midterm_question1 LAUREN E.

SILVER

1A. The social class-mortality gradient refers to the phenomenon of differences in health (e.g., mortality
and morbidity from certain diseases) by social position or socioeconomic status (SES)namely, the
higher an individuals SES, the better his or her health (Marmot; Williams & Collins). This difference in
health is described as a gradient because the association between health status and SES within societies
generally is evident along the entire spectrum of SES; that is, the lower ones SES (whether measured by
education, income, occupation, etc.), the lower ones health status and the higher ones chance of disease-
related mortality (Marmot; Williams & Collins; lecture). Moreover, the social class-mortality gradient in
health can be seen within racial/ethnic groups and within age groups in the same society, and even
internationally within both poor and wealthy nations (lecture). Conventional explanations of the social
class-mortality gradient suggest that the link between SES and health is mediated by intervening factors,
such as access to health care, quality of health care, and lifestyle or health-related behaviors (Marmot;
Williams & Collins; Lantz; lecture). However, a growing body of research suggests that the proposed
mediating factors above explain a small amount of the relationship between SES and health outcomes
(Lantz; Marmot; Muennig; lecture). Instead, some hypothesize that SES and health are moderated by
income/economic inequality and, thus, are related more directly (Marmot; Williams & Collins; Kawachi).
Higher levels of income inequality (i.e., larger differences in wealth and affluence) could result in
frustration (among those of lower SES) and reduced social capital, which may have a direct affect on
health outcomes (Kawachi; Williams & Collins, Wilkinson; lecture).
The Gini Coefficient is a measure of income inequality, or wealth distribution, within a society
that measures how much wealth is distributed in each 10% of the population (lecture). The Gini
Coefficient ranges from 0 (perfect equality) to 1 (perfect inequality)the lower the Gini Coeffiicient, the
more equally wealth is distributed within a society (lecture). Wealth is distributed more equally in a
society with a Gini Coefficient of .250 than in a society with a coefficient of .450. Given the determinants
of the social-class mortality gradient and, in turn, the health of populations (as described above), the
social-class mortality gradient would be smaller and, in turn, the health of the population most likely
midterm_question1 LAUREN E. SILVER

would be better in the society with the lower level of inequality as measured by the lower Gini
Coefficient.
1B. The Fundamental Cause Theory suggests that no matter what factors mediate the relationship
between SES and health, lower classes have poorer health (Phelan, lecture). Regardless of such factors as
advances in preventive medicine, the social class-mortality gradient (as described in 1A) persists (lecture,
Phelan). More specifically, higher-SES individuals possess resources (e.g., knowledge, prestige, social
connections) that they can use to benefit their health and they deliberately use these resources to maintain
and improve their health (Phelan). The deliberate use of these resources by higher-SES individuals turns
SES into a fundamental cause of the social-class gradient, despite changes in disease patterns and risk
factors (Phelan). Reducing health risk behaviors among lower social class populations, therefore, may
only have a smallif not trivialnarrowing effect on the social class-mortality gradient. First (as
described in 1A), health risk behaviors explain a small proportion of the relationship between SES and
health and mortality. Secondand most importantreducing health risk behaviors among lower social
class populations will not provide them with the same level of unique resources that are available to
higher-SES populations. Thus, policies aimed at the social determinants of health may prove more
effective (Muennig; lecture).
1C. Medicalization refers to the phenomenon of expanding notions of what is considered pathological
and, therefore, treatablefrom a medical standpoint, such as problematic behaviors (e.g., gambling) and
natural biological processes (e.g., menopause) (lecture; Barsky; Conrad; McCrea). Medicalization may
have positive (e.g., biomedical innovations may relieve symptoms) and negative (e.g., commercialization)
consequences (lecture; Barsky). In particular, medicalization may lead to what Barsky describes as a
paradoxical side effectindividuals believing that more and more of what ails them is curable. Due to
this paradoxical side effect, medicalizing life conditions (e.g., aging and childbirth) likely would widen
not narrowthe social class-mortality gradient. Lower-SES, health-literate populations may come to
view natural life conditions as medically problematic, but lack the resources to address them (e.g., lacking
access to prenatal care, lacking financial means to treat age-related wrinkles with botox, etc.).