Medical Sociology Ep. 1: The most important theory for living with empathy

Looking at two of the most formative medical sociology theories that made me decide to dedicate my life to this

I feel like I don’t talk a lot about what I study on Tik Tok, but it’s something that I’m really passionate about and am asked about it pretty frequently by followers. I study medical sociology, and I truly think it’s something that everyone should learn about to some degree. Even if you’re not intellectually interested in the topics, it’s so important for moving throughout the world with empathy and understanding how many factors go into the conditions that you see people existing in all around you. So I’m going to start a series on here discussing different medical sociology and social determinants of health theories that I think everyone should know. I will be putting this series on public because I think it’s unethical to financially gatekeep public health education, but I will be posting some of my papers to my paid subs :)

In this episode, I want to discuss three of the most fundamental theories that showed me just how important and underrated this field of study is: stress process theory, cumulative disadvantage theory, and fundamental cause theory.

Fundamental cause theory explains how such drastic health inequities like the mortality gradient across socioeconomic status (I will hereon refer to this as “SES” for brevity) continue to exist - and even worsen - despite constant medical advancement. It essentially establishes that health inequities are socially reproduced, which is the core theory behind medical sociology. The primary focus is that SES and health are inherently linked; this link operates through knowledge, power/prestige, income/wealth, and social networks; and SES affects health primarily through risk factors, mostly being neighborhood conditions, medical knowledge, healthy behaviors, and baseline access to medical care. There is an emphasis on the flexible resources (knowledge, wealth, social networks) - they can flexibly command resources just as effectively no matter what changes in risk factors, protective factors, or in the disease itself. This is key to another central tenet of FCT, which is that SES health gradients reproduce themselves over time, regardless of changes in circumstances. Intervening mechanisms will continue to change, thus the SES-health link is ever-changing but still remains. This part of the theory took me a while to understand in class, and I think it clicked with an example, taken from a great article in the Journal of Health and Social Behavior: before screening for colon cancer existed, there was no mechanism that could link SES to health outcomes in being able to detect colon cancer early and prevent cancer mortality. However, the invention of cancer screenings immediately established a link between SES and health, wherein people with more resources were able to access screenings more and thus reduce mortality (Phelan, Link & Tehranifar 2010). The creation of cancer screenings in itself became a mechanism that reproduced the link between social conditions and health. This link is constantly reproduced throughout changes in intervening mechanisms.

Stress process theory describes how one’s social characteristics (race, gender, socioeconomic status) determines their stress exposures (discrimination, lack of resources, violence, etc.), which then affects their health, and the strength of this effect is mediated by social/personal resources (which is often also determined by one’s various social statuses). It is essential to understanding that one’s health has so little to do with the individual’s actions or particular lifestyle choices, and so much more to do with their external conditions. What was so shocking for me to learn more about this theory is how little it’s implemented in actual healthcare and health learning, both of which seem to still focus on emphasizing individual choices as the basis of health. Stress process theory can also be used to describe the effects of stress on health in the life course perspective - stressful life events (ex: losing a job) lead to negative role changes (employed → unemployed), new role changes lead to increased chronic stress exposure (financial insecurity, social stress of not being in a role to support your loved ones), which then impacts health. However, the strength with which these factors relate to each other and combine to impact health is mediated by the support and coping resources available. This is where socioeconomic status, race, gender, ability, etc. come in to establish drastic health disparities in response to chronic life stressors.

Cumulative disadvantage theory lies in a similar vein, but I think is much more critical to the empathy aspect that I mentioned earlier, hence why I really think it should be mandatorily taught in health classes (in my ideal world). It may seem like a pretty basic Discrimination and Inequity 101 idea, but I think it’s more nuanced. So if you read this and think “no duhhh”, fuck you! Essentially, we are all born into various circumstances (socioeconomic status, race, gender, etc.) that determine our socially-structured variations in stress exposure. Those circumstances likely also determine our access to resources to help cope with such stress exposures, as well as the efficacy of those resources to actually help treat/cope with our symptoms. Cumulative disadvantage theory describes how the differences that exist among a given cohort of people in a particular measure (in this case, health) can widen over the life course - even exponentially - due to the cumulative effects of social structures on chronic stress and ability/resources to cope. For example, this theory establishes plainly that women accumulate more disadvantages than men. Of course it’s not that cut-and-dry, there are significant nuances introduced by, say, race. But at a very basic level, CDT posits that a woman and man born into roughly the same conditions will develop into vastly different conditions with vastly different health outcomes, with the overall trend being that the woman encounters more chronic stress, and the accumulation thereof affects her access to or the efficacy of coping resources. I found cumulative disadvantage theory to be a particularly compelling response to bigoted pop culture “criticisms” of obese people, but I have too much to say on that for this one post (more on that to come).

I wanted to establish these right off the bat because I will continue to reference them a lot in future publications about the topic.

This is just a barely-even-introduction to such a fascinating, nuanced, and ever-growing field. What I want you to get out of this is that all the most advanced medicine in the world can’t create a healthy population. In fact, health has almost nothing to do with what goes on in hospitals. And it’s also not so much to do with an individual’s choices to smoke cigarettes or eat vegan, but rather the conditions that exist both within and around them that affect the choices they even can make. The more I delved into this field, the more I realized that public health has ALMOST nothing to do with actual healthcare - public health is housing, welfare, social safety nets, urban planning, education, labor rights . . . it’s everything that happens to you before you end up in the hospital.

Phelan, J., Link, B., & Tehranifar, P. (2010) Social Conditions as Fundamental Causes of Health Inequalities: Theory, Evidence, and Policy Implications. Journal of Health and Social Behavior (51) 28-40