McCartney Gerry, Bartley Mel, Dundas Ruth, Katikireddi Srinivasa Vittal, Mitchell Rich, Popham Frank, Walsh David, Wami Welcome
NHS Health Scotland, 5th Floor, Meridian Court, 5 Cadogan Street, Glasgow, Scotland, UK.
SSM Popul Health. 2018 Nov 2;7:015-15. doi: 10.1016/j.ssmph.2018.10.015. eCollection 2019 Apr.
The literature on health inequalities often uses measures of socio-economic position pragmatically to rank the population to describe inequalities in health rather than to understand social and economic relationships between groups. Theoretical considerations about the meaning of different measures, the social processes they describe, and how these might link to health are often limited. This paper builds upon Wright's synthesis of social class theories to propose a new integrated model for understanding social class as applied to health. This model incorporates several social class mechanisms: social background and early years' circumstances; Bourdieu's habitus and distinction; social closure and opportunity hoarding; Marxist conflict over production (domination and exploitation); and Weberian conflict over distribution. The importance of discrimination and prejudice in determining the opportunities for groups is also explicitly recognised, as is the relationship with health behaviours. In linking the different social class processes we have created an integrated theory of how and why social class causes inequalities in health. Further work is required to test this approach, to promote greater understanding of researchers of the social processes underlying different measures, and to understand how better and more comprehensive data on the range of social class processes these might be collected in the future.
关于健康不平等的文献通常从实用角度使用社会经济地位指标对人群进行排名，以描述健康方面的不平等，而非理解不同群体之间的社会和经济关系。对于不同指标的含义、它们所描述的社会过程以及这些过程如何与健康相联系的理论思考往往较为有限。本文基于赖特对社会阶级理论的综合，提出了一个新的综合模型，用于理解应用于健康领域的社会阶级。该模型纳入了多种社会阶级机制：社会背景和早年境遇；布迪厄的惯习和区隔；社会封闭和机会囤积；马克思主义关于生产的冲突（支配与剥削）；以及韦伯主义关于分配的冲突。歧视和偏见在决定群体机会方面的重要性也得到了明确承认，与健康行为的关系亦是如此。在将不同的社会阶级过程联系起来的过程中，我们构建了一个关于社会阶级如何以及为何导致健康不平等的综合理论。还需要进一步开展工作来检验这一方法，以促进研究人员对不同指标背后的社会过程有更深入的理解，并了解未来如何更好、更全面地收集关于这些社会阶级过程范围的数据。
