Towards to Better Understanding the Persistent Association Between SES and Health: The Intersections Between Fundamental Cause, Diffusion of Innovations and Cultural-Health Capital Theories

Fundamental Cause (FCT) is one of the most relevant theoretical contributions from medical sociology in the past twenty years (Link and Phelan, 1995). Most empirical tests of FCT have focused on how “flexible resources” play a critical role in the persistence of an inverse association between SES and health. In addition, another set of empirical papers have been testing how specific preventive innovations shape and reshape the association between SES and health in favor of higher SES. So, most empirical studies have focused on the mechanisms that reproduce health inequalities. A core proposition of FCT, namely that these mechanisms are replaced by new ones over time has received far less attention. We state that an intersection of three theories, namely FCT, Diffusion of Innovation and Cultural-Health Capital, helps to explain why the association between SES and health persist beyond extensive dissemination of preventive knowledge.

The objectives of our study are threefold: (a) to shed light on how new mechanisms emerge along different dissemination stages of preventive knowledge; (b) to test whether old mechanisms wane in importance in relation to this dissemination process, and (c) to discuss whether cultural-health capital is the "key flexible” resource that provides the ability to transfer others resources into good health.

We use data from two waves of the Spanish National Health Survey (2006-2007; 2011-2012) to explore this issue and test our hypotheses. We base our empirical analysis on health-care preventive practices with different rates of adoption by our target populations.  

Result shows that the emergence and demise of the mechanisms is associated with the diffusion process of preventive health knowledge. Results also show that, during the subsequent stages of the diffusion process, (incorporated) cultural health capital gains relevance as a flexible resource that contributes to inequalities in preventive health care use.