SOCIAL PSYCHOPHYSIOLOGY, SOCIAL CIRCUMSTANCES, AND HEALTH 1 Douglas Carroll, Ph.D. University of Birmingham David Sheffield, Ph.D. East Tennessee State University ABSTRACT Health varies markedly with social circumstances. While we are still without a comprehensive account of the mechanisms which underlie this variation, it is clear that psychological factors are involved and that key pathways may prove to be psychophysiologi- cal. Thus, social psychophysiological research of the kind illus- trated in this Special Issue is ideally placed to help unravel some of the mechanisms by which social circumstances impact on health. Nevertheless, the success of this sort of social psychophysiological enterprise most likely depends on reconceptualizing psychophysi- ological reactivity as a situational, or psychological exposure, concept rather than as an individual difference concept. This shifts the research goal from one of identifying individuals at risk for disease to identifying the psychological exposures that put individu- als and groups at risk. (Ann Behav Med 1998, 20(4):333-337) INTRODUCTION The rather ambitious objective of this final article in the Special Issue on social psychophysiology is to try to place the other contributions into some kind of broad health science context. It is our contention that these papers, whether they explicitly acknowl- edge it or not, are, in fact, part of a challenging and critically important project. Its aim is to increase our understanding of the psychophysiological pathways through which variations in the psychological fabric of our social circumstances map on to variations in our health. The broad mission of social psychophysi- ology is to examine the psychophysiological consequences of social processes. As such, it is perfectly placed to help unravel the mechanisms by which social circumstances impact on health. SOCIAL CIRCUMSTANCES AND HEALTH It is now a commonplace observation that health is related to social circumstances. The most striking example is the marked inequalities in health contingent on socioeconomic status (1-3). A strong association with all-cause mortality has been observed regardless of whether socioeconomic status is measured in terms of occupation (4), income (5), material assets (6), education (7), or composite indices of deprivation (8). The magnitude of these health variations with socioeconomic status is most easily illus- i Preparation of this manuscript was supported in part by financial support to the second author from the National Heart, Lung, and Blood Institute, Bethesda, MD (1-R29-HL-56825). Reprint Address: D. Carroll, Ph.D., School of Sport and Exercise Sciences, University of Birmingham, Birmingham, B 15 2TT, England. 9 1998 by The Society of Behavioral Medicine. trated by considering the consequent variations in life expectancy. At age 20, given the mortality rates operating around 1980 in the U.K., men in higher social class groups could expect to live five years longer than men in lower social class groups (9). The association between health and socioeconomic status holds not only for all-cause mortality, but is evident in a range of health outcomes. It is apparent for most major cause of death groupings, such as cardiovascular disease (10), and for objective measures of morbidity (11,12) as well as for both behavioral and subjective measures of health and well-being (12,13). The associa- tion holds for women as well as men (14), is characteristic of all the western countries studied in this context (15), and is manifest in data derived for earlier eras (16,17). The generality of the phenomenon across different contexts, different health outcome measures, and different indices of socioeconomic status makes it highly unlikely that it is an artifact of measurement. It is important to appreciate that it is not a matter of the poorest suffering from the worst health, while everyone else enjoys uniformly good health. Rather, it is the case of a continuous gradient of health and ill health mapped on to fine gradations in socioeconomic status (1,3). Expressed another way, inequalities in health persist into the better-off social groups. This has implica- tions for the underlying mechanisms. Classical epidemiology tended to regard health variations as a product of occupational and environmental exposure to physical and chemical hazards. How- ever, it is difficult to see how differential exposures of this sort could account for health variations among the better-off social groups. This is not to suggest that physical pathogens in the workplace and the wider environment are not implicated. The effects on health of damp and substandard housing, chemical hazards at work, and environmental pollutants are undoubtedly substantial (18-20). It is just that these factors cannot explain health variations over the full range of the gradient. The principle of proximity (21) considers that macro social constructs, such as socioeconomic status, exert an impact on matters such as health through smaller, more proximal, mediating processes. It has been argued that the identification of these mediating factors and their underlying mechanisms constitutes the most formidable intellectual challenge facing not only those whose primary research focus lies with health inequalities but also those grappling with behavioral and psychological health-related pro- cesses (1,2). Indeed, Carroll et al. (3) contended that understanding the mechanisms underlying the health gradients contingent on socioeconomic status "might be regarded as a key test of the frequently evoked but imperfectly articulated biopsychosocial model of health championed by the newly formalized disciplines of health psychology and behavioral medicine" (3, p. 36). What might those more proximal factors be? First, let us assume that social causation is at work here and that the association between health and socioeconomic status is not the product of 333