[Non-reciprocal social exchange is a health risk: a medical sociological research model].

Contrary to a reductionist disease concept prevailing in molecular medicine, a systemic disease concept is emphasised in this sociopsychosomatic approach towards analysing disease as a result of disturbed social exchange among people. More precisely, violations of the norms of social reciprocity in core social roles in adult life, in particular in the work role, are assumed to trigger stressful experience with adverse long-term consequences for health. The model of effort-reward imbalance at work provides an illustrative case of nonreciprocal social exchange. It defines distinct conditions in which an imbalance between high efforts spent and low rewards received in turn is maintained by the workers. In this model social rewards are analysed in terms of money, esteem and promotion prospect including job security. The contribution summarises results from 6 international prospective and cross-sectional epidemiological investigations testing the model of effort-reward imbalance at work with regard to different health indicators (especially coronary heart disease, hypertension, depression, alcohol dependence). In all instances an elevated risk of illness is observed among those who experience non-reciprocal social exchange in terms of effort-reward imbalance at work, compared to people who are free from this type of stressful experience. Results are derived from logistic regression analysis adjusting for the effects of potential confounders. In view of this evidence the medical sociological approach outlined here may be helpful in contrasting a reductionist concept of disease with a systemic concept centred around the sociopsychosomatic aspects of human health and disease. Copyright 2002 S. Karger GmbH, Freiburg