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Cited by 2,155Historical and modern epidemiology studiesHealth disparities and outcomesPublic Health and Social Inequalities

Theories for social epidemiology in the 21st century: An ecosocial perspective

Open access
Krieger, Nancy·2001·International Journal of Epidemiology
DOI 10.1093/ije/30.4.668
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Abstract

‘Both thinking and facts are changeable, if only because changes in thinking manifest themselves in changed facts. Conversely, fundamentally new facts can be discovered only through new thinking.’ Ludwick Fleck (1935) Genesis and Development of a Scientific Fact.1,pp.50–51 ‘Once we recognize the state of the art is a social product, we are freer to look critically at the agenda of our science, its conceptual framework, and accepted methodologies, and to make conscious research choices.’ Richard Levins and Richard Lewontin (1987) The Dialectical Biologist.2,p.286 In social epidemiology, to speak of theory is simultaneously to speak of society and biology. It is, I will argue, to speak of embodiment. At issue is how we literally incorporate, biologically, the world around us, a world in which we simultaneously are but one biological species among many—and one whose labour and ideas literally have transformed the face of this earth. To conceptualize and elucidate the myriad social and biological processes resulting in embodiment and its manifestation in populations' epidemiological profiles, we need theory. This is because theory helps us structure our ideas, so as to explain causal connections between specified phenomena within and across specified domains by using interrelated sets of ideas whose plausibility can be tested by human action and thought.1–3 Grappling with notions of causation, in turn, raises not only complex philosophical issues but also, in the case of social epidemiology, issues of accountability and agency: simply invoking abstract notions of ‘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? Not surprisingly, theorizing about social inequalities in health runs deep. One reason is that it is fairly obvious that population patterns of good and bad health mirror population distributions of deprivation and privilege. Comments to this effect can be found in the Hippocratic corpus4 and in early texts of ancient Chinese medicine.5 Shared observations of disparities in health, however, do not necessarily translate to common understandings of cause; it is for this reason theory is key. Consider only centuries of debate in the US over the poor health of black Americans. In the 1830s and 1840s, contrary schools of thought ask: is it because blacks are intrinsically inferior to whites?— the majority view, or because they are enslaved?—as argued by Dr James McCune Smith (1811–1865) and Dr James S Rock (1825–1866), two of the country's first credentialled African American physicians.6 In contemporary parlance, the questions become: do the causes lie in bad genes?, bad behaviours?, or accumulations of bad living and working conditions born of egregious social policies, past and present?7,8 The fundamental tension, then and now, is between theories that seek causes of social inequalities in health in innate versus imposed, or individual versus societal, characteristics. 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 In this article, I accordingly note the emergence of self-designated social epidemiology in the mid-20th century, review key theories invoked by contemporary social epidemiologists, and highlight the need for advancing theories useful for the 21st century. Building on holistic models of health developed between World War I and World War II13 and on the ‘social medicine’ framework forged during the 1940s,14–16 it is in the mid-20th century that ‘social epidemiology’ gains its name-as-such. The term apparently first appears in the title of an article published by Alfred Yankauer in the American Sociological Review in 1950: ‘The relationship of fetal and infant mortality to residential segregation: an inquiry into social epidemiology’,17 a topic as timely now as it was then; Yankauer later becomes editor of the American Journal of Public Health. The term then reappears in the introduction to one of the first books pulling together the behavioural and medical sciences, edited by E Gartly Jaco, published in 1958, Patients, Physicians, and Illness: Sourcebook in Behavioral Science and Medicine,18 and is included in the title of Jaco's next book, The Social Epidemiology of Mental Disorders; A Psychiatric Survey of Texas, published in 1960.19 By 1969, enough familiarity with the field exists that Leo G Reeder presents a major address to the American Sociological Association called ‘Social epidemiology: an appraisal’.20 Defining ‘social epidemiology’ as the ‘study of the role of social factors in the aetiology of disease’

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Crossref · 10.1093/ije/30.4.668

Cites

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Claims the paper makes

10 of 122 cited sources checked · 4 supported · 0 flagged · accuracy not yet measured

  • Interpretationcitation
    § Social production of disease/political economy of health · p. 4

    An emphasis on 'fundamental social causes' does not offer principles for thinking through systematically whether-and if so, which-specific public health and policy interventions are needed to curtail social inequalities in health, above and beyond securing adequate living standards and reducing economic inequality.

