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Social Inequalities in HealthNew evidence and policy implications$
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Johannes Siegrist and Michael Marmot

Print publication date: 2006

Print ISBN-13: 9780198568162

Published to Oxford Scholarship Online: September 2009

DOI: 10.1093/acprof:oso/9780198568162.001.0001

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Socio-economic differences in health

Socio-economic differences in health

Are control beliefs fundamental mediators?

(p.153) Chapter 7 Socio-economic differences in health
Social Inequalities in Health

Hans Bosma

Oxford University Press

This chapter addresses the role of control beliefs in socio-economic differences in health and provides support for the assumption that low control beliefs might be fundamental mediators in the association between low socio-economic status and poor health. It begins with a socio-historical background to the unhealthy psychological profile in lower socio-economic status groups. It then presents evidence for low control beliefs being, at least partially, rooted in both childhood and adulthood socio-economic circumstances, and the possibility that these beliefs might also be related to the wider socio-economic environment, as defined by neighbourhoods and countries. The chapter presents evidence for low control beliefs being related to heightened risks of disease through varying pathways. It quantifies the contribution of low control beliefs to the socio-economic status-disease association. The possibility that control beliefs may be involved in status attainment processes and the consequences of this for a potential influence of indirect selection are then discussed. Other remaining questions, such as conceptual and empirical issues regarding the control concept, are addressed in the penultimate section. Finally, implications for, and difficulties of, efficient and effective interventions are discussed.

Keywords:   low control beliefs, socio-economic environment, health outcomes, social inequality, poor health

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