interaction of numerous characteristics of a population, not only at the individual level but also at structural levels in order to capture the multiple factors that influence individual lives. Most of the research using intersectionality theory, however, has been qualitative because of the difficulty in measuring all variables simultaneously using quantitative methods.
Pierre Bourdieu
Once ranked as the leading intellectual in France, Bourdieu (1984) focused on how the routine practices of individuals are influenced by the external structure of their social world and how these practices, in turn, reproduce that structure. Through his key concept of habitus, Bourdieu connects social practices to culture, structure, and power (Swartz 1997). Bourdieu (1990) describes the habitus as a mental scheme or organized framework of perceptions (a structured structure operating as a structuring structure) that predisposes the individual to follow a particular line of behavior as opposed to others that might be chosen. These perceptions are developed, shaped, and maintained in memory and the habitus through socialization, experience, and the reality of class circumstances. While the behavior selected may be contrary to normative expectations and usual ways of acting, behavioral choices are typically compatible with the dispositions and norms of a particular group, class, or the larger society; therefore, people tend to act in predictable and habitual ways even though they have the capability to choose differently. Through selective perception, the habitus adjusts aspirations and expectations to “categories of the probable” that impose boundaries on the potential for action and its likely form.
Of all Bourdieu’s works, the one most relevant for medical sociologists remains his book Distinction (1984), in which he systematically accounts for the patterns of cultural consumption and competition over definitions of taste of the French social classes. It includes an analysis of food habits and sports that describes how a class-oriented habitus shaped these particular aspects of health lifestyles. Cockerham (1999, 2000, 2007; Cockerham et al. 1997) follows Bourdieu’s theoretical framework in his theory of health lifestyles and in identifying negative health lifestyles as the primary social determinant of ongoing downturn in life expectancy in Russia. The group most responsible for reduced longevity are middle-age, working-class males. The living conditions of these men and their relatively low and powerless position in the social structure produced a habitus fostering unhealthy practices (heavy drinking and smoking, disregard for diet, and rejection of exercise) that resulted in a lifestyle promoting heart disease, accidents, and other health problems leading to a shortened life span. These behaviors were norms established through group interaction, shaped by the opportunities available to them, and internalized by the habitus. The structure of everyday life both limited and molded health-related choices to the extent that lifestyles led to premature deaths.
According to Williams (1995), the merit of Bourdieu’s analysis for understanding the relationship between class and health lifestyles lies in his depiction of the relative durability of various forms of health-related behavior within particular social classes and the relatively seamless fashion in which he links agency and structure. “In particular,” states Williams (1995: 601), “the manner in which his arguments are wedded to an analysis of the inter-relationship between class, capital, taste, and the body in the construction of lifestyles … is both compelling and convincing.” Although Bourdieu has been criticized for overemphasizing structure at the expense of agency and presenting an overly deterministic model of human behavior (Münch 1993), he nevertheless provides a framework for medical sociologists to conceptualize health lifestyles and for sociologists generally to address the agency–structure interface (Cockerham 2005).
Life Course Theory
Life course theory in medical sociology is intended to explain how social experiences and conditions of adversity and inequality in childhood and adolescence affect health later in life. The theory advances the proposition that people go through a sequence of age-based stages and social roles within particular families and social structures over the course of their lives. It maintains that socioeconomic disadvantages originating in childhood accumulate over the life course to disadvantage health in old age, while socioeconomic advantages over a person’s lifetime likewise accumulate but do so to promote relatively good health when elderly. It considers both the early origins of chronic diseases whose symptoms are not obvious until later in life and the social processes and behaviors that promote susceptibility to these diseases until older ages or avoidance of such afflictions.
A subcategory of life course theory that is commonly utilized in medical sociology is the concept of cumulative advantage/disadvantage (Ferraro et al. 2016; Willson and Shuey 2019). It posits that the initial advantages or disadvantages that people have in life, including health, are typically associated with structural variables – especially SES, but others such as gender and race. The effects of these variables accumulate over time in either positive or negative ways to benefit or erode health. Another subcategory is cumulative inequality theory which likewise maintains that early disadvantage increases the later potential for risks to health, but it also acknowledges the potential use of resources at mid-life to mitigate or eliminate the effects of early life disadvantages before the onset of old age (Williams et al. 2019). Cumulative inequality theory begins with an initial position that negative life events and experiences place people at increased risk, positive experiences create opportunities for them, and both can alter life chances for individuals and groups for better or worse.
The Stress Process
Leonard Pearlin (1989) is known for the stress process model and his initial paper on this topic is the most cited paper in medical sociology. He states that stress involves a demanding situation whose experience of it is perceived as threatening or burdensome. In his view, stress originates in situations, yet what is also important is how people react to it in the context of their lives. This meant there is much more to stress research than simply looking at how people respond to certain stressors but also the social circumstances of stressed people. Pearlin maintained that the stress process consists of three components: (1) stressors, which he defines as any condition having the potential to arouse the adaptive capacity of the individual; (2) moderators, which consist of coping abilities, sense of mastery, and sources of social support; and (3) outcomes, the health effects of the distress experienced by the person. He identified two major types of social stressors: life events and chronic strain. The theory holds that not all people react to these stressors the same way because of differences in stress moderators which, in turn, influence different outcomes. The merit of Pearlin’s stress process model is that it links the experience of stress directly to patterns of social stratification through its depiction of the origins of stress, its mediators, and outcomes.
Fundamental Cause Theory
The most popular theoretical concept in American medical sociology today is Bruce Link’s and Jo Phelan’s (1995; Phelan and Link 2013) theory of fundamental causes. The theory maintains that in order for a social variable to qualify as a fundamental cause of sickness and mortality, it must meet four basic criteria: First, it must influence multiple disease outcomes. Consequently, the association is not limited to affecting only one or a few diseases but many. Socioeconomic status qualifies, for example, because SES is related to virtually all major causes of death from disease. Second, it must impact the onset and outcomes of diseases through multiple risk factors, not just one or two. So there have to be more than a few ways it can cause people to become sick, such as stress, smoking, unhealthy diets, poor housing, obesity, drug and alcohol abuse, lack of exercise, and insufficient preventive health care. Third, it involves access to resources that can be used to avoid risks or minimize the consequences of a disease if a person does become ill. And fourth, the connection with health is reproduced over time. That is, the effects persist despite changes in risks, protective factors, and diseases which led Link and Phelan (1995: 87) to call them “fundamental” in the first place. In order to test the theory, empirical validation of these four core features are required.
SES
