Health Disparities in the Nineteenth Century United States: Fundamental Cause Theory and the Pre-Modern Era

• In Event: 343 - Section on Medical Sociology Roundtables (one-hour)
  In Refereed Roundtable: Table 03. Health Disparities

Abstract

Fundamental Cause Theory (Freese and Lutfey 2011; Link and Phelan 1995) postulates two sets of meta-mechanisms that account for the enduring association between socioeconomic status and disease. First, people may exercise agency to intentionally access and utilize health knowledge to avoid disease. Second, gradients in contextual exposures may account for gradients in morbidity. In this paper we investigate the magnitude and nature of health disparities in the United States in the late 19th century—an era in which there was very little effective or accurate information about what caused the most common diseases and disabilities or how to avoid them. This empirical work informs theoretical discussions about the importance of the contextual exposures set of meta-mechanisms for health disparities. Were there health disparities in an era in which the agency meta-mechanism was unavailable because advantaged people could do very little to effectively avoid disease by obtaining and acting on health knowledge? To address these questions, we use data form the 10% and 1% micro-data samples from the 1880 U.S. Census—the only decennial enumeration that included questions about health and disability status. Our preliminary analyses demonstrate that there were socioeconomic and demographic disparities in morbidity in the United States in 1880. We conclude by elaborating on the theoretical implications of this basic empirical finding: Health disparities can arise even when there is little useful health knowledge and thus even when advantaged people cannot exercise agency to intentionally protect their health.

Authors

• John Robert Warren, University of Minnesota

• Sarah Garcia, University of Minnesota