Understanding Health Disparities: The Promise of the Stress Process Model

摘要: Evidence revealing racial and socioeconomic disparities in health has long been available continues to accumulate. Among those that are now well documented Black-white inequities overall health, all-cause mortality life expectancy, low birth weight, infant mortality, reproductive hypertension heart disease, as various psychiatric substance use problems. Similar found across status (SES). Although race SES associated, prior research substantial within (Geronimus et al. 1996; Williams 1999). This paper argues progress understanding the origins of such consequential can be materially enhanced by adopting theoretical guidance embodied work Leonard I. Pearlin. It is hypothesized arise a degree from differences lifetime exposure social stress. For more than quarter century, Pearlin’s stress process model represented dominant perspective researchers attempting identify potentially modifiable contingencies mental health. The high success accounting for variations depressive symptoms psychological distress suggests its potential power advancing our disparities.These have massive impact terms unequal suffering dramatic economic costs. thus no surprise accumulated aimed at identifying disparities. clear availability, use, effectiveness medical care (e.g. Escarce 1993; Ferguson 1997; Fincher 2004; Johnson Klabunde 1998; Peterson 1997), level trust institutions physicians, implicated (Doescher 2000; Kao 1998a, b; Saha 2003; Thom Campbell variety behaviors (Fraser Healthy People 1990; McGinnis Foege 1993). However, it also adjustments these collective leave majority unexplained Lynch Marmot Lantz 2001). Available evidence points conclusion factors play fundamental role – includes but goes substantially beyond their significance established risk poor nutrition, smoking, sedentary style, obesity. consensus yet emerged about identity or nature how they might effectively addressed. will argued this state affairs arises several significant deficiencies characterized most studies, including failure studies physical general outcomes take advantage conceptual insights