Complex pathways to understanding socioeconomic inequalities in health and health behavior: How resources shape the ability to act

Abstract

The research presented in this thesis contributes to our understanding of complex pathways to socioeconomic inequalities in health and health behavior in adulthood in Western high-income countries. Investigations of specific, theory-based pathways and a broader understanding of the complex system underlying socioeconomic inequalities in health provided insights into the nuanced ways in which the different types of resources individuals have access to (economic, social, cultural) shape their ability to act and their health and health behavior. A few main findings were that mechanisms may be behavior-specific, meaning that different types of resources are important for different health behaviors, broader social structures directly impact the specific contexts individuals inhabit and should be considered in research on this topic, and there is likely a reinforcing process between the resources individuals have access to and their ability to act over time. Based on my work, I see opportunities to incorporate more key properties of a complex systems perspective (e.g., feedback loops) into regression-based studies, to integrate more theory into complex systems work, and for complex systems models to inform the pathways we investigate using regression-based methods. My findings do not point to straightforward solutions to address socioeconomic inequalities in health, though these may not be the types of solutions we should be seeking. Instead, understanding how individuals are actively, autonomously able to act in ways that impact their health, within the constraints of their resources, societal structures, and the paradigm governing their complex worlds requires in-depth engagement with those individuals and with the complex system as a whole.