Difficulty: Intermediate | Prerequisites: Basic understanding of health behaviours from Exam 1
Big picture: This section covers two major health-risk behaviours (smoking and drinking) and then broadens to the structural determinants of health: social class and race/ethnicity. The course asks you to understand not just what the health impacts are, but why they fall unevenly across populations. Four theoretical models explain how social class produces health disparities, and separate theories address how societal reactions to race and ethnicity affect health at both individual and population levels. This is some of the most conceptually dense material on Exam 2.
Smoking and drinking are major health-risk behaviours that affect different populations unequally. Health disparities between social classes are explained by four models (behavioural, materialist, psycho-social, life-course), and race/ethnicity produces its own layer of health inequity through societal reactions, discrimination, and unequal access to resources. The exam expects you to know who is most affected, why, and which theoretical model explains which mechanism.
Socioeconomic status (SES)
A composite measure of an individual's or family's economic and social position, typically based on income, education, and occupation. In simple terms, where you sit on the ladder of money, education, and job prestige.
Health disparities
Systematic, avoidable differences in health outcomes between population groups defined by social, economic, demographic, or geographic characteristics. Think of it as the gap in health between groups that should not exist if everyone had equal access and opportunity.
Behavioural model (of health disparities)
The theory that social class differences in health are explained by differences in health behaviours: wealthier people tend to make healthier choices (diet, exercise, smoking avoidance). In simple terms, rich people eat better and smoke less.
Materialist model
The theory that poverty directly exposes people to health-damaging material conditions: pollution, unsafe housing, hazardous work, poor-quality food, and limited healthcare access. Think of it as: your environment makes you sick, and poverty puts you in worse environments.
Psycho-social model
The theory that the psychological stress of being lower on the social hierarchy causes health damage, through chronic stress, perceived inequality, and reduced social support. In simple terms, poverty is stressful, and chronic stress harms the body.
Life-course model
The theory that health is shaped by the accumulation of advantages and disadvantages across an entire lifetime, from prenatal conditions through childhood, working life, and old age. Think of it as: health inequalities compound over time, like interest on a debt.
Certain populations are more likely to smoke: lower SES groups, certain racial/ethnic groups, people with mental health conditions, and those in high-stress environments
Smoking's health impacts are wide-ranging: cardiovascular disease, lung cancer, chronic obstructive pulmonary disease (COPD), stroke, and complications in pregnancy
Smoking is the single largest preventable cause of death in developed countries
Understanding population-level patterns (who smokes more and why) is more important for the exam than memorising specific statistics
Know who drinks: patterns vary by age, gender, SES, and culture
Health impacts of alcohol include liver disease, cardiovascular effects (both positive at low levels and negative at high levels), impaired judgement and accidents, addiction, and mental health consequences
The distinction between use and abuse matters: moderate consumption differs from problem drinking in both pattern and health outcomes
Alcohol abuse is linked to domestic violence, risky sexual behaviour, and workplace injuries
Behavioural model
Health disparities arise because wealthier people make better health choices
They are more likely to exercise, eat well, avoid smoking, and seek preventive care
Limitation: this model can imply that poor health is simply a matter of personal choice, ignoring structural constraints
Materialist model
Poverty exposes people directly to health-damaging conditions
Examples: living near industrial pollution, working in physically dangerous jobs, lacking access to clean water or healthy food, inability to afford healthcare
This model emphasises that the material environment, not just behaviour, drives health outcomes
Psycho-social model
The psychological experience of poverty and inequality causes health damage
Chronic stress from financial insecurity, social exclusion, and perceived low status activates the body's stress response persistently
Long-term stress damages cardiovascular, immune, and metabolic systems
Life-course model
Health is the product of accumulated advantage or disadvantage across the entire lifespan
Prenatal nutrition, childhood education, adult employment, and retirement security all compound
A child born into poverty faces not one health risk but a chain of risks that build on each other over decades
Racial and ethnic groups experience systematic health disparities: differences in life expectancy, chronic disease rates, maternal and infant mortality, and access to care
These disparities are driven by societal reactions to race/ethnicity (discrimination, residential segregation, unequal access to education and employment), not by biological race itself
Theories focus on how racism operates at both the individual level (interpersonal discrimination, stereotype threat, mistrust of healthcare providers) and the population level (institutional racism, policy, and resource allocation)
The exam expects you to know health disparity statistics for Native American/First Nations peoples, Hispanic populations, and African Americans, at least directionally (higher, lower, growing, shrinking)
Assigned readings and videos are flagged as important sources for this section
Students often treat the four models of social class and health as competing theories. They are better understood as complementary lenses, each highlighting a different mechanism. The exam may ask you to compare them, not pick the "right" one.
