Goijaerts Janna, van der Zwan Natascha, Bussemaker Jet
Department Public Health and Primary Care/Health Campus The Hague, Leiden University Medical Centre, The Hague, Netherlands.
Institute of Public Administration, Faculty Governance and Global Affairs, Leiden University, The Hague, Netherlands.
Sociol Health Illn. 2025 Jan;47(1):e13879. doi: 10.1111/1467-9566.13879.
Despite welfare state expansion in liberal democracies during the 20th century, health inequalities between socio-economic groups persist. Understanding individuals' lived experiences can inform policy for reducing unequal health outcomes in these lives. We build on Fundamental Cause Theory (FCT), which posits that low socio-economic status is the fundamental cause of health problems in (later) life. We argue that this theory is incomplete in developing policy interventions to tackle unequal health outcomes, because it assumes the relationship between socio-economic status and health to be linear and unidirectional. Based on our findings from biographic interviews of 15 disadvantaged individuals in the Netherlands, we propose a refinement of FCT by taking into account the complex life trajectories of individuals experiencing unequal health outcomes. Specifically, we argue that these individuals' trajectories can be broken down into at least five distinct patterns (ping-pong, snowball, escalator, quicksand and lever) between socio-economic and health issues. These patterns provide a theoretical addition to the existing FCT on the dynamics of life trajectories, the intensity with which problems develop and the importance of external factors. This helps not only to understand the emergence of health problems, but also to imagine more suitable policy responses.
尽管20世纪自由民主国家的福利国家有所扩张，但社会经济群体之间的健康不平等现象依然存在。了解个人的生活经历可为减少这些人群中不平等健康结果的政策提供参考。我们以根本原因理论（FCT）为基础，该理论认为社会经济地位低下是（晚年）健康问题的根本原因。我们认为，该理论在制定应对不平等健康结果的政策干预措施方面并不完善，因为它假定社会经济地位与健康之间的关系是线性和单向的。基于我们对荷兰15名弱势群体进行的传记访谈结果，我们建议通过考虑健康结果不平等个体的复杂生活轨迹来完善根本原因理论。具体而言，我们认为这些个体的轨迹在社会经济和健康问题之间至少可以分为五种不同模式（乒乓球模式、雪球模式、自动扶梯模式、流沙模式和杠杆模式）。这些模式在生活轨迹动态、问题发展强度以及外部因素的重要性方面为现有的根本原因理论提供了理论补充。这不仅有助于理解健康问题的出现，还有助于设想更合适的政策应对措施。