    “Nor does an emphasis on 'fundamental social causes' 60 offer principles for thinking through, systematically, whether -and if so, which -specific public health and policy interventions are needed to curtail social inequalities in health, above and beyond securing adequate living standards and reducing economic inequality.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [60] Link BG, Phelan JC. Editorial: understanding sociodemographic differences in health—the role of fundamental social causes. Am J Public Health1996;86:471–73. source
  • Interpretationcitation
    § Ecosocial theory and related multi-level dynamic perspectives · p. 4

    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”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites [10] Krieger N. Epidemiology and the web of causation: has anyone seen the spider? Soc Sci Med1994;39:887–903. source
    • cites [45] McMichael AJ. Prisoners of the proximate: loosening the constraints on epidemiology in an age of change. Am J Epidemiol1999;149:887–97. source
    • cites [93] Susser M, Susser E. Choosing a future for epidemiology: II. from black boxes to Chinese boxes and eco-epidemiology. Am J Public Health1996;86:674–77. source
  • Interpretationcitation
    § Ecosocial theory and related multi-level dynamic perspectives · p. 6

    Economic and social deprivation is a pathway linking racial discrimination to increased risk of hypertension among African Americans.

    “(1) economic and social deprivation : for example, residential and occupational segregation lead to greater economic deprivation among African Americans and increased likelihood of living in neighbourhoods without good supermarkets”
    Quote in the paperSubstantial claim1 of 5 sources checked
    • cites [7] Krieger N. Discrimination and health. In: Berkman L, Kawachi I (eds). Social Epidemiology. New York: Oxford University Press, 2000, pp.36–75.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [8] Williams DR. Race, socioeconomic status, and health. The added effects of racism and discrimination. Annals NY Acad Sci1999;896: 173–88. source

      The RACISM AND SES section (page unavailable) links discriminatory residential segregation to economic disadvantage for African Americans, and RACISM AND HEALTH: DIRECT EFFECTS describes an indirect pathway from racism to poorer health through socioeconomic position. Our copy does not identify hypertension as an outcome of that pathway or substantiate the citing sentence’s specific example about neighbourhoods without good supermarkets (searched: hypertension, blood pressure, supermarket). (LLM, conf=0.85)

      Experimental — accuracy not yet measured
    • cites [110] Krieger N, Rowley DL, Herman AA, Avery B, Phillips MT. Racism, sexism, and social class: implications for studies of health, disease, and well-being. Am J Prev Med1993;9(Suppl.):82–122. source
    • cites [111] Anderson NB, Myers HF, Pickering T, Jackson JS. Hypertension in blacks: psychosocial and biological perspectives. J Hypertens1989;7:161–72. source
    • cites [112] Lopes AA, Port FK. The low birth weight hypothesis as a plausible explanation for the black/white differences in hypertension, non-insulin-dependent diabetes, and end-stage renal disease. Am J Kidney Dis1995;25:350–56. source
  • Interpretationcitation
    § Ecosocial theory and related multi-level dynamic perspectives · p. 6

    Toxic substances and hazardous conditions is a pathway linking racial discrimination to increased risk of hypertension among African Americans.

    “(2) toxic substances and hazardous conditions : residential segregation increases risk of exposure to lead paint in older houses and to soil contaminated by lead from car exhaust”
    Quote in the paperSubstantial claim2 of 5 sources checked
    • cites [7] Krieger N. Discrimination and health. In: Berkman L, Kawachi I (eds). Social Epidemiology. New York: Oxford University Press, 2000, pp.36–75.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [8] Williams DR. Race, socioeconomic status, and health. The added effects of racism and discrimination. Annals NY Acad Sci1999;896: 173–88. source

      In “Racism and Health: Direct Effects” (page unavailable), the paper says residential segregation can create poor-quality housing and disproportionate exposure to environmental toxins. It does not identify lead paint or lead-contaminated soil as the exposures, or link this pathway specifically to hypertension among African Americans. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
    • cites [110] Krieger N, Rowley DL, Herman AA, Avery B, Phillips MT. Racism, sexism, and social class: implications for studies of health, disease, and well-being. Am J Prev Med1993;9(Suppl.):82–122. source
    • cites [113] Sorel JE, Heiss G, Tyroler HA, Davis WB, Wing SB, Ragland DR. Black-white differences in blood pressure among participants in NHANES II: the contribution of blood lead. Epidemiol1991;2:348–52. source
    • cites [114] Lanphear BP, Weitzman M, Eberly S. Racial differences in urban children's environmental exposures to lead. Am J Public Health1996;86:1460–63. source

