Читать книгу The Social Causes of Health and Disease - William C. Cockerham - Страница 7

The capability of social factors to make people ill seems to be widely recognized by the general public. Ask people if they think society can make them sick, and the probabilities are high they will answer in the affirmative. Stress, poverty, low socioeconomic status, unhealthy lifestyles, and unpleasant living and work conditions are among the many inherently social variables typically regarded by lay persons as causes of ill health. However, with the exception of stress, this view is not expressed in much of the research literature. Studies in public health, epidemiology, behavioral medicine, and other sciences in the health field typically minimize the relevance of social factors in their investigations. Usually social variables are characterized as distant or secondary influences on health and illness, not as direct causes (Link and Phelan 1995, 2000; Phelan and Link 2013). Being poor, for example, is held to produce greater exposure to something that will make a person sick, rather than bring on sickness itself. However, social variables have been found to be more powerful in inducing adversity or enrichment in health outcomes than formerly assumed. Society may indeed make you sick or, conversely, promote your health.

It is the intent of this book to assess the evidence indicating that this is so. It is clear that most diseases have social connections. That is, the social context can shape the risk of exposure, the susceptibility of the host, and the disease’s course and outcome – regardless of whether the disease is infectious, genetic, metabolic, malignant, or degenerative (Holtz et al. 2006). This includes major afflictions like heart disease, Type 2 diabetes, stroke, cancers like lung and cervical neoplasms, HIV/ AIDS and other sexually-transmitted infections, pulmonary diseases, kidney disease, and many other ailments. Even rheumatoid arthritis, which might at first consideration seem to be exclusively physiological, is grounded in socioeconomic status, with lower-status persons having a significantly greater risk of becoming arthritic than individuals higher up the social scale (Bengtsson et al. 2005; Pederson et al. 2006). Consequently, the basic thesis of this book is that social factors do more than influence health for large populations and the lived experience of illness for individuals; rather, such factors have a direct causal effect on physical health and illness.

How can this be? Just because most diseases have a social connection of some type does not necessarily mean that such links can actually cause a disease to occur – or does it? Social factors such as living conditions, lifestyles, stressors, norms, social values, and attitudes are obviously not pathogens like germs or viruses, nor are they cancer cells or coagulated clots of blood that clog arteries. Yet, quarantined in a laboratory, viruses, cancers, and the like do not make a person sick. They need to be exposed to a human host and assault the body’s physiological defenses in order to be causal. However, assigning causation solely to biological entities does not account for all of the relevant factors in a disease’s pathogenesis, especially in relation to the social behaviors and conditions that bind the person to the disease in the first place. Social factors can initiate the onset of the pathology and, in this way, serve as a direct cause for several diseases. Two of many examples are the coronavirus and smoking tobacco.