Social Epidemiology: Past, Present, and Future

In a context where epidemiologic research has been heavily influenced by a biomedical and individualistic approach, the naming of “social epidemiology” allowed explicit emphasis on the social production of disease as a powerful explanatory paradigm and as critically important for interventions to improve population health. This review briefly highlights key substantive areas of focus in social epidemiology over the past 30 years, reflects on major advances and insights, and identifies challenges and possible future directions. Future opportunities for social epidemiology include grounding research in theoretically based and systemic conceptual models of the fundamental social drivers of health; implementing a scientifically rigorous yet realistic approach to drawing conclusions about social causes; using complementary methods to generate valid explanations and identify effective actions; leveraging the power of harmonization, replication, and big data; extending interdisciplinarity and diversity; advancing emerging critical approaches to understanding the health impacts of systemic racism and its policy implications; going global; and embracing a broad approach to generating socially useful research. Expected final online publication date for the Annual Review of Public Health, Volume 43 is April 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

“Known to be unhealthy” - How social epidemiology produces health differences

Inspired and informed by contemporary research within Science and Technology Studies (STS), this essay discusses how social epidemiological research serves to create and produce health inequalities in society. Focusing in particular on how social epidemiology establishes the relationship between socio-economic status and health, it examines how the accumulation of different studies relying on different indicators and measures results in the construction of new facts and generalizations concerning the health of people with a lower socio-economic status. By identifying groups “known to be unhealthy”, the essay presents social epidemiology as participating in the co-production of the social and political infrastructures underlying policy decisions. To increase awareness within social epidemiology of the politics of its own knowledge practices, it concludes by recommending new interdisciplinary collaborations.

Contagion and Psychiatric Disorders: The Social Epidemiology of Risk (Comment on “The Epidemic of Mental Disorders in Business”)

In their 2022 paper, Kensbock, Alkærsig, and Lomberg provide compelling evidence of an increased risk in treated depressive, anxiety, and stress-related disorders within workplaces, associated with the introduction of new hires who either have treated disorders themselves or are hired from workplaces with an increased prevalence of treated disorders. The authors interpret these findings as evidence of a “contagion” effect for psychiatric disorders, illustrative of workplace spread of disorder that may affect the mental health of employees. In this commentary, we contextualize these findings through psychiatric epidemiology. The evidence provided by Kensbock and colleagues is consistent with a long history of evidence in psychiatric and social epidemiology illustrating that many health outcomes are affected by those in our social networks and that psychiatric disorders, in particular, evidence spatial and temporal autocorrelation as well as social network spread that can be best conceptualized through well-known infectious disease principles. Thus, there is a large empirical literature that supports the findings of Kensbock, Alkærsig, and Lomberg. That said, the findings should not be overinterpreted; they fit some patterns of previous literature and known facts about psychiatric disorders, but not all. They also must be appropriately situated within the literature on workplace determinants of mental well-being more generally and, in particular, the global movements to situate the rights of workers with mental illness for employment protections and safe working conditions.

Why Canada Is in Court to Protect Healthcare for All: Global Implications for Universal Health Coverage

Countries worldwide are currently endeavoring to safeguard the long-term health of their populations through implementing Universal Health Coverage (UHC), in line with the United Nation's 2015-30 Sustainable Development Goals (SDGs). Canada has some of the world's strongest legislation supporting equitable access to care for medically necessary hospital and physician services based on need, not ability to pay. A constitutional challenge to this legislation is underway in British Columbia (BC), led by a corporate plaintiff, Cambie Surgeries Corporation (CSC). This constitutional challenge threatens to undermine the high bar for UHC protection that Canada has set for the world, with potential adverse implications for equitable international development. CSC claims that BC's healthcare law—the Medicare Protection Act (MPA)—infringes patients' rights under Canada's constitution, by essentially preventing physicians who are enrolled in BC's publicly-funded Medicare plan from providing expedited care to patients for a private fee. In September 2020, after a trial that ran for 3.5 years and included testimony by more than 100 witnesses from around the world, the court dismissed the plaintiffs' claim. Having lost their case in the Supreme Court of BC, the plaintiffs' appealed in June 2021. The appellate court's ruling and reasons for judgment are expected sometime in 2021. We consider the evidence before the court from the perspective of social epidemiology and health inequalities, demonstrating that structural features of a modern society that exacerbate inequalities, including inequitable access to healthcare, can be expected to lead to worse overall societal outcomes.