      The Discussion (p. 1461) links the racial disparity in children's blood lead levels to poorer housing conditions, lead-contaminated house dust, and deteriorated painted surfaces. But the Results report similar soil lead levels for Black and White children, and the paper does not establish that residential segregation caused the exposures or that car exhaust contaminated the soil. It does not examine hypertension. (LLM, conf=0.87)

      Experimental — accuracy not yet measured
  • Interpretationcitation
    § Ecosocial theory and related multi-level dynamic perspectives · p. 6

    Resistance to racial oppression reduces risk of hypertension among African Americans.

    “(6) resistance to racial oppression: individual and community resources and social movements to counter racism and to enhance dignity, along with enactment and implementation of legislation to outlaw racial discrimination, reduces risk of hypertension among African Americans.”
    Quote in the paperSubstantial claim1 of 4 sources checked
    • cites [7] Krieger N. Discrimination and health. In: Berkman L, Kawachi I (eds). Social Epidemiology. New York: Oxford University Press, 2000, pp.36–75.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [8] Williams DR. Race, socioeconomic status, and health. The added effects of racism and discrimination. Annals NY Acad Sci1999;896: 173–88. source

      The ‘Racism and Health: Direct Effects’ section links experiences of discrimination to adverse health and cardiovascular reactivity, but does not say that resistance to racial oppression reduces hypertension risk among African Americans. Searches for resistance, hypertension, and anti-discrimination legislation found no passage establishing that specific claim; page numbers were unavailable in our copy. (LLM, conf=0.72)

      Experimental — accuracy not yet measured
    • cites [110] Krieger N, Rowley DL, Herman AA, Avery B, Phillips MT. Racism, sexism, and social class: implications for studies of health, disease, and well-being. Am J Prev Med1993;9(Suppl.):82–122. source
    • cites [119] Cooper R, Steinhauer M, Miller W, David R, Schatzkin A. Racism, society, and disease: an exploration of the social and biological mechanisms of differential mortality. Int J Health Services1981;11:389–414. source
  • Classified as probably not a substantial claim. 33
  • May combine two claims. 18
  • The quote only partly states this claim. 2

  • Probably not a substantial claim: may not pass S4 (based).

    Findingnone given
    § Current theoretical trends in social epidemiology · p. 2

    The three main theories explicitly invoked by practising social epidemiologists are psychosocial, social production of disease/political economy of health, and ecosocial theory and related multi-level frameworks.

    “The three main theories explicitly invoked by practising social epidemiologists are: (1) psychosocial, (2) social production of disease and/or political economy of health, and (3) ecosocial theory and related multi-level frameworks.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingnone given
    § 'Social epidemiology' gains a name … · p. 2

    Among slightly over 432,000 Medline-indexed articles with keyword 'epidemiology' between 1966 and 2000, only 4% also employ keyword 'social', and fewer than 0.1% are additionally indexed by 'theory'.

    “Despite these gains, it is nevertheless sobering to realize that among the slightly over 432 000 articles indexed in Medline by the keyword 'epidemiology' between 1966 and 2000, only 4% also employ the keyword 'social', and-as Reeder surely would be sorry to learn-fewer than 0.1% are additionally indexed by the term 'theory'.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Findingnone given
    § Psychosocial theory · p. 2

    Between 1966 and 1974, the keywords 'psychosocial' and 'epidemiology' together index only 40 articles in Medline; between 1995 and 1999 alone, the number jumps to nearly 1200.

    “Between 1966 and 1974, the keywords 'psychosocial' and 'epidemiology' together index only 40 articles in Medline; between 1995 and 1999 alone, the number jumps to nearly 1200.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

    Findingnone given
    § Ecosocial theory and related multi-level dynamic perspectives · p. 5

    Emerging ecologically inclined multi-level social epidemiological frameworks remain nascent and sketchy, the bare beginnings of a mental map.

