Dimensions of vulnerability salient for health: a sociological approach

Figures & data

Table 1. Notions of stigma and deviance.

STIGMA (offences against norms of shame)	DEVIANCE (offences against norms of blame)
Enacted stigma	Enacted deviance
Actual discrimination (shaming)	Actual discrimination (blaming)
Felt stigma	Felt deviance
Fear of discrimination and sense of shame	Fear of discrimination and sense of blame
Project stigma	Project deviance
Active resistance to enacted and felt stigma	Active resistance to enacted and felt deviance

Table 2. Types of asset flow salient for health and longevity.

(1) Biological (or body) assets can be affected by class relations even prior to birth. Low-income families, for example, are more likely to produce babies of low birthweight; and low birthweight babies carry an increased risk of chronic disease in childhood, possibly in part through biological programming;

(2) Psychological assets yield a generalized capacity to cope, extending to what is increasingly conceptualized as “resilience”. In many ways the “vulnerability factors” that Brown and Harris (1978) found reduced working-class women’s capacity to cope with life-events causally pertinent for clinical depression are class-induced interruptions to the flow of psychological assets;

(3) Social assets have come to assume pride of place in many accounts of health inequalities and feature strongly in the work of Marmot and Wilkinson. The terms social assets or “social capital” refer to aspects of social integration, networks and support. The political use to which social capital is being put should not occasion its neglect;

(4) Cultural assets or “cultural capital” are initially generated through processes of primary socialization and go on to encompass formal educational opportunities and attainment. Class-related early arrests to the flow of cultural assets can have long-term ramifications for employment, income levels, and therefore health;

(5) Spatial assets have been shown to be significant for health by area-based studies. These have documented that areas of high mortality tend to be areas` with high rates of net out-migration; and it tends to be the better qualified and more affluent who exercise the option to move;

(6) Symbolic assets, representing the variable distribution of social status or “honour”, are known to impact on health via people’s (sense of) social position, especially relative to those others who comprise their reference groups;

(7) Material assets refer to “relative deprivation” due to impoverishment and meagre standard of living. The relevance of material assets for health and longevity has long been stressed, although the mechanisms linking low income with health remain much debated.

Scambler and Scambler (2015)

Table 3. Stigma and/or deviance, shame and/or blame.

Stigma + Deviance +	Stigma + deviance -
Abjects	Rejects
Stigma - Deviance -	Stigma - deviance +
Normals	Losers

Brown, G., & Harris, T. (1978). Origins of depression. London: Tavistock.

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Scambler, G., & Scambler, S. (2015). Theorizing health inequalities: The untapped potential of dialectical critical realism. Social Theory and Health, 13, 340–354.

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