Intersectional and social epidemiology approaches to understanding the Influence of race, ethnicity, and caste on global public health

Ethnicity, race, caste, sex, and gender are characteristics that can determine social status, health, and illness for both individuals and communities. They are among the many attributes that social epidemiologists account for when conducting research to understand the forces driving health disparities. Intersectional theory posits that each individual comprises multiple, interlocking identities that are projected on to them by the society in which they live. These identities confer multilayered privilege or disadvantage based on context-specific power dynamics, social norms, and biases. Intersectionality is a perspective that grew out of the social justice movements that have shaken entrenched systems of power and social norms over the last 60 years. Intersectional theory challenges traditional epidemiological methods of measuring associations between demographic variables and health outcomes. It also offers social epidemiology an opportunity to explore new methodologies that illuminate factors contributing to health disparities and promote social justice as core research objectives. This chapter illustrates intersections between social determinants and health outcomes in a descriptive case study focused on India and explores innovative methods for incorporating intersectionality into epidemiological research methods and analysis.

‘When will the doctor be around so that I come by?!’ Geo-socio effects on health care supply, access and utilisation: experiences from Kalangala Islands, Uganda

Background The study set out to give an in-depth intersection of geo, eco-socio exposition of the factors relating to geography, healthcare supply and utilization in an island setting. This analysis is informed by what has emerged to be known as social epidemiology. We provide in-depth explanation of context to health care access, utilization and outcomes. We argue that health care delivery has multiple intersections that are experientially complex, multi-layered and multi-dimensional to the disadvantage of vulnerable population segments of society in the study area. Methods We used a cross-sectional qualitative exploratory design. Qualitative methods facilitated an in-depth exploration and understanding of this island dispersed and peripheral setting. Data sources included a review of relevant literature and an ethnographic exploration of the lived experiences of community members while seeking and accessing health care. Data collection methods included in-depth interviews (IDI) from selected respondents, observation, focus group discussions (FGDs) and key informant interviews (KII). Results We report based on the health care systems model which posits that, health care activities are diverse but interconnected in a complex way. The identified themes are; the role of geography, access (geographical and financial) to health services, demand and utilization, Supplies, staffing and logistical barriers and a permissive and transient society. When and how to travel for care was beyond a matter of having a health need/ being sick and need arising. A motivated workforce is as critical as health facilities themselves in determining healthcare outcomes. Conclusion Geography doesn’t work and affect health outcomes in isolation. Measures that target only individuals will not be adequate to tackle health inequalities because aspects of the collective social group and physical environment may also need to be changed in order to reduce health variations.

New transmission mechanism for the sustainable and humanistic development of human capital: Demand for the ‘rigidity turn’

The author considers the becoming complex reality as developing nonlinearly and demanding new transmission mechanisms for the formation of human capital and also factors that contribute to changes in these realities: self-reflection of both nature and society; social gaps and traumas as becoming a norm; backward and forward trends; the increasing number of bifurcation points; ambivalences; side effects of digital innovations; consequences of global pandemics, etc. - all of them facilitate changes in the mechanism for the development of human capital. In the 1960s, G. Becker and T. Schultz introduced the term human capital to start the studies of factors that make mechanisms of its formation more complex. Since then, many theories have been introduced to explain challenges to human capital, because various transmission mechanisms of influencing human capital have been formed as culturally and politically determined. Today, there are two challenges affecting the nature of human capital: digitalization and the global covid-19 pandemic create new requirements for human capital and change the transmission mechanism of its formation. However, the dominant pragmatic and formal-rational approaches to human capital distort its humanistic and sustainable components. The author insists on the need to create a new transmission mechanism for the sustainable and humanistic human capital development, which would include social-cultural and value elements, humanized digital technologies, bioethics and social epidemiology - in order to help social actors to function more effectively under the global complexity and nonlinear development. The author outlines the theory of the rigidity turn as a social discourse, which aims at studying long-lived phenomena of social order and developing intellectual and practical foundations of the sustainable and humanistic formation of the human capital.

Epidemiologists’ ambivalence towards the epigenetics of social adversity

This article studies how social epidemiologists get involved in research carried out on rodent models to explore the biological pathways underpinning exposure to social adversity in early life. We analyze their interdisciplinary exchanges with biologists in a social epigenetics project—i.e., in the experimental study of molecular alterations following social exposures. We argue that social epidemiologists are ambivalent regarding the use of non-human animal models on two levels: first, in terms of whether such models provide scientific evidence useful to social epidemiology, and second, regarding whether such models help promote their conception of public health. While they maintain expectations towards rodent experiments by elevating their functional value over their representational potential, they fear that their research will contribute to a public health approach that focuses on individual responsibility rather than the social causes of health inequalities. This interdisciplinary project demonstrates the difficulties encountered when research in social epigenetics engages with the complexities of laboratory experiments and social environments, as well as the conflicting sociopolitical projects stemming from such research.