The Role of Work in Fundamental Cause Theory: A Lens for Understanding Health Inequalities, Slides of Social Theory

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THE IMPORTANCE OF WORK IN FUNDAMENTAL CAUSE

THEORY

B R U C E L I N K U N I V E R S I T Y O F C A L I F O R N I A R I V E R S I D E

POSE AND REFLECT ON TWO QUESTIONS

• What can a focus on work do for fundamental cause theory?
• What can fundamental cause theory do for a program of research on

work?

FUNDAMENTAL CAUSE

THEORY

• Fundamental Cause Theory seeks to explain the persistence of health

inequalities in different places and at different times.

• We identify socioeconomic status and racism as fundamental causes
  • Each is important for multiple disease outcomes
  • Through multiple replaceable mechanisms
  • Mechanisms are replaced in different places and at different times so as to reproduce the fundamental relationship.

Link, Bruce G., and Jo Phelan. "Social conditions as fundamental causes of disease." Journal of health and social behavior (1995): 80-94. Phelan, Jo C., and Bruce G. Link. "Is racism a fundamental cause of inequalities in health?." Annual Review of Sociology 41 (2015): 311-330.

DIAGRAM OF A FUNDAMENTAL CAUSE

• “Fundamental Cause” (FC) and “Replaceable Mechanisms” (RM)
• If a mechanism linking a fundamental cause to an outcome is blocked the fundamental cause will find expression through another mechanism thereby preserving the fundamental relationship.

FC

M 1

M 2

Outcome

MAGIC? HOW DOES THIS HAPPEN?

• SES

• People use flexible SES-related resources of knowledge, money, power, prestige, and beneficial social connections to scramble individually and collectively to obtain health advantageous circumstances for themselves and those in their circle of caring.
• Racism
• People seeking to maintain their privileged positions in racial hierarchies deploy racism to maintain their advantage thereby harming the health of those who are the target of the racism.

HOW DOES THIS WORK? “DOING” CLASS – “DOING”

FUNDAMENTAL CAUSE

• If fundamental cause theory is correct agentic action of those higher up reliably creates a spread in health fortunes across places and times.
• Now that could sound a bit abstract -- let me make it more concrete by moving no further than within my own circumstances.

Wife Co-Author Jo Phelan

Daughter

DAY TIME

• Lot 50, work 3 rd^ floor, choice of

stairs or elevator

• Sedentary all day but in an

ergonomic chair

• Place of work negotiates my

health care package – it is comprehensive.

• No toxic fumes, dangerous

machines, bookshelves are battened down and I have a nice boss

EVENING

• Relatively healthy dinner.
• Spousal support
• Comfortable, quite place

to sleep

MULTIPLE HEALTH RELEVANT ASPECTS OF DAILY

LIFE SHAPED BY FLEXIBLE RESOURCES

• Health relevant circumstances embedded in multiple aspects of our lives – a

massive multiplicity perhaps. We are often unaware

• Not immediately consequential for health
• We think about them in terms other than health
• Only important in rare circumstances
• This massive multiplicity is shaped by our resources – knowledge, money,

power, prestige and beneficial social connections.

• And then either through these resources or independently major societal

fault lines of “us them” – fault lines supported by racism and stigmatization also shape this massive multiplicity of health relevant circumstances.

SOCIAL SHAPING

• Resources, racism and stigmatization shape access to health-relevant

circumstances like a magnet shapes patterns of filings:

• We expect patterns of health and mortality to result.

FUNDAMENTAL CAUSES – FLEXIBLE RESOURCES

• When people hear “fundamental cause” they often think the cause furthest to the left in a causal diagram or at the top of some multi-leveled model.
• But the key concept in FCT is “flexible” broadly useful resources. What people actually use to gain a health advantage.
• But these flexible resources come from somewhere.

CENTRALITY OF WORK

• Where these flexible resources

come from is complex.

• But a major source/context is

work.

• Knowledge, money, power,

prestige and beneficial

connections.

• Also where discrimination

occurs -- the restricting of

people’s freedom to pursue

ends they desire.

Work

Knowledge Money

Beneficial Social Prestige Connections

Power

WHAT CAN FCT DO FOR A PROGRAM OF RESEARCH

ON WORK?

• First, the lens idea – if you think of work from a FCT perspective you will be reminded of the importance of flexible resources and the impact of racism and stigmatization.
• Second, if you are concerned about the reproduction of health inequalities in the work context, FCT gives you a way of thinking about how to address persistence.
• Third, it can help you avoid an excessive burrowing into the mechanistic linkages involved in more proximal causes to the exclusion of inequality generating processes. - Whac-a-Mole

CAN FLEXIBLE RESOURCES IN THE WORK

CONTEXT BE ALTERED?

• Distribution of flexible resources have been dramatically altered over

time.

• Relevant to health disparities flexible resources are distributed

unequally in work settings.

• Plausible evidence links inequalities in the distribution of flexible

resources to discrimination.