Social Epidemiology

by

Regina A. Galer-Unti

• LAST REVIEWED: 27 November 2023
• LAST MODIFIED: 27 November 2023
• 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

McKeown, et al. 1975 introduces the notion that the decline in mortality rates in England and Wales in the early eighteenth century may not have been due to improvements in medical care. McGinnis and Foege 1993 is a now classic work published roughly twenty years after the previously mentioned work. Using ample data sets, the authors support the link between socioeconomic status, social factors, and actual causes of death. Wilkinson and Pickett 2011 describes how economic inequality is detrimental for personal and societal health. The Institute of Medicine 2001, in 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. In 2008, the World Health Organization (WHO) published a report (World Health Organization Commission on Social Determinants of Health 2008) on the social determinants of health, and the piece is widely credited as an influential paper for encouraging and influencing policies designed to mitigate health inequalities. The most comprehensive collection of works of leaders in social epidemiology research is housed in the edited book Berkman and Kawachi 2000 (second edition with Glymour in 2014), 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. Kawachi and Subramanian 2018 and Diez Roux 2022 examine past successes, current failures, and future work in the field of social epidemiology.

• Berkman, L. F., and I. 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.

• Diez Roux, A. V. 2022. Social epidemiology: Past, present, and future. Annual Review of Public Health 43:79–98.

  DOI: 10.1146/annurev-publhealth-060220-042648

  In this comprehensive overview of the history, present state, and future directions of social epidemiology, the impact and challenges of social determinants on health outcomes are highlighted and the need for interdisciplinary approaches to address health disparities are stressed. Future work may include integration of genomics and community engagement in order to advance understanding and reduction of health disparities.

• 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.

• Kawachi, I., and S. V. Subramanian. 2018. Social epidemiology for the 21st century. Social Science and Medicine 196:240–245.

  DOI: 10.1016/j.socscimed.2017.10.034

  Authors provide their analysis of the current and future directions of social epidemiology. The role of social determinants in health outcomes, the importance of multilevel approaches, and the need for interdisciplinary collaboration are discussed. Emerging areas of research, such as epigenetics and the microbiome, are considered. Authors advocate for more attention to the social and political context in which health disparities surface.

• Krieger, N. 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, N. 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.

• McGinnis, J. M., and W. 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, T., 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.

  DOI: 10.2307/2173935

  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.

• Wilkinson, R., and K. Pickett. 2011. The spirit level: Why greater equality makes societies stronger. London: Bloomsbury.

  Authors of this influential book posit that income inequality is the root cause of a wide range of social problems, including poor health outcomes, high crime rates, and reduced social mobility. Data from many countries is used to support their claims. Policy solutions that prioritize reducing income inequality are proposed.

• World Health Organization Commission on Social Determinants of Health. 2008. Closing the gap in a generation. Geneva: World Health Organization.

  This landmark report called for action on a range of social determinants, including education, housing, and employment. The report has been influential in policy and program formation designed to address health inequalities globally.