Gradients, socioeconomic

The results regarding socioeconomic gradients undermines the hypothesis that the principal social class influence on health is material deprivation. In fact, the social class gradient in health cuts deeply into the affluent middle classes. The implication is that the conditions under which people live can affect human health directly, and not only through material deprivation. Early childhood experience, one s place in the social environment, and the experiences of daily life must be powerful determinants of the length and healthfulness of life (Kelly et al., 1997, p. 438). 

In sum, Wilkinson focuses his explanatory hypothesis on social anxiety. He links social anxiety to shame, depression and violence, and emphasizes that social anxiety has its roots in perceptions of inferiority, unattractiveness, failure or rejection. This helps explain why health is so closely related to lack of friends, low social status, violence and poor early emotional attachment, all of which are associated with similar patterns of raised basal cortisol levels and attenuated responses to experimental stressors. He concludes, therefore, that social anxiety is a very plausible central source of the chronic anxiety that depresses health standards and feeds into the socioeconomic gradient in health. As he puts it, the most important psychosocial determinant of population health is the levels of the various forms of social anxiety in the population, and these in turn are determined by income distribution, early childhood and social networks (Wilkinson, 1999, p. 60). Thus, social anxiety is suggested as an explanation for the links between health and friendship, health and early emotional development, health and the direct psychosocial effects of low social status, the patterning of violence and health in relation to inequality, and health and social cohesion (Wilkinson, 1999, p. 61). 

Elizabeth Lloyd That you cannot give a full explanation of what s happening in the group without giving an account of the gradient, and, in fact, the difference in socioeconomic gradients - I wouldn t prefer to call them causal myself but that they are descriptors of the situation that you cannot take them away from the explanation and understand it in the same way. I said one explains the phenomena in terms of what types of entities and their properties and so I take that to be a standard definition of a reductionist or anti-reductionist position. 

Elizabeth Lloyd An explanation that, for example, said why it was that living in a society with a steep socioeconomic gradient was correlated with the kind of death and mortality rates that we re showing, and why living in a society with a much shallower gradient was correlated with a much lower death rate. 

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