researchers to acknowledge
and investigate the role of social, psychological, and behavioral
factors in the prevention, etiology, and treatment of both physical
and mental illnesses. Despite its wide acceptance, at least in
principle, the vast majority of the medical literature ignores
the role of psychological and sociological factors. A review
of medical school curricula or the contents of leading journals
(e.g. Journal of the American Medical Association or Lancet) suggests
that the medical establishment remains skeptical about the relevance
of psychosocial factors in the etiology of disease.
The above not withstanding, the subfield of "psychosomatic
medicine," historically dominated by psychiatrists, has a
long tradition of emphasizing mind-body connections. Increasingly,
a broader array of researchers have been investigating the impact
of personality, behavior, and a variety of social factors on morbidity
and mortality. While the majority are psychologists, there are
also physicians, social epidemiologists, sociologists, anthropologists,
and others. Many of these researchers identify themselves with
one or more of the interdisciplinary fields of psychosomatic medicine,
"behavioral medicine," and "health psychology."
In this chapter I review selected empirical findings and issues
from behavioral medicine that are likely to interest sociologists.
The first section is primarily descriptive, reviewing the fact
that the risk of many diseases, and death itself, is socially
patterned. Much of the emphasis is on mortality and cardiovascular
disease, but the general point applies to other causes of death
and many non-fatal diseases. Since, in my opinion, the subfield
of social stratification lies at the core of sociology, and this
section emphasizes the link between stratification and health.
While many mechanisms surely contribute to this relationship,
I am particularly interested in the effect that stress may have
on health and the possibility that differential exposure to stress
in the social environment partially accounts for social class
differences in health. The latter part of the chapter presents
select findings from studies of animals and humans pertaining
to the impact of social stress on health.
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