    “Nascent, these emerging ecologically inclined multi-level social epidemiological frameworks remain rather sketchy, the bare beginnings of a mental map.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Findingnone given
    § Ecosocial theory and related multi-level dynamic perspectives · p. 5

    Explicit applications of these frameworks to aetiologic inquiry and to interventions are only just underway.

    “Concomitantly, explicit applications to aetiologic inquiry and to interventions are only just underway.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Premisecitation
    § Theory · p. 1

    Theory helps structure ideas to explain causal connections between specified phenomena within and across specified domains by using interrelated sets of ideas whose plausibility can be tested.

    “This is because theory helps us structure our ideas, so as to explain causal connections between specified phenomena within and across specified domains by using interrelated sets of ideas whose plausibility can be tested by human action and thought. 1-3”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [1] Fleck L. Genesis and Development of a Scientific Fact. Chicago: University of Chicago Press, 1935.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [2] Levins R, Lewontin R. The Dialectical Biologist. Cambridge, MA: Harvard University Press, 1987.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [3] Ziman J. An Introduction to Science Studies: The Philosophical and Social Aspects of Science and Technology. Cambridge: Cambridge University Press, 1984. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisenone given
    § Social production of disease/political economy of health · p. 3

    Other analyses within the social production of disease/political economy of health trend address social inequalities involving race/ethnicity, gender and sexuality, as they play out within and across socioeconomic position and diverse societies.

    “Other analyses address social inequalities involving race/ethnicity, gender and sexuality, as they play out within and across socioeconomic position, within and across diverse societies.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation
    § Social production of disease/political economy of health · p. 3

    The social production of disease/political economy of health school emerged in the politically turbulent 1960s and 1970s and focuses on the social production of disease and/or political economy of health.

    “Hearkening back to social analyses of health of the 1830s and 1840s, as well as 1930s and 1940s, this school of thought-emerging in the politically turbulent 1960s and 1970s-focuses on what it terms the 'social production of disease' and/or 'political economy of health'. 46-48”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [46] Doyal L. The Political Economy of Health. London: Pluto Press, 1979.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [47] Conrad P, Kern R (eds). The Sociology of Health and Illness: Critical Perspectives. New York: St Martin's Press, 1981.
    • cites [48] Breilh J. Epidemiologia Economia Medicina y Politica. Mexico City, Mexico: Distribuciones Fontamara, 1988 (4th edition; 1st edition published in 1979 by Universidad Central del Ecuador).

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationreasoning
    § Current theoretical trends in social epidemiology · p. 2

    The three theories differ in their emphasis on different aspects of social and biological conditions in shaping population health, how they integrate social and biological explanations, and their recommendations for action.

    “Where they differ is in their respective emphasis on different aspects of social and biological conditions in shaping population health, how they integrate social and biological explanations, and thus their recommendations for action.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning
    § Social production of disease/political economy of health · p. 4

    Both improved living standards and noneconomic interventions (with economic costs and consequences) matter for health.

    “Stated another way, both improved living standards and noneconomic interventions (albeit with economic costs and consequences) matter.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Interpretationreasoning
    § Theory · p. 1

    The fundamental tension in theories of social inequalities in health is between innate versus imposed, or individual versus societal, characteristics.

    “The fundamental tension, then and now, is between theories that seek causes of social inequalities in health in innate versus imposed, or individual versus societal, characteristics.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationcitation
    § Psychosocial theory · p. 2

    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”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [10] Krieger N. Epidemiology and the web of causation: has anyone seen the spider? Soc Sci Med1994;39:887–903. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationcitation
    § Psychosocial theory · p. 2

    John Cassel's 1976 article 'The contribution of the social environment to host resistance' is one of psychosocial epidemiology's still-defining papers.

    “The importance of the 'host-agent-environment' model for psychosocial epidemiology is evidenced by the title of one of the field's still-defining papers: John Cassel's (1921-1976) final opus, 'The contribution of the social environment to host resistance'. 30”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [30] Cassel J. The contribution of the social environment to host resistance. Am J Epidemiol1976;104:107–23. source

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning
    § Theory · p. 1

    Grappling with causation in social epidemiology raises issues of accountability and agency.

