Fundamental Cause Theory suggests the replacement of mechanisms that produce the persistent relationship between socioeconomic status and health over time. Understanding how this process operates is central to explaining the reproduction of health inequality. We use data from the Onco-barometer survey (2010) to test a set of hypotheses derived from FCT, Diffusion Of Innovations theory and the intersection between these theories to examine how socioeconomic inequality emerges and evolves across the cycle of diffusion of six relevant preventive practices in Spain: faecal occult blood tests, prostate-specific antigen tests, Papanicolaou tests, mammograms, cholesterol readings and blood-pressure checks. Because these preventive measures are characterised by differing rates of spontaneous knowledge and use amongst the Spanish population, we assume that they are at different stages in the diffusion cycle. Results suggest that SES has a dynamic influence according to the diffusion stage of each preventive measure. We argue that the conjunction of these theories offers a dynamic ‘imagery’ that can help to explain the generation and diminishment of inequalities. Moreover, this integration has the potential to bring ‘social change’ back into the study of health inequalities, which is essential to understanding equitable (and inequitable) returns produced by preventive innovations.

Inspired by the ‘Fundamental Cause Theory (FCT)’ we explore social inequalities in preventable versus relatively less-preventable illnesses in Spain. The focus is on the education-health gradient, as education is one of the most important components of an individual’s socioeconomic status (SES). Framed in the context of the recent economic crisis, we investigate the education gradient in depression, diabetes, and myocardial infarction (relatively highly preventable illnesses) and malignant tumors (less preventable), and whether this educational gradient varies across the regional-economic context and changes therein. We use data from three waves of the Spanish National Health Survey (2003–2004, 2006–2007, and 2011–2012), and from the 2009–2010 wave of the European Health Survey in Spain, which results in a repeated cross-sectional design. Logistic multilevel regressions are performed with depression, diabetes, myocardial infarction, and malignant tumors as dependent variables. The multilevel design has three levels (the individual, period-regional, and regional level), which allows us to estimate both longitudinal and cross-sectional macro effects. The regional-economic context and changes therein are assessed using the real GDP growth rate and the low work intensity indicator. Education gradients in more-preventable illness are observed, while this is far less the case in our less-preventable disease group. Regional economic conditions seem to have a direct impact on depression among Spanish men (y-stand. OR = 1.04 [95 % CI: 1.01–1.07]). Diabetes is associated with cross-regional differences in low work intensity among men (y-stand. OR = 1.02 [95 % CI: 1.00–1.05]) and women (y-stand. OR = 1.04 [95 % CI: 1.01–1.06]). Economic contraction increases the likelihood of having diabetes among men (y-stand. OR = 1.04 [95 % CI: 1.01–1.06]), and smaller decreases in the real GDP growth rate are associated with lower likelihood of myocardial infarction among women (y-stand. OR = 0.83 [95 % CI: 0.69–1.00]). Finally, there are interesting associations between the macroeconomic changes across the crisis period and the likelihood of suffering from myocardial infarction among lower educated groups, and the likelihood of having depression and diabetes among less-educated women. Our findings partially support the predictions of the FCT for Spain. The crisis effects on health emerge especially in the case of our more-preventable illnesses and among lower educated groups. Health inequalities in Spain could increase rapidly in the coming years due to the differential effects of recession on socioeconomic groups

Background Urban regeneration policies are area-based interventions addressing multidimensional problems. In this study, we analyse the impact of urban regeneration processes on the evolution of inequalities in mortality from certain causes. On the basis of Fundamental Cause Theory (FCT), our main hypothesis is that the impact of urban regeneration programmes will be more clearly observed on the causes of preventable deaths, as these programmes imply a direct or indirect improvement to a whole range of ‘flexible resources’ that residents in relevant areas have access to, and which ultimately may influence the inverse relationship between socioeconomic status and health. Methods Using a quasi-experimental design and data from Longitudinal Statistics on Survival and Longevity of Andalusia (Spain), we analyse differences in the evolution of standard mortality ratios for preventable and less-preventable causes of premature death. This encompasses 59 neighbourhoods in 37 municipalities where urban regeneration projects were implemented in the last decade within the framework of three different programmes and in 59 counterparts where these policies were not implemented. Results As expected in line with FCT, there are no significant patterns in the evolution of internal differences in terms of less-preventable mortality. However, excessive preventable mortality strongly decreases in the neighbourhoods with intervention programmes, specifically in those where two or more projects were in force. This is even more apparent for women. Conclusions The urban regeneration policies studied seem to contribute to reducing health inequity when the interventions are more integral in nature.

In the last three decades, numerous studies in different countries have corroborated the main postulates of the Fundamental Cause Theory (FCT), providing evidence showing how health inequalities are reproduced as society increases its capacity to control disease and/or avoid its consequences through preventive innovations. However, documenting the reproductive logic proposed by the theory requires the development of a dynamic analytical approach to consider socioeconomic disparities in the incorporation of multiple preventive innovations over time, which could act as mediating mechanisms of the durable relationship between socioeconomic status and health/mortality. This study draws on data from different waves of the National Health Interview Survey and the National Health and Nutrition Examination Survey to analyze the diffusion processes of various innovations in the U.S. The results of the study show that educational inequalities emerge, are amplified, and are reduced by the continuous diffusion of preventive innovations, supporting the meta-hypothesis of substitution of mediating mechanisms according to the interconnections of FCT and Diffusion of Innovation Theory.

El análisis de la desigualdad en las ciudades cuenta con una amplia tradición, desde los análisis de áreas urbanas mediante ecología factorial de la Escuela de Chicago a los estudios contemporáneos sobre ‘vulnerabilidad urbana’. Desde un punto de vista operativo su objetivo principal ha consistido en elaborar un índice sintético que permita situar a las áreas urbanas en un continuum respecto a los recursos que poseen sus residentes y/o los riegos que enfrentan. En este trabajo se presenta una propuesta y validación de un indicador para medir el nivel socio-económico de áreas urbanas. En primer lugar, se revisan algunos aspectos básicos de esta tradición en el análisis de la sociología urbana. En segundo lugar, se presenta la propuesta para, en tercer lugar, proceder a su validación, finalizando con unas breves conclusiones sobre el indicador propuestos y sus posibles limitaciones.The analysis of inequality in cities has a wide tradition, from the analysis of urban areas through factorial ecology of the Chicago School to contemporary studies on 'urban vulnerability'. From an operative point of view, its main objective has been to elaborate a synthetic index that allows to place to the urban areas in a continuum with respect to the resources that own its residents and / or the risks that they face. This paper presents a proposal to measure the socio-economic level of urban areas and its validation. First, some basic aspect in the analysis of urban inequalities are reviewed. Then, the proposal is presented and validated, and finally, some few conclusions about the proposal and its limitations are included.