摘要：Research on economic inequalities in health has been largely polarized between psychosocial and neomaterial approaches. Examination of symbolic capital—the material display of social status and how it is structurally constrained—is an underutilized way of exploring economic disparities in health and may help to resolve the existing theoretical polarization. In contemporary society, what people do with money and how they consume and display symbols of wealth may be as important as income itself. After tracing the historical rise of consumption in capitalist society and its interrelationship with economic inequality, I discuss evidence for the role of symbolic capital in health inequalities and suggest directions for future research. In the United States and other developed nations, economic disparities in health are dramatic. Individuals lower on the economic scale have poorer average health than do those who are better off. This phenomenon persists across multiple measures of economic position, primarily income, education, and occupation, 1 , 2 and across multiple indicators of health, including all-cause mortality, cardiovascular and metabolic diseases, cancers, and infant mortality. 2 – 4 Unlike in developing nations, where thresholds of absolute poverty are strong predictors of mortality, health disparities in the United States and Europe exist across the entire economic spectrum. 3 This gradient effect, coupled with observations that overall levels of societal inequality are associated with health, 5 suggests that relative economic position is a critical variable in health inequalities. The pathways by which relative economic position can influence health have been the focus of considerable research attention across biomedical and social science disciplines. In general, the main approaches characterizing this literature are (1) a neomaterial perspective, focusing on the health effects of lower objective economic status, mediated primarily through pathways of limited access to institutional, physical, and social health benefits, and (2) a psychosocial approach, focusing on the psychological consequences of lower subjective economic position, such as depression and chronic stress, and their effects on physiological processes and health behaviors. One pathway through which psychosocial mechanisms may operate is feelings of relative deprivation, 6 described as a process of social comparison whereby individuals feel deprived in relative evaluation with another reference group in society. It is hypothesized that these feelings of deprivation can result in chronic stress for individuals, with significant consequences for biology and disease. 7 Relative deprivation is a difficult construct to operationalize, however, particularly because identifying meaningful reference groups to which individuals make social comparisons is challenging. Strategies to address this problem include comparing individuals or households within similar occupational classes, age categories, or geographical areas. 8 – 10 In each of these strategies, the indicator on which analyses are based, and along which people are assumed to make subjective comparisons leading to feelings of deprivation, is income. It is often the case, however, that others' incomes are not objectively known, meaning that it may not be the best variable for evaluating psychologically relevant social comparisons. In contemporary society it may be what people do with money and how they consume and display symbols of wealth, rather than money per se, that serve as the bases for establishing social identity and position. In a consumer-oriented society, material goods provide the basis for social evaluation and are thus an important medium through which inequalities are experienced. Focusing on symbolic capital, the material display of social status and how it is structurally constrained, specifically as it relates to consumption and commoditization, may be one way to better understand how relative economic position influences health. Here I trace the historical rise of consumption in capitalist society and its interrelationship with economic inequality, discuss evidence for the role of symbolic capital in health inequalities, and propose directions for future research.
