also happens to reside in a disadvantaged community (where other families are poor) rather than in a middle-class community. Furthermore, poverty may differentially and independently affect the health of an individual at different stages of the life course (e.g., in utero, during infancy and childhood, during pregnancy, or during old age).

In short, the influence of social and cultural variables on health involves dimensions of both time (critical stages in the life course and the effects of cumulative exposure) as well as place (multiple levels of exposure). The contexts in which social and cultural variables operate to influence health outcomes are called, generically, the social and cultural environment.


In recent years, social scientists and social epidemiologists have turned their attention to a growing range of social and cultural variables as antecedents of health. These variables include SES, race/ethnicity, gender and sex roles, immigration status and acculturation, poverty and deprivation, social networks and social support, and the psychosocial work environment, in addition to aggregate characteristics of the social environments such as the distribution of income, social cohesion, social capital, and collective efficacy. Comprehensive surveys of current areas of research in the social determinants of health can be found in existing textbooks (Marmot and Wilkinson, 2006; Berkman and Kawachi, 2000). This chapter focuses on presenting the key research findings for a few selected social variables—SES, the psychosocial work environment, and social networks/ social support. These variables are highlighted because of their robust associations with health status and their well-documented and reliable methods of measuring these variables, and because there are good reasons to believe that these variables interact with both behavioral as well as inherited characteristics to influence health. Race/ethnicity, another set of important variables with robust associations to health, is addressed in Chapter 5.

SES and Health

An association between SES and health has been recognized for centuries (Antonovsky, 1967). Socioeconomic differences in health are large, persistent, and widespread across different societies and for a diverse range of health outcomes. In the social sciences, SES has been measured by three different indicators, taken either separately or in combination: educational attainment, income, and occupational status. Although these measures are moderately correlated, each captures distinctive aspects of social position,

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