    “Grappling with notions of causation, in turn, raises not only complex philosophical issues but also, in the case of social epidemiology, issues of accountability and agency: simply invoking abstract notions of 'society' and disembodied 'genes' will not suffice.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationcitation
    § Social production of disease/political economy of health · p. 4

    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.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [10] Krieger N. Epidemiology and the web of causation: has anyone seen the spider? Soc Sci Med1994;39:887–903. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § 'Social epidemiology' gains a name … · p. 1

    By 1969, enough familiarity with social epidemiology exists that Leo G Reeder presents a major address to the American Sociological Association.

    “By 1969, enough familiarity with the field exists that Leo G Reeder presents a major address to the American Sociological Association called 'Social epidemiology: an appraisal'. 20”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [20] Reeder LG. Social epidemiology: an appraisal. (Revised version of a paper read at the annual meeting of the American Sociological Association, San Francisco, September, 1969). In: Jaco EG (ed.). Patients, Physicians, and Illness. 2nd Edn. New York: The Free Press, 1972, pp.97–101.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

    Premisenone given
    § Theory · p. 1

    Humans literally incorporate, biologically, the world around us.

    “At issue is how we literally incorporate, biologically, the world around us, a world in which we simultaneously are but one biological species among many-and one whose labour and ideas literally have transformed the face of this earth.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationnone given
    § Psychosocial theory · p. 3

    A psychosocial framework directs attention to endogenous biological responses to human interactions, focusing on responses to stress and on stressed people in need of psychosocial resources.

    “In summary, then, a psychosocial framework directs attention to endogenous biological responses to human interactions. Its focus is on responses to 'stress' and on stressed people in need of psychosocial resources.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation
    § Social production of disease/political economy of health · p. 4

    McKeown is only half right: although medical care per se can claim little credit for declines in incidence or mortality before World War II, economic growth alone did not improve health; specific public health policies were also of fundamental importance.

    “Yet, as Simon Szreter and other public health historians have convincingly demonstrated, McKeown is only half right: although medical care per se can claim little credit for declines in incidence or mortality before World War II, economic growth alone did not improve health. Rather, specific public health policies, e.g. those aimed at cleaning the water and eliminating bovine tuberculosis, were”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites 87,88,89,pp.79-96

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning
    § Theory · p. 1

    In social epidemiology, theory concerns both society and biology, specifically embodiment.

    “In social epidemiology, to speak of theory is simultaneously to speak of society and biology. It is, I will argue, to speak of embodiment.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationcitation
    § Psychosocial theory · p. 2

    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”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [10] Krieger N. Epidemiology and the web of causation: has anyone seen the spider? Soc Sci Med1994;39:887–903. source

  • Classified as probably not a substantial claim.

    Interpretationcitation
    § Ecosocial theory and related multi-level dynamic perspectives · p. 4

    The goal of these frameworks is not a totalizing theory but to generate integral and testable principles useful for guiding specific inquiry and action.

    “Their goal is not a totalizing theory to explain everything (and therefore nothing), but rather to generate a set of integral (and testable) principles useful for guiding specific inquiry and action, much as evolutionary theory (broadly writ, with contending interpretations) guides biological disciplines ranging from paleontology to molecular biology. 2,94-96”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [2] Levins R, Lewontin R. The Dialectical Biologist. Cambridge, MA: Harvard University Press, 1987.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [94] Mayr E, Provine B (eds). The Evolutionary Synthesis: Perspectives on the Unification of Biology; with a new preface by Ernst Mayr. Cambridge, MA: Harvard University Press, 1998. (1st Edn: 1980).

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [95] Lewontin RC. The Triple Helix: Gene, Organism, and Environment. Cambridge, MA: Harvard University Press, 2000.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [96] Sober E. Philosophy of Biology. 2nd Edn. Boulder, CO: Westview Press, 2000.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Interpretationcitation
    § Ecosocial theory and related multi-level dynamic perspectives · p. 5

    Social relations influence our most basic understandings of biology and our social constructions of disease.

