fragmentation and dislocation, and thence to a breakdown in social networks, mutuality andtrust; these, in their turn, jeopardise health and well-being. Social capital is criticallydiminished. Some commentators hold that prolonged stress due to psychosocial factorsresults in an increase in ‘allostatic load’: if too many negative changes occur too rapidly,bodily adjustment is compromised, resulting in overload and exhaustion. An inconsideratemanager would be harder to accommodate in a workplace that was overly hot, cold or noisy,or when the individual had been on an inadequate diet. There isprima facieevidence for anassociation between SECs and allostatic overload.Of course these three subsections do scant justice to the research programmes they purportto represent, but then these are literatures that are exhaustively, one might almost saytediously, reviewed. Nor do they by any means exhaust the range of perspectives on healthinequalities either emanating from or addressed by sociologists.If the behavioural, material and psychosocial orientations are mainstream, each with itsevidence base, it would be remiss not to mention other, divergent perspectives. One examplefocuses on what in the Black Report (1980) was called ‘social selection’. Canning and Bowser(2010: 1223) see the socioeconomic gradient in health ‘to be in large part the result ofdifferentials in health, reversing the direction of causality put forward in the Marmotreports’. They advocate direct health interventions, especially in child health, as mechanismsfor improving both health and socioeconomic outcomes. Ironically, as we shall see, thisemphasis on health interventions in childhood mirrors Marmot’s own recommendations.Another argument is that it is intelligence, or IQ, that strikes as the most impressiveindependent variable for health inequalities (see for example Batty and Deary 2004).Although more vehicle than theory, life-course approaches to explaining health inequalitiescall on the temporal dimension and warrant a special mention. The underlying premise isthat factors disadvantageous for health and longevity tend both to cluster and to accumulateover time. The phenomenon of clustering comes as no surprise: people residing in low-incomehouseholdsandsub-standardhousingaremostlikelytofindthemselvesinneighbourhoods lacking in social amenities and to be impoverished socially as well aseconomically (although there are of course exceptions). Childhood emerges in the researchliterature and in rival paradigms alike as a pivotal time for health, and this is reﬂected in thelater discussion; but childhood is not of course the only life-stage of significance for health.Health inequalities135Ó2011 The AuthorSociology of Health & IllnessÓ2011 Foundation for the Sociology of Health & Illness/Blackwell Publishing Ltd
In a contribution on life-course inﬂuences on health at older ages, Bartley and Blane (2009)develop the themes of clustering and accumulation to address the issue of how the socialbecomes biological. They cite their own work on the ‘inverse housing law’ to show that
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