Social Determinants of Health - contributions from European Health and Medical Sociology

Abstract

A major domain of recent research in health or medical sociology is concerned with social determinants of health, and more specifically with the explanation of social inequalities in health. Substantial input to this research was provided by European medical sociologists and social epidemiologists. In this article, I give a short review of the current state of art in explaining the social gradient of health, pointing to five complementary approaches: social selection, health care provision, early life deprivation, unhealthy lifestyles, and material and psychosocial stressors/resources in adult life. This latter explanation is discussed in more detail with regard to health-adverse working and employment conditions. New scientific evidence on the influence of poor quality of work on physical and mental health is presented, with particular reference to two sociological models of stressful work, demand control and effort-reward imbalance. Moreover, their contribution towards explaining unequal adult health is discussed in the frame of two hypotheses, the mediation and the effect modification hypothesis. In conclusion, substantial sociological input and progress of the sub-specialty of health or medical sociology was achieved in recent past, and this new knowledge is already being applied in various contexts of health and social policy.