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Controlling disease and creating disparities: a fundamental cause perspective
1Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, 722 W. 168 St., New York, NY 10032, USA. jcp13@columbia.edu
Summary
Health disparities in developed nations arose alongside significant population health improvements. The "fundamental causes" theory explains how controlling disease, combined with social inequalities, creates these disparities.
Area of Science:
- Public Health
- Sociology
- Epidemiology
Background:
- 20th-century developed countries saw major population health gains.
- Simultaneously, racial and socioeconomic health disparities emerged for key diseases.
- Existing explanations for disparities inadequately address these historical shifts.
Purpose of the Study:
- To explain the emergence of racial and socioeconomic health disparities.
- To reconcile these disparities with overall population health improvements.
- To evaluate genetic and social causation theories against historical data.
Main Methods:
- Analyzed changing mortality patterns by race and socioeconomic status.
- Compared trends for diseases with increasing versus limited preventability.
- Examined the role of societal resources in distributing health gains.
Main Results:
- Genetic and some social causation theories are inconsistent with observed trends.
- The "fundamental causes" theory aligns with historical data.
- Increased capacity to control disease exacerbates disparities when combined with social inequalities.
Conclusions:
- Fundamental causes, not genetics, best explain persistent health disparities.
- Societal resources mediate the benefits of medical advancements, creating disparities.
- Understanding these dynamics is crucial for addressing health inequities.