Abstract
An important contribution of new knowledge linking sociology with medicine concerns the development of chronic diseases within societies. For a majority of chronic diseases, a social gradient of their distribution has been documented, leaving population groups with lower socioeconomic position at higher risk. While explanations of indirect effects of these social inequalities point to factors such as unhealthy behaviours and delayed or lacking medical care, direct effects explore the pathways from exposure to disadvantageous social conditions to chronic disease development via enhanced stress-related neuronal, neuroendocrine and immune processes. This contribution discusses current evidence on these pathways, based on epidemiologic and naturalistic, quasi-experimental study designs. A robust base of knowledge demonstrates associations of adverse stress-related work and employment conditions with elevated risks of two highly prevalent chronic disorders, ischaemic heart disease and depression. These conditions are more prevalent among lower socioeconomic groups, and they can contribute to the explanation of the social gradient. Importantly, findings point to new preventive strategies, targeting disadvantageous socio-environmental contexts and vulnerable population groups.