Ecology, after all, is a science devoted to study of evolving interactions between living organisms and inanimate matter and energy over time and space. Rather, they distinguish ecological theory from the diverse social theories upon which they and the other social epidemiological frameworks rely. Nascent, these emerging ecologically inclined multi-level social epidemiological frameworks remain rather sketchy, the bare beginnings of a mental map. Much more elaboration is required; calling the question can perhaps spur the needed work.
Concomitantly, explicit applications to aetiologic inquiry and to interventions are only just underway. From an ecosocial perspective, however, it is possible to formulate several constructs that can begin to serve as a mental checklist for epidemiological research. Relevant ecosocial constructs thus minimally include: 7 , With these constructs at hand, we can begin to elucidate population patterns of health, disease and well-being as biological expressions of social relations, and can likewise begin to see how social relations influence our most basic understandings of biology 1 , 2 , 7 , and our social constructions of disease 1 , —thereby potentially generating new knowledge and new grounds for action.
‘Social epidemiology’ gains a name …
Consider, as one example, the phenomenon of pregnancy in relation to risk of cancer. Let us start with breast cancer. As is well known, pregnancy decreases risk of breast cancer over the lifetime if it occurs early, but thereafter increases risk, especially after age This phenomenon is often invoked to explain, in part, why incidence of breast cancer increases with affluence and why the rate has climbed during the 20th century over and above increases due to earlier age at menarche , since more educated women tend to have children later in life and educational level of women, especially in industrialized societies, has generally been on the rise.
For two sites, however, thyroid and Hodgkin's disease, parity is associated with incidence only among women. One implication of these findings is not to presume parity exerts effects solely by pregnancy-related biological processes; the other is to consider the social meaning of parity even when the biology of pregnancy is relevant. Simplistic divisions of the social and biological will not suffice.
Consider, too, how an ecosocial perspective can contribute to unravelling the unexplained excess risk of hypertension among African Americans. Suggesting much work remains to be done, however, few of the proposed pathways have been extensively studied and, to date, fewer than 25 epidemiological studies have explicitly investigated somatic consequences of racial discrimination—a mere 0.
In conclusion, theory matters: both to define social epidemiology and to distinguish among trends within this field. These diverse frameworks encourage us to think critically and systematically about intimate and integral connections between our social and biological existence—and, especially in the case of social production of disease and ecosocial theory, to name explicitly who benefits from and is accountable for social inequalities in health.
By focusing attention on under-theorized and under-researched conjoint social and biological determinants of disease distribution, these theories, even in nascent form, can potentially give new grounds for action—and underscore that theory, absent action, is an empty promise. If not these theories, however, other frameworks will need to be elaborated to enhance social epidemiologists' ability to analyse and provide evidence useful for addressing the myriad ways we both embody and transform the co-mingled social and biological world in which we live, love, work, play, fight, ail and die.
If social epidemiologists are to gain clarity on causes of and barriers to reducing social inequalities in health, adequate theory is a necessity, not a luxury. Who shall create this theory? The task is ours. As sole author of this paper, I have: 1 conceptualized and written the entire paper, from start to finish; 2 checked the references for accuracy and completeness; 3 assumed sole responsibility to vouch for its validity; 4 NO conflict of interest, in that I have not received any financial support from any group who will gain from the publication of the paper; 5 NOT published this material previously in a substantively similar form.
This paper was originally prepared for: Theory and Action: A series of meetings to link research and practice, London, England, 27—29 March Shared observations of disparities in health do not necessarily translate to common understandings of cause; it is for this reason theory is key.
To gain clarity on causes of and barriers to reducing social inequalities in health, social epidemiologists will need to generate improved theoretical frameworks and the necessary data to test and refine them. No funds from any grant supported this project. Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide.
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Sign In. Advanced Search. Article Navigation. Close mobile search navigation Article Navigation. Volume Article Contents. Current theoretical trends in social epidemiology. Conclusion: theory matters. Theories for social epidemiology in the 21st century: an ecosocial perspective Nancy Krieger. Oxford Academic. Google Scholar. Cite Citation.
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