Unfair exchange and health: Social bases of stress-related diseases

Abstract

In this contribution it is argued that the analysis of exchange characteristics of core social roles in adult life offers a promising approach towards studying the social bases of stress-related diseases. More specifically, the theoretical model of effort-reward imbalance claims that the violation of a core principle of social exchange, reciprocity, elicits sustained stress reactions with adverse long-term effects on health. This model has been extensively tested with regard to the work role, and a brief review of empirical evidence is given, based on findings from prospective epidemiological studies. Taken together, results demonstrate that the risk of incident stress-related disease, such as coronary heart disease or depression, is about twice as high in men and women scoring high on effort-reward imbalance at work compared to non-exposed people. Finally, recent extensions of the theoretical model beyond the work role and beyond health as the main study outcome are discussed, illustrating the utility of this concept for general sociology.