Social Epidemiology

by

Regina A. Galer-Unti

• LAST REVIEWED: 05 May 2017
• LAST MODIFIED: 28 May 2013
• DOI: 10.1093/obo/9780199756797-0097

Introduction

The term social epidemiology refers to the branch of epidemiology that investigates how social interactions and social conditions impact the public’s health. Researchers in this area have the perspective that health and disease are multicausative and impact the host on a variety of levels. Social factors are part of this multicausative explanation, as they play a role in the individual’s exposure to disease. Social epidemiologists study socioeconomic status (at one point in time and across the life course), race, gender, workplace, impact of neighborhood, social networks and support, and a variety of other social factors in an attempt to understand how social conditions affect population health. Social epidemiologists also study the impact of such determinants as social capital, income inequality, and social policies on health. Social epidemiology has broadened greatly in the last decade, and the following bibliography provides a collection of works designed to emphasize the history of this branch of epidemiology, define terminology, examine the work of noted authors in the field, and provide an introduction to the main concepts in social epidemiology.

Introductory Works

McKinlay and McKinlay 1977 introduces the notion that the decline in US mortality rates may not be due to improvements in medical care. McKeown, et al. 1975 makes a similar argument regarding death rates in England and Wales. McGinnis and Foege 1993 is a now classic work published roughly twenty years after the previously mentioned works. Using ample data sets, the authors support the link between socioeconomic status, social factors, and actual causes of death. Institute of Medicine 2001, a report entitled Health and Behavior: The Interplay of Biological, Behavioral, and Societal Influences, dedicates one chapter to an overview of social epidemiology and clarifies the position of this branch within the field of epidemiology as a whole. The most comprehensive collection of works of leaders in social epidemiology research is housed in the edited book Berkman and Kawachi 2000, which serves as a proper introduction to this area of study. Krieger 2001b further defines the field, explaining the underlying theoretical basis for social epidemiology. Krieger 2001a provides a glossary of terminology that is useful for continuity and clarity, but also serves to further define this branch of epidemiology. Berkman 2009 examines past successes, current failures, and future work in the field of social epidemiology. Krieger 2011 discusses the importance of epidemiologic theory to epidemiologic practice and health policy.

• Berkman, Lisa F. 2009. Social epidemiology: Social determinants of health in the United States: Are we losing ground? Annual Review of Public Health 30:27–41.

  DOI: 10.1146/annurev.publhealth.031308.100310

  Reviews longitudinal studies and finds that there has been an increase in social inequalities. Cites a need for social epidemiologists to augment their techniques and develop more successful interventions and contribute to appropriate policies.

• Berkman, Lisa F., and Ichiro Kawachi, eds. 2000. Social epidemiology. New York: Oxford Univ. Press.

  Sets the stage for social epidemiology as a branch of the field of epidemiology. Authors are leading researchers in the field, and this work encapsulates previous and current work in social epidemiology while setting the stage for the next decades of work in the field.

• Institute of Medicine. 2001. Health and behavior: The interplay of biological, behavioral, and societal influences. Washington, DC: National Academy.

  Chapter 4 outlines the work of social epidemiologists and other researchers, and their findings that social factors play importantly in population health work. Gives historical perspective to the emergence of social epidemiology, and to areas of study such as income inequality, social capital, and social conditions.

• Krieger, Nancy. 2001a. A glossary for social epidemiology. Journal of Epidemiology and Community Health 55:693–700.

  DOI: 10.1136/jech.55.10.693

  Noted author in social epidemiology provides terminology and definition of key terms, such as discrimination, social determinants of health, and life course perspective.

• Krieger, Nancy. 2001b. Theories for social epidemiology in the 21st century: An ecosocial perspective. International Journal of Epidemiology 30.4: 668–677.

  DOI: 10.1093/ije/30.4.668

  Provides discussion of three theoretical frameworks that show promise as guides for social epidemiological research. The frameworks are psychosocial, social production of disease/political economy of health, and ecosocial and other multilevel frameworks. Krieger argues the need for theory in social epidemiology and discusses the advancement of theory.

• Krieger, Nancy. 2011. Epidemiology and the people’s health: Theory and context. New York: Oxford Univ. Press.

  DOI: 10.1093/acprof:oso/9780195383874.001.0001

  Krieger describes epidemiologic theory and practice, health outcomes, and health policy. She discusses the history of the field and theories of epidemiology, followed by examples revealing how the distribution of health and disease and the epidemiologic theories themselves are greatly impacted by culture, history, social conditions, and politics.

• McGinnis, J. Michael, and William H. Foege. 1993. Actual causes of death in the United States. Journal of the American Medical Association 270.18: 2207–2212.

  DOI: 10.1001/jama.1993.03510180077038

  In this widely cited article, the authors draw conclusions about the nongenetic factors associated with US mortality. Using sixteen years of study data, the authors codified and enumerated a variety of factors (e.g., tobacco use) that contribute to mortality, and they note that socioeconomic status is also an important factor in mortality.

• McKeown, Thomas, R. G. Record, and R. D. Turner. 1975. An interpretation of the decline of mortality in England and Wales during the twentieth century. Population Studies 29.3: 1–422.

  One of many articles published by McKeown and colleagues; illustrative of the central treatise that the decline in mortality and rise in population in early-18th-century England and Wales was not due to modern medicine. Instead, the increase in population was due to improved sanitation and nutrition.

• McKinlay, John B., and Sonja M. McKinlay. 1977. The questionable contribution of medical measures to the decline of mortality in the United States in the twentieth century. Milbank Memorial Fund Quarterly: Health and Society 55.3: 405–428.

  DOI: 10.2307/3349539

  Authors add to the argument that the decline in mortality in the 20th century was not due to medical care, but to changes in the environment.