The Blackwell Companion to Medical Sociology

Health and Social Stratification 69
Figure 4.1 Main determinants of health
Source: Dahlgren and Whitehead 1991.
behaviors, such as smoking, drinking, eating and exercising, are likely to be
health-damaging or health-promoting. Thirdly, individuals do interact with each
other in communities and the mutual support provided helps sustain the health
of its members. Fourthly, people's material livingand workingconditions influence
their ability to maintain good health. These conditions vary a lot between
individuals, groups, and whole societies. Fifthly, social, structural, cultural, and
other environmental factors characterizingcommunities and whole societies
contribute to people's health and its social patterning.
An examination of health inequalities will concentrate on the social structural
influences included in the outermost layer of Dahlgren and Whitehead's model.
However, in accordance with the research tradition, the model emphasizes
interrelationships between the determinants effective at different levels. Therefore,
an examination of social inequalities in health needs to make frequent
reference to other layers of the social determinants as well. Particularly, attention
should be paid to how gender and life course shape the social patterning of
health.
The he Dimensions imensions of Health ealth
The Black Report (Townsend and Davidson 1982) and studies earlier on in the
health inequalities research tradition have relied mostly on mortality and main
causes of death. Very often only men have been included. The main reason for
these limitations is availability of data. Additionally, mortality data has advantages
in being reliable and valid in most countries, and allowing comparisons