Social epidemiology And approaches or theories of social epidemiology
Social epidemiology is a branch of epidemiology that studies the distribution and determinants of health and disease in populations. In “Social Epidemiology,” Berkman and Kawachi defined social epidemiology as “the branch of epidemiology that studies the social distribution and social determinants of states of health.” Social epidemiology focuses particularly on the effects of sociostructural factors on states of health.
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| Epidemiology and Social epidemiology |
••Sociostructural factors in the field of social epidemiology
Social class
Gender
Race/ethnicity
Discrimination
Social network
Social capital
Income
distribution
Social policy
The major premise of social epidemiology is that each society forms its own distribution of health and disease (1). In other words, social epidemiology assumes that the distribution of health and disease in a society reflects the distribution of advantages and disadvantages in that society. Based on this premise, social epidemiology examines which sociostructural factors affect the distribution of health and disease, as well as how these factors influence individual and population health. Social epidemiology proposes to identify societal characteristics that affect the pattern of disease and health distribution in a society and to understand its mechanisms (1). Although social epidemiology has developed recently, the idea that social conditions affect health already existed at the beginning of the 19th century.
Approaches of social epidemiology/ Theories of social epidemiology
1) biological Paradigm-
The biological paradigm assumes that all diseases are biological phenomena and can be described fully in biological terms. It guides the views that a population is merely the sum of its individuals, and that the population pattern of diseases is simply a reflection of individual risk factors. Consequently, social level factors cannot be considered “real” causes of diseases, if the biological paradigm is used.
2)Bio-psychosocial Paradigm-
bio-psychosocial paradigm is an important concept in social epidemiology. Social epidemiology uses the biopsychosocial paradigm in contrast, modern epidemiology often uses the biological paradigm. bio-psychosocial paradigm of social epidemiology assumes that the biology of organisms is determined in multilevel, interactive environments. In other words, diseases are assumed to be products of mutual interaction among social factors, individual factors, and biological factors. The bio-psychosocial paradigm assumes that population is not merely the sum of its individuals; rather, every population has its own history and culture, which determine how and why people are exposed to specific individual risk factors. In social epidemiology, social factors can be risk factors of health by adding to or interacting with individual and biological factors.
3) Population Health Paradigm-
According to population health paradigm , An individual’s risk of disease cannot be isolated from the disease risks of the population to which s/he belongs. This is Geoffrey Rose’s population perspective, which has a crucial meaning in social epidemiology.
4)Ecosocial theory of disease distribution
Ecosocial and other emerging multi-level epidemiological frameworks seek to integrate social and biological reasoning and a dynamic, historical and ecological perspective to develop new insights into determinants of population distributions of disease and social inequalities in health. The central question for ecosocial theory is: who and what is responsible for population patterns of health, disease, and wellbeing, as manifested in present, past, and changing social inequalities in health? Adequate epidemiological explanations accordingly must account for both persisting and changing distributions of disease, including social inequalities in health, across time and space.
To aid conceptualisation, ecosocial theory uses a visual fractal metaphor of an evolving bush of life intertwined with the Scaffolding of society that diVerent core social groups daily reinforce or seek to alter. A fractal metaphor is chosen because fractals are recursive structures, repeating and self similar at every scale, from micro to macro. Thus, ecosocial theory invites consideration of how population health is generated by social conditions necessarily engaging with biological processes at every spatiotemporal scale, whether from subcellular to global, or nanoseconds to millenniums. Core concepts for ecosocial theory accordingly include:
(1) embodiment, a concept referring to how we literally incorporate, biologically, the material and social world in which we live, from in utero to death; a corollary is that no aspect of our biology can be understood absent knowledge of history and individual and societal ways of living.
(2) pathways of embodiment, structured simultaneously by:
(a) societal arrangements of power and property and contingent patterns of production, consumption, and reproduction, and
(b) constraints and possibilities of our biology, as shaped by our species’ evolutionary history, our ecological context, and individual histories, that is, trajectories of biological and social development.
(3) cumulative interplay between exposure, susceptibility, and resistance, expressed in pathways of embodiment, with each factor and its distribution conceptualised at multiple levels (individual, neighbourhood, regional or political jurisdiction, national, inter-national or supra-national) and in multiple domains (for example, home, work, school, other public settings), in relation to relevant ecological niches, and manifested in processes at multiple scales of time and space.
(4) accountability and agency, expressed in pathways of and knowledge about embodiment, in relation to institutions (government, business, and public sector), communities, households, and individuals, and also to accountability and agency of epidemiologists and other scientists for theories used and ignored to explain social inequalities in health; a corollary is that, given likely complementary causal explanations at Different scales and levels, epidemiological studies should explicitly name and consider the benefits and limitations of their particular scale and level of analysis. More than simply adding biology to social analyses, or social factors to biological analyses, the ecosocial framework begins to envision a more systematic integrated approach capable of generating new hypotheses, rather than simply reinterpreting factors identied by one approach (for example, biological) in terms of another ( for example social).
5)political economy of health paradigm
political economy of health refers to related (if not identical) theoretical frameworks that explicitly address economic and political determinants of health and distributions of disease within and across societies, including structural barriers to people living healthy lives.These theories accordingly focus on economic and political institutions and decisions that create, enforce, and perpetuate economic and social privilege and inequality, which they conceptualise as root fundamental causes of social inequalities in health.