paths through which these factors may influence health and mortality. Thus, interpretations based on selection arguments can serve to identify social and economic processes that perpetuate social stratification in societies at large as well as within racial and ethnic groups.
In this chapter we introduce terminological clarifications and examine some examples of selection processes. We provide a precise definition of selection processes that pertain to health and mortality inequalities, and introduce a simple taxonomy to classify them. We examine strategies for conceptualizing selection processes within the literature on health and mortality. We review a broad array of arguments regarding selection, from those that promote it as a universal cause of all social and economic inequalities in mortality and health, to those that consider it as the intellectual debris of genetic determinism. We examine in some detail three classes of selection processes that are relevant in the area of racial and ethnic health disparities. Using a mixture of simulated and empirical data, we estimate the potential magnitude of their effects and show that, in some cases at least, the impact of selection processes can be quite large—large enough to lead to misinterpretation of observable data and to erroneous policy prescriptions. The chapter ends with a brief discussion of alternative approaches that address conceptual and empirical problems associated with the identification of selection processes.
The observed association between an individual’s social class or position and health status and mortality risks can be due to two different processes. The first is one whereby influences on health and mortality result from the action of characteristics intrinsic to the social position. Individuals are endowed with these characteristics only by virtue of having attained the social position. For example, members of higher social classes may experience lower mortality because they command more wealth or have attained higher educational levels, and either of these traits is conducive to better health and lower mortality risks.
The second process occurs because individuals have traits or attributes that simultaneously increase their likelihood of accessing (leaving) social positions and exert an influence on their health status and mortality risks. For example, attributes that enhance an individual’s health status during adulthood may also contribute to more advantageous earning profiles and to higher educational attainment. In this case the observed association between social position or class, on the one hand, and health status and