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Social Epidemiology | Public Health and Social Media

January 28, 2017

In the realm of public health and public health policy, the field of epidemiology not only plays a crucial role, but an obligatory one. According to the World Health Organization, epidemiology is “the study of the distribution and determinants of health-related states or events (including disease), and the application of this study to the control of diseases and other health problems” (WHO, 2014). In a previous post found here, I outline the importance of epidemiology in the creation of public health law as defined by Bhattacharya. Another key component of the study of public health is the understanding of the social determinants of health. These are the influences that contribute to an individual’s or group’s health. Generally, these elements can be biological, socioeconomic, psychosocial, behavioral, or social (CDC, 2014). A recently recognized field within the scientific community called social epidemiology studies the intersection between epidemiology and the social determinants of health.

As defined by Nancy Krieger, a social epidemiologist and Director at the Harvard School of Public Health, social epidemiology “is distinguished by its insistence upon explicitly investigating the social determinants of population distributions of health disease and well being” (Almgren, 2013). The study itself is not new as many scientists over the years have addresses the same issues, however the concepts and discoveries have remained fragmented across various fields of science. The field is underdeveloped, and the progress of formal training programs in social epidemiology has been slow, which has resulted in the term being underused and simply misunderstood. In his text Health Care Politics, Policy, and Services, Almgren describes three main theories used in the field of Social Epidemiology according to Krieger. These theories are psychosocial theories, political economy/social production of disease theories and theories that derive from the ecological perspective. Each of these theories is briefly described below to gain a better understanding of the frameworks used in the study of social epidemiology.

Psychosocial Theoretical Framework

This framework works within the host-pathogen-environment model, which describes the intersection between the host, pathogen, and environment in the development and progression of disease (Engering, Hogerwerf, Slingenbergh, 2013). It concentrates on specific weaknesses to disease produced as a result of psychosocial situations. For example, the chronic stress that develops in an individual as a result of their social environment has an effect on the individual’s biological defenses, therefore creating a susceptibility to host-pathogen threats. Following this framework, social environments and relationships have been identified as having a large impact on one’s ability to withstand disease (Almgren, 2013).

Political Economy/Social Production of Disease Theoretical Framework

In her work, Krieger explains that the “root causes of health inequalities are embedded in the economic and political structures and processes that promote and perpetuate economic and social privilege” (Almgren, 2013). As determined by this model, the social determinants of health that are connected with societal and economic power are low income, harmful working environments, and remoteness from health care resources. This hierarchal framework on which social epidemiology is based on, emphasizes the connection between social privilege of the dominant class, and the consequence of disease. An age-old example theory is pneumoconiosis, more commonly known as the black lung disease, which has been affecting workers in the mining industry for years. Unfortunately, the disease is incurable and the severity is entirely dependent on how long the individual was exposed, and to how much coal (American Lung Association, 2014). The individual’s susceptibility to this disease depends solely on their exposure to harmful substances as a result of their working condition.

The Ecosocial Theoretical Framework

The Ecosocial Framework builds on the Political Economy/Social Production Framework by examining how structural relationships are not only responsible for, but also produces inequities in health. This framework is less hierarchical, and instead builds on the association between biological and social characteristics of interconnection to explain the design of health and disease. Almgren describes a case study of a Native American community in the United States with significantly high mortality and disease rates as compared to the American population. For example, high rates of motor vehicle accidents can be attributed to the rural roads, old and unsafe vehicles, and alcoholism. These characteristics of the Native American community are accredited to the historical racial oppression of this population, and the result in early death and exposure to disease.

The key to the field of social epidemiology is the fact that humans are not only biological, but also social beings. Because of this, both the biological science of an individual and the social structure in which they exist must be understood to truly understand the disease risk and impact. Unfortunately, effective models for social epidemiology are still being developed (click here for an example) and therefore are not being used by professionals responsible for the creation of public health policy. Social epidemiology also remains an underutilized study as it is seen as radical, and neglecting specific theoretical and procedural consistency. With more focus on recognized education programs and research into defined methods and models to follow, social epidemiology could become a highly applicable tool in the creation of social and public health policy.

Almgren, Gunnar. Health Care Politics, Policy, and Service: A Social Justice Analysis. New York: Springer PUBLISHING COMPANY, 2013. Print.

Engering A., Hogerwerf L., Slingenbergh J. “Pathogen–host–environment interplay and disease emergence.” Emerging Microbes & Infections. 2 (2013). Print.

“Health Topics: Epidemiology.” World Health Organization. World Health Organization, 2014. Web. 3 Nov. 2014.



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