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Cited by 1,419Historical and modern epidemiology studiesMedicine, History, and PhilosophyPhilosophy and History of Science

Epidemiology and the web of causation: has anyone seen the spider?

Krieger, Nancy·1994·Social Science & Medicine
DOI 10.1016/0277-9536(94)90202-x
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Abstract

'Multiple causation' is the canon of contemporary epidemiology, and its metaphor and model is the 'web of causation.' First articulated in a 1960 U.S. epidemiology textbook, the 'web' remains a widely accepted but poorly elaborated model, reflecting in part the contemporary stress on epidemiologic methods over epidemiologic theories of disease causation. This essay discusses the origins, features, and problems of the 'web,' including its hidden reliance upon the framework of biomedical individualism to guide the choice of factors incorporated in the 'web.' Posing the question of the whereabouts of the putative 'spider,' the author examines several contemporary approaches to epidemiologic theory, including those which stress biological evolution and adaptation and those which emphasize the social production of disease. To better integrate biologic and social understandings of current and changing population patterns of health and disease, the essay proposes an ecosocial framework for developing epidemiologic theory. Features of this alternative approach are discussed, a preliminary image is offered, and debate is encouraged.

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Crossref · 10.1016/0277-9536(94)90202-x

Cites

173 of 173 references verified0 citation errors · 0 not checkable

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  • Literature articulating the theoretical frameworks informing research and debates in social epidemiology is sparse.

    “Yet, despite the key role of theory, explicit or implicit, in shaping what it is we see-or do not see, what we deem knowable-or irrelevant, and what we consider feasible-or insoluble, literature articulating the theoretical frameworks informing research and debates in social epidemiology-and epidemiology more broadly-is sparse. 9-12”

    From Theories for social epidemiology in the 21st century: An ecosocial perspective (2001) · cites this paper as [10]

  • The host-agent-environment framework, despite conceptual expansion, retains restrictive assumptions in its language, including locating agency in the agent and treating environment as a catch-all.

    “Despite conceptual expansion, several restrictive assumptions still pervade the new framework's very language. 10 'Agency', for example, remains located in the 'agent' -typically an exogenous entity that acts upon a designated 'host'; terminology alone renders it inhospitable to conceive of the 'host' having 'agency'! 'Environment', moreover, serves as a catch-all category, with no distinctions”

    From Theories for social epidemiology in the 21st century: An ecosocial perspective (2001) · cites this paper as [10]

  • Newer frameworks to explain current and shifting patterns of disease distribution are multidimensional and dynamic, unlike prior images.

    “Instead, unlike prior images-whether of a triangle connecting 'host', 'agent' and 'environment', 28 or a 'chain of causes' 90 arrayed along a scale of biological organization, from 'society' to 'molecular and submolecular particles', 9,p.70 or a spiderless two-dimensional 'web of causation', 91,pp.18-22 or a 'causal pie' sans cook, 92,p.588 -the new mental pictures are both multidimensional and”

    From Theories for social epidemiology in the 21st century: An ecosocial perspective (2001) · cites this paper as [10]

  • The host-agent-environment model became increasingly diffuse and by 1960 the 'web of causation' was born.

    “Gaining complexity without an explicit accounting of social agency, the model becomes increasingly diffuse and, by 1960, the spiderless 'web of causation' is born. 10”

    From Theories for social epidemiology in the 21st century: An ecosocial perspective (2001) · cites this paper as [10]

  • A social production of disease/political economy of health perspective affords few principles for investigating what social determinants of health are determining; biology is opaque.

    “Yet, despite its invaluable contributions to identifying social determinants of population health, a social production of disease/political economy of health perspective affords few principles for investigating what these determinants are determining. 10 Biology is opaque.”

    From Theories for social epidemiology in the 21st century: An ecosocial perspective (2001) · cites this paper as [10]

Cites

Flagged first, then by citations

Research works printed but not linked: 5

  1. Terris, 1979, The epidemiological tradition, Pub. Hlth Rep., 94, 203
  2. Bernal, 1954, Vol. 1–4
  3. Cooper, 1986, The biological concept of race and its application to epidemiology, J. Hlth Politics Policy Law, 11, 87
  4. Krieger N. Influence of social class, race, and gender on the etiology of hypertension among women in the United States. Conference proceedings, “Women, behavior, and cardiovascular disease,” National Heart, Lung, and Blood Institute, Washington, DC. In press.
  5. 1987, NIH Guide for Grants and Contracts

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Authors
Krieger, N.
Affiliations
Kaiser Permanente (US)
Corresponding author
Krieger, Nancy
ORCID
Krieger, Nancy
Venue
Social Science & Medicine
Publisher
Elsevier BV
Published
1994-10
Volume
39
Issue
7
Pages
887-903
ISSN
0277-9536 (ISSN-L)
DOI
10.1016/0277-9536(94)90202-x
OpenAlex
W2107968130
Semantic Scholar
9c8ed6cbfb6745fdb72e64b084b981734fc8293d
Cited by
1,419
References
173
Citations by year
2026: 42 · 2025: 64 · 2024: 42 · 2023: 57 · 2022: 68 · 2021: 66 · 2020: 49 · 2019: 75 · 2018: 61 · 2017: 53 · 2016: 64 · 2015: 40 · 2014: 63 · 2013: 54 · 2012: 38
FWCI
52.90
Type
journal article
Language
en
Open access
closed
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Social Science & Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • RePEc: Research Papers in Economics (submittedVersion)
Topics
  • Social Sciences › Sociology and Political Science › Historical and modern epidemiology studies
  • Health Sciences › Medicine › Psychiatry and Mental health › Medicine, History, and Philosophy
  • Social Sciences › Arts and Humanities › History and Philosophy of Science › Philosophy and History of Science
Keywords
multiple causation, etiology, social determinants of health, history of epidemiology
MeSH terms
Computer Simulation, Epidemiologic Methods, Forecasting, Health Services Accessibility, Humans, Morbidity, Philosophy, Medical, Risk Factors, Social Class, Social Environment, Causality

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