How Does Socioeconomic Status Affect Health? The Sequential Mediation of Social Capital and Health Lifestyles

The positive gradient between socioeconomic status (SES) and health is well established, yet the mechanisms through which SES translates into health advantages remain underexplored in the Taiwanese context. Drawing on Fundamental Cause Theory (FCT), Health Lifestyle Theory (HLT), and Social Capital Theory, this study proposes and tests a serial mediation model in which SES promotes social participation, which in turn shapes regular exercise behavior, ultimately affecting physical and mental health. Using data from the 2021 Taiwan Social Change Survey Health Module (N = 1,465), we employ path analysis with bias-corrected and accelerated (BCa) bootstrapping (3,000 resamples) to estimate serial indirect effects, and multigroup path analysis to examine gender moderation. Results show that: (1) SES exerts significant positive indirect effects on both physical health (PCS) and mental health (MCS) through the sequential pathway of social participation to regular exercise (BCa 95% CIs exclude zero); (2) social participation's direct effect on health is nonsignificant, functioning primarily as an upstream enabler of health behavior rather than an independent protective factor; and (3) the direct effect of SES on exercise differs significantly by gender—significant among men but nonsignificant among women, suggesting gender-differentiated pathways through which SES translates into health behavior. This study provides the first SEM-based test of the sequential mediation mechanism linking social capital and health lifestyles in a nationally representative Taiwanese adult sample, with implications for health promotion policies that prioritize building social participation environments over individual behavior change alone.