Explanatory perspectives

Abstract

Chapter 3 (‘Explanatory perspectives’) provides a digest of the vast amounts of explanatory research on health inequalities that has been conducted over the past three decades. It introduces recent methodological advances, such as the counterfactual approach to causality, quasi-experimental study designs, and mediation analysis. It reviews the scientific evidence that education, occupational class and income have a causal effect on health. It introduces life-course models, summarizes current understanding of the role of six groups of contributing factors (genetics, childhood environment, material living conditions, social and psychological factors, health-related behaviours, and health care), and describes the biological mechanisms of ‘embodiment’ of social inequality. It also discusses the merits of nine overarching theories of health inequalities: ‘social selection’, ‘diffusion of innovations’, ‘cultural capital’, ‘inverse equity’, ‘inverse care law’, ‘neo-materialism’, ‘psychosocial environment’, ‘fundamental causes’ and ‘political economy of health’.