SOCIAL CONDITIONS AS FUNDAMENTAL CAUSES OF DISEASE

Over the last several decades, epidemiological studies have been enorm ously successful in identifying risk factors for major diseases. Howev er, most of this research has focused attention on risk factors that a re relatively proximal causes of disease such as diet, cholesterol lev el, exercise and the like. We question the emphasis on such individual ly-based risk factors and argue that greater attention must be paid to basic social conditions if health reform is to have its maximum effec t in the time ahead. There are two reasons for this claim. First we ar gue that individually-based risk factors must be contextualized, by ex amining what puts people at risk of risks, if we are to craft effectiv e interventions and improve the nation's health. Second, we argue that social factors such as socioeconomic status and social support are li kely ''fundamental causes'' of disease that, because they embody acces s to important resources, affect multiple disease outcomes through mul tiple mechanisms, and consequently maintain an association with diseas e even when intervening mechanisms change. Without careful attention t o these possibilities, we run the risk of imposing individually-based intervention strategies that are ineffective and of missing opportunit ies to adopt broad-based societal interventions that could produce sub stantial health benefits for our citizens.