Intended for healthcare professionals


Social mobility and health: cause or effect?

BMJ 1996; 313 doi: (Published 24 August 1996) Cite this as: BMJ 1996;313:435
  1. Espen Dahl
  1. ESPEN DAHL Research director Institute for Applied Social Science, Pb 2947 T(empty set)yen, 0608 Oslo, Norway

    More likely that adverse social circumstances cause ill health than the other way around

    Since the publication of the Black report in 1980,1 health researchers throughout the industrialised world have given extensive attention to the issue of inequalities in health. Health inequalities are large, widespread, and remarkably persistent. Different socioeconomic indicators give roughly the same picture, showing inequalities with a variety of health measures2 in both sexes and at all ages, with adolescence as a possible exception.3 The consistent and robust links between socioeconomic status and health suggest that scientists of different disciplines have a lot to explain.

    Much discussion has been devoted to the relative explanatory power of two hypotheses: social causation and health selection. The social causation hypothesis maintains that health is related to socially determined structural factors such as working environment or behavioural factors such as diet. The health selection hypothesis maintains that social mobility is affected by health, and that the healthy move up the class hierarchy while the less healthy move down.

    In this week's issue of the BMJ, two studies shed new light on the health selection-social causation controversy. The two studies have different methodological designs, …

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