Sociological research has long explored the role of social structure and social stratification as a key determinant of health. Social structure refers to enduring patterns of social life that shape an individual's attitudes and beliefs; behaviors and actions; and material and psychological resources. Among the social structures investigated within sociology, social class, usually operationalized as socioeconomic status (SES), has proven particularly relevant for understanding racial disparities in health. In a seminal study in the 1840s, Engels (1984) showed how life expectancy in Liverpool, England varied by the occupation of the residents. Moreover, he showed how specific exposures in both occupational and residential environments were related to the elevated risk of particular diseases. More recent sociological research has found that SES is inversely associated with high quality health care, stress, exposure to social and physical toxins, social support, and healthy behaviors. Accordingly, SES remains one of the strongest known determinants of variations in health status (Williams and Collins 1995).
