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March 9th, 2020

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An ecosocial theory of disease

The correlation between health, income, and wealth is widely recognized in contemporary research and policy circles. This broadly social understanding of public health outcomes has its origins in a theoretical tradition dating back to the 1970s and 80s, in which scholars began to embed medical research within a political and economic framework.

In a 2001 paper, epidemiologist NANCY KRIEGER seeks to strengthen the theoretical foundations of epidemiological research by linking them back to biological study.

From the paper:

"If social epidemiologists are to gain clarity on causes of and barriers to reducing social inequalities in health, adequate theory is a necessity. Grappling with notions of causation raises issues of accountability and agency: simply invoking abstract notions like 'society' and disembodied 'genes' will not suffice. Instead, the central question becomes who and what is responsible for population patterns of health, disease, and well-being, as manifested in present, past and changing social inequalities in health?

Arising in part as a critique of proliferating theories that emphasize individuals' responsibility to choose healthy lifestyles, the political economy of health school explicitly addresses economic and political determinants of health and disease, including structural barriers to people living healthy lives. Yet, despite its invaluable contributions to identifying social determinants of population health, a political economy of health perspective affords few principles for investigating what these determinants are determining. I propose a theory that conceptualizes changing population patterns of health, disease and well-being in relation to each level of biological, ecological and social organization (e.g. cell, organ, organism/ individual, family, community, population, society, ecosystem). Unlike prior causal frameworks—whether of a triangle connecting 'host', 'agent' and 'environment', or a 'chain of causes' arrayed along a scale of biological organization, from 'society' to 'molecular and submolecular particles'—this framework is multidimensional and dynamic and allows us to elucidate population patterns of health, disease and well-being as biological expressions of social relations—potentially generating new knowledge and new grounds for action."

Link to the piece.

  • Krieger's 1994 article takes a closer look at epidemiological causal frameworks, questioning the adequacy of multiple causation. And her 2012 paper asks: "Who or what is a population?" and articulates the analytical significance of this definition for epidemiological research. Link and link.
  • "Disease epidemics are as much markers of modern civilization as they are threats to it." In NLR, Rob and Rodrick Wallace consider how the development of the global economy has altered the spread of epidemics, taking the 2014 Ebola outbreak as a case study. Link.
  • Samuel S. Myers and Jonathan A. Patz argue that climate change constitutes the "greatest public health challenge humanity has faced." Link.
  • A history of epidemics in the Roman Empire, from 27 BC – 476 AD, by Francois Relief and Louise Cilliers. Link. And a 1987 book by Ann Bowman Jannetta analyzes the impact of disease on institutional development in early modern Japan. Link.
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