Students sometimes assume the behavioural model blames individuals for their health. The model describes a pattern (wealthier people make healthier choices) but does not necessarily say this is the only explanation. The other three models address the structural reasons behind those choices.
Students frequently confuse the materialist and psycho-social models. The materialist model is about physical exposure (pollution, unsafe housing). The psycho-social model is about the psychological experience of inequality (stress, status). One is about what is in your environment; the other is about how your environment makes you feel.
Students sometimes treat racial health disparities as biological. The course emphasises that disparities are driven by social and structural factors (discrimination, access, segregation), not by inherent biological differences between races.
Be able to name and distinguish all four models of social class and health (behavioural, materialist, psycho-social, life-course) with a one-sentence summary and an example of each
Know the difference between individual-level and population-level mechanisms by which race/ethnicity affects health
Understand which populations are more likely to smoke and drink, and the major health consequences of each
Health disparity statistics for Native Americans, Hispanics, and African Americans are specifically flagged for the exam (know the direction of the disparity, not necessarily exact numbers)
The assigned readings and videos for race/ethnicity are called out as particularly useful sources
True or False: The materialist model explains health disparities through the psychological stress of being poor. (False: that is the psycho-social model. The materialist model focuses on physical/material exposures.)
Fill in the blank: The ______ model argues that health is shaped by accumulated advantages and disadvantages across the entire lifespan. (Life-course)
True or False: Racial health disparities are primarily caused by biological differences between races. (False: they are driven by social and structural factors.)
Fill in the blank: The behavioural model explains health disparities by arguing that wealthier people make healthier ______. (Choices / health behaviours)
True or False: Smoking is the single largest preventable cause of death in developed countries. (True)
Q: Compare and contrast the materialist and psycho-social models of health disparities.
A: The materialist model focuses on physical and material exposures: poverty places people in environments with pollution, unsafe housing, hazardous work, and poor food access. The psycho-social model focuses on the psychological impact of inequality: chronic stress from financial insecurity, low social status, and social exclusion damages health through sustained activation of the stress response. Both are structural explanations, but one operates through the physical environment and the other through psychological pathways.
Q: What does the life-course model add to our understanding of health disparities that the other three models do not?
A: The life-course model introduces a time dimension. Rather than explaining disparities through a single mechanism at one point in time, it argues that advantages and disadvantages accumulate across the entire lifespan, from prenatal conditions through childhood, adulthood, and old age. A child born into poverty faces compounding risks that build on each other over decades.
Q: How do societal reactions to race/ethnicity affect health at the individual and population levels?
A: At the individual level, discrimination, stereotype threat, and mistrust of healthcare providers affect health behaviours and access to care. At the population level, institutional racism, residential segregation, and unequal resource allocation create systematic differences in exposure to health risks and access to health-promoting resources.
Q: Name two populations more likely to smoke and explain one structural reason for this pattern.
A: Lower SES groups and people with mental health conditions are more likely to smoke. One structural reason is that lower SES communities are more heavily targeted by tobacco advertising and have fewer resources for cessation programmes, making it harder to quit even when the desire to do so is present.
The social class and race material connects to Women's Health (racial disparities in maternal and infant mortality are a specific exam topic). It also links back to eating behaviour and obesity, since food access and diet quality are directly shaped by SES and neighbourhood resources. The life-course model reappears in discussions of pregnancy and developmental health.
Smoking, tobacco, alcohol use, alcohol abuse, binge drinking, SES, socioeconomic status, health disparities, health inequalities, behavioural model, materialist model, psycho-social model, life-course model, racial health disparities, institutional racism, discrimination, residential segregation, stereotype threat, Native American health, Hispanic health disparities, African American health disparities, social determinants of health, PSY 320, health psychology, Michigan State University, Exam 2