Advancing the study of health inequality: Fundamental causes as systems of exposure

SSM Popul Health. 2020 Feb 7:10:100555. doi: 10.1016/j.ssmph.2020.100555. eCollection 2020 Apr.

Abstract

We tend to study health inequalities as differentials in disease and death that exist within a population. But the most important cause of health inequality is social stratification, and social stratification only varies between populations. Here, I highlight a way forward in the study of health inequality that resolves this mismatch of analytical levels: we must study the fundamental causes as systems of exposure. Through this critical review of the literature, I argue that the explicit study of variation in social stratification is the next frontier in research on fundamental causes of health inequality.

Keywords: Fundamental cause theory; Racial hierarchy; SES; Social determinants; Social stratification; Systems thinking.