Socioeconomic Differentials in Health: A Review and Redirection

The social structure and personality perspective provides a theoretical and analytical framework for understanding the persisting association between socioeconomic status (SES) and health outcomes. Current research suggests that health behaviors, stress, social ties, and attitudinal orientations are critical links between social structure and health status. These psychosocial factors are linked more strongly to health status than is medical care and are related systematically to SES. The social distributions of these factors represent the patterned response of social groups to the conditions imposed on them by social structure. Accordingly the elimination of inequalities in health status ultimately may require changes not only in psychosocial factors or health care delivery, but also in socioeconomic conditions. Research is needed that will identify the criticalfeatures of SES which determine health, delineate the mechanisms and processes whereby social stratification produces disease, and specify the psychological and interpersonal processes that can intensify or mitigate the effects of social structure.