    “and can likewise begin to see how social relations influence our most basic understandings of biology 1,2,7,101 and our social constructions of disease 1,102”
    Quote in the paperNot a substantial claim0 of 5 sources checked
    • cites [1] Fleck L. Genesis and Development of a Scientific Fact. Chicago: University of Chicago Press, 1935.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [2] Levins R, Lewontin R. The Dialectical Biologist. Cambridge, MA: Harvard University Press, 1987.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [7] Krieger N. Discrimination and health. In: Berkman L, Kawachi I (eds). Social Epidemiology. New York: Oxford University Press, 2000, pp.36–75.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [101] Krieger N. Refiguring ‘race’: epidemiology, racialized biology, and biological expressions of race relations. Int J Health Services2000;30:211–16. source
    • cites [102] Rosenberg CE, Golden J. Framing Disease: Studies in Cultural History. New Brunswick, NJ: Rutgers University Press, 1992.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationcitation
    § Ecosocial theory and related multi-level dynamic perspectives · p. 5

    An ecosocial approach raises questions beyond social determinants of age at first pregnancy to inquire how pregnancy itself is conceptualized in relation to risk of breast cancer.

    “An ecosocial approach, however, would raise questions beyond social determinants of age at first pregnancy to inquire how pregnancy itself is conceptualized in relation to risk of breast cancer.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [84] Krieger N. Exposure, susceptibility, and breast cancer risk: a hypothesis regarding exogenous carcinogens, breast tissue development, and social gradients, including black/white differences, in breast cancer incidence. Breast Cancer Res Treat1989;13:205–23. source

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning
    § Ecosocial theory and related multi-level dynamic perspectives · p. 6

    Simplistic divisions of the social and biological will not suffice.

    “Simplistic divisions of the social and biological will not suffice.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

    Interpretationreasoning
    § Ecosocial theory and related multi-level dynamic perspectives · p. 5

    No aspect of our biology can be understood absent knowledge of history and individual and societal ways of living.

    “a corollary is that no aspect of our biology can be understood absent knowledge of history and individual and societal ways of living.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationcitation
    § Ecosocial theory and related multi-level dynamic perspectives · p. 6

    An ecosocial perspective can contribute to unravelling the unexplained excess risk of hypertension among African Americans.

    “Consider, too, how an ecosocial perspective can contribute to unravelling the unexplained excess risk of hypertension among African Americans.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [7] Krieger N. Discrimination and health. In: Berkman L, Kawachi I (eds). Social Epidemiology. New York: Oxford University Press, 2000, pp.36–75.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationreasoning
    § Ecosocial theory and related multi-level dynamic perspectives · p. 5

    The ecosocial approach fully embraces a social production of disease perspective while aiming to bring in a comparably rich biological and ecological analysis.

    “Focused on the guiding question of 'who and what drives current and changing patterns of social inequalities in health' , the ecosocial approach (but not necessarily the other multi-level frameworks) fully embraces a social production of disease perspective while aiming to bring in a comparably rich biological and ecological analysis.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable). May combine two claims. The quote only partly states this claim.

    Interpretationcitation
    § Ecosocial theory and related multi-level dynamic perspectives · p. 5

    Ecosocial constructs of embodiment, pathways of embodiment, and dynamic and cumulative interplay between exposure, susceptibility and resistance require analysing pregnancy in relation to developmental biology of the breast, endocrine system, and cardiovascular system.

    “Constructs of 'embodiment', 'pathways of embodiment', and the 'dynamic and cumulative interplay between exposure, susceptibility and resistance' would require analysing pregnancy in relation to developmental biology of the breast”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [84] Krieger N. Exposure, susceptibility, and breast cancer risk: a hypothesis regarding exogenous carcinogens, breast tissue development, and social gradients, including black/white differences, in breast cancer incidence. Breast Cancer Res Treat1989;13:205–23. source
    • cites [104] Russo J, Russo IH. Toward a unified concept of mammary carcinogenesis. Progress Clin Biol Res1997;396:1–16.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning
    § Ecosocial theory and related multi-level dynamic perspectives · p. 6

    Another implication of the parity findings is to consider the social meaning of parity even when the biology of pregnancy is relevant.

    “the other is to consider the social meaning of parity even when the biology of pregnancy is relevant.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation
    § Ecosocial theory and related multi-level dynamic perspectives · p. 4

    Core to an ecological approach are concerns with scale, level of organization, dynamic states, mathematical modelling, and understanding unique phenomena in relation to general processes.

