School of Sociology, University College Dublin, Dublin, Ireland.
Sociol Health Illn. 2020 Sep;42(7):1626-1641. doi: 10.1111/1467-9566.13156. Epub 2020 Jul 28.
Fundamental Cause Theory (FCT) is among the most influential explanations for health inequalities. The theory posits that the social gradient in health persists because higher-socioeconomic status (SES) groups are systematically more able to take advantage of new medical innovations and health-enhancing knowledge due to their greater access to resources. Taking the life histories of people with diabetes (PwD) (N = 17) in the Republic of Ireland as a case study, this paper aims to elucidate the behaviours and agencies underlying 'fundamental causality' through examining how PwD of contrasting SES respond to disease management information. Findings highlight how the most common barriers to effective diabetes control were chronic psychological distress, combined with the cultural significance of alcohol consumption, which was central to both the social and economic subsistence of male participants in particular. However, higher-SES groups were more likely to experience a 'turnabout' in their life, whereby they could remove themselves from the conditions giving rise to their distress and move into a social space where more health-enhancing behaviours were possible. It concludes with a discussion of potential mechanisms that may explain why such turnabouts were more likely to occur in the case of higher-SES groups and the implications for FCT.
基础病因理论（FCT）是解释健康不平等现象最有影响力的理论之一。该理论认为，健康状况的社会梯度持续存在，是因为较高社会经济地位（SES）的群体由于能够更充分地利用资源，因此更有能力利用新的医学创新和增进健康的知识。本文以爱尔兰共和国的糖尿病患者（PwD）（N=17）的生活史为例，旨在通过研究 SES 不同的 PwD 对疾病管理信息的反应，阐明“基础因果关系”背后的行为和机构。研究结果突出表明，有效控制糖尿病的最常见障碍是慢性心理困扰，再加上饮酒的文化意义，这对男性参与者的社会和经济生存都至关重要。然而，较高 SES 群体更有可能经历“转机”，使他们能够摆脱导致其痛苦的条件，并进入一个更有可能采取增进健康行为的社会空间。最后，本文讨论了可能的机制，这些机制可以解释为什么在较高 SES 群体中更有可能出现这种转机，并探讨了这些机制对 FCT 的影响。
