The argument here is that the social determinants of health play their role through citizens’ interpretations of their standings in the social hierarchy.[97][98] There are two mechanisms by which this occurs.
At the individual level, the perception and experience of one’s status in unequal societies lead to stress and poor health. Comparing their status, possessions, and other life circumstances to those better-off than themselves, individuals experience feelings of shame, worthlessness, and envy that have psychobiological effects upon health. These processes involve direct disease-producing effects upon neuro-endocrine, autonomic and metabolic, and immune systems.[99] These comparisons can also lead to attempts to alleviate such feelings by overspending, taking on additional employment that threaten health, and adopting health-threatening coping behaviours such as overeating and using alcohol and tobacco.[100]
At the communal level, widening and strengthening of hierarchy weakens social cohesion, a determinant of health.[101] Individuals become more distrusting and suspicious of others with direct stress-related effects on the body. Such attitudes can also weaken support for communal structures such as public education, health, and social programs. An exaggerated desire for tax reductions on the part of the public can weaken public infrastructure.
This approach directs attention to the psychosocial effects of public policies that weaken the social determinants of health. But these effects may be secondary to how societies distribute material resources and provide security to its citizens – processes described in the materialist and neo-materialist approaches. Material aspects may be paramount and the stresses associated with deprivation simply add to the toll on individuals’ bodies.
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