    “Core to an ecological approach are concerns with: (1) scale : referring to quantifiable dimensions of observed spatiotemporal phenomenon, whether measured in nanoseconds or millennia, microns or kilometres; (2) level of organization : theorized and inferred, in relation to specified nested hierarchies, from individual to population to ecosystem; (3) dynamic states : reflecting combined interplay”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [97] Roughgarden J. Primer of Ecological Theory. Upper Saddle River, NJ: Prentice Hall, 1998.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [98] Peterson DL, Parker VT (eds). Ecological Scale: Theory and Application. New York: Columbia University Press, 1998.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Classified as probably not a substantial claim.

    Interpretationreasoning
    § Ecosocial theory and related multi-level dynamic perspectives · p. 5

    These frameworks distinguish ecological theory from the diverse social theories upon which they and the other social epidemiological frameworks rely.

    “Rather, they distinguish ecological theory from the diverse social theories upon which they and the other social epidemiological frameworks rely.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationcitation
    § Ecosocial theory and related multi-level dynamic perspectives · p. 5

    A concern with accountability and agency, scale and level, challenges gender-biased views that posit reproductive hormones as primary determinants of women's health.

    “A concern with 'accountability and agency', as well as scale and level, would additionally challenge genderbiased views positing reproductive hormones as primary determinants of women's health.”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [68] Doyal L. What Makes Women Sick? Gender and The Political Economy of Health. New Brunswick, NJ: Rutgers University Press, 1995. source
    • cites [69] Fee E, Krieger N. Women's Health, Politics, and Power: Essays on Sex/ Gender, Medicine, and Public Policy. Amityville, NY: Baywood Publishers, 1994.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [70] Ruzek SB, Olesen VL, Clarke AE (eds). Women's Health: Complexities and Differences. Columbus: Ohio State University Press, 1997.
    • cites [105] Oudshoorn N. Beyond the Natural Body: An Archaeology of Sex Hormones. New York: Routledge, 1994. source

  • Probably not a substantial claim: may not pass S4 (based).

    Premisenone given
    § KEY MESSAGES · p. 7

    In contemporary social epidemiology, the three main theoretical frameworks for explaining disease distribution are psychosocial, social production of disease/political economy of health, and ecosocial and other emerging multi-level frameworks.

    “In contemporary social epidemiology, the three main theoretical frameworks for explaining disease distribution are: (1) psychosocial, (2) social production of disease/political economy of health, and (3) ecosocial and other emerging multi-level frameworks.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

    Interpretationnone given
    § KEY MESSAGES · p. 7

    Ecosocial and other emerging multi-level frameworks seek to integrate social and biological reasoning and a dynamic, historical and ecological perspective to develop new insights into determinants of population distributions of disease and social inequalities in health.

    “ecosocial and other emerging multi-level frameworks seek to integrate social and biological reasoning and a dynamic, historical and ecological perspective to develop new insights into determinants of population distributions of disease and social inequalities in health.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given
    § KEY MESSAGES · p. 7

    A psychosocial framework directs attention to endogenous biological responses to human interactions.

    “A psychosocial framework directs attention to endogenous biological responses to human interactions”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation
    § Ecosocial theory and related multi-level dynamic perspectives · p. 6

    To date, fewer than 25 epidemiological studies have explicitly investigated somatic consequences of racial discrimination-a mere 0.06% of the nearly 40 000 articles indexed by the keyword 'race' in Medline since 1966.

    “to date, fewer than 25 epidemiological studies have explicitly investigated somatic consequences of racial discrimination-a mere 0.06% of the nearly 40 000 articles indexed by the keyword 'race' in Medline since 1966.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [7] Krieger N. Discrimination and health. In: Berkman L, Kawachi I (eds). Social Epidemiology. New York: Oxford University Press, 2000, pp.36–75.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

    Interpretationreasoning
    § References · p. 7

    If social epidemiologists are to gain clarity on causes of and barriers to reducing social inequalities in health, adequate theory is a necessity, not a luxury.

    “If social epidemiologists are to gain clarity on causes of and barriers to reducing social inequalities in health, adequate theory is a necessity, not a luxury.”
    Quote in the paperNot a substantial claim

  • The quote only partly states this claim.

    Interpretationcitation
    § Ecosocial theory and related multi-level dynamic perspectives · p. 6

    Inadequate health care is a pathway linking racial discrimination to increased risk of hypertension among African Americans.

    “(5) inadequate health care : poorer detection and clinical management of hypertension among African Americans increases risk of untreated and uncontrolled hypertension”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [112] Lopes AA, Port FK. The low birth weight hypothesis as a plausible explanation for the black/white differences in hypertension, non-insulin-dependent diabetes, and end-stage renal disease. Am J Kidney Dis1995;25:350–56. source
    • cites [118] Svetkey LP, George LK, Tyroler HA, Timmons PZ, Burchett BM, Blazer DG. Effects of gender and ethnic group on blood pressure control in the elderly. Am J Hypertens1996;9:529–35. source

  • Classified as probably not a substantial claim.

    Interpretationnone given
    § Ecosocial theory and related multi-level dynamic perspectives · p. 6

    The ecosocial framework envisions a more systematic integrated approach capable of generating new hypotheses, rather than simply reinterpreting factors identified by one approach in terms of another.

    “the ecosocial framework begins to envision a more systematic integrated approach capable of generating new hypotheses, rather than simply reinterpreting factors identified by one approach (e.g. biological) in terms of another (e.g. social).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based). May combine two claims.

    Interpretationnone given
    § Conclusion: theory matters · p. 6

    Theory matters both to define social epidemiology and to distinguish among trends within this field.

    “In conclusion, theory matters: both to define social epidemiology and to distinguish among trends within this field.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given
    § KEY MESSAGES · p. 7

    A social production of disease/political economy of health framework explicitly addresses economic and political determinants of health and disease but leaves biology opaque.

    “a social production of disease/political economy of health framework explicitly addresses economic and political determinants of health and disease but leaves biology opaque”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based). May combine two claims.

    Interpretationnone given
    § KEY MESSAGES · p. 7

    Shared observations of disparities in health do not necessarily translate to common understandings of cause; theory is key for this reason.

    “Shared observations of disparities in health do not necessarily translate to common understandings of cause; it is for this reason theory is key.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

    Interpretationnone given
    § KEY MESSAGES · p. 7

    To gain clarity on causes of and barriers to reducing social inequalities in health, social epidemiologists will need to generate improved theoretical frameworks and the necessary data to test and refine them.

    “To gain clarity on causes of and barriers to reducing social inequalities in health, social epidemiologists will need to generate improved theoretical frameworks and the necessary data to test and refine them.”
    Quote in the paperNot a substantial claim
44 of 44

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Same journal volume is assigned to 1977 and 1987

    Minor

    The references assign volume 7 of the International Journal of Health Services to both 1977 and 1987.

1 of 1

Cites

Flagged first, then by citations

4 of the 131 references couldn’t be matched to a known paper.

Research works printed but not linked: 9

  1. Airs, Waters, Places. In: Lloyd GER (ed.). Hippocratic Writings. London: Penguin Books, 1983, pp.148–69.
  2. Krieger N. Discrimination and health. In: Berkman L, Kawachi I (eds). Social Epidemiology. New York: Oxford University Press, 2000, pp.36–75.
  3. Schnall PL, Kern R. Hypertension in American society: an introduction to historical materialist epidemiology. In: Conrad P, Kern R (eds). The Sociology of Health and Illness: Critical Perspectives. New York: St Martin's Press, 1981, pp.97–122.
  4. Navarro V. Editorial: a beginning. Int J Health Services1971;1:1–2.
  5. Black D, Morris JN, Smith C, Townsend P. The Black Report (Report of the Working Group on Inequalities in Health). London: Penguin, 1982.
  6. Committee on Environmental Justice, Health Sciences Policy Program, Health Sciences Section, Institute of Medicine. Toward Environmental Justice: Research, Education, and Health Policy Needs. Washington, DC: National Academy Press, 1999.
  7. Mann JM, Gruskin S, Grodin MA, Annas GJ (eds). Health and Human Rights. New York: Routledge, 1999.
  8. MacMahon B, Pugh TF, Ipsen J. Epidemiologic Methods. Boston: Little, Brown & Co., 1960, pp.18–22.
  9. Mayr E, Provine B (eds). The Evolutionary Synthesis: Perspectives on the Unification of Biology; with a new preface by Ernst Mayr. Cambridge, MA: Harvard University Press, 1998. (1st Edn: 1980).

Cited by

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Related

Authors
Krieger, N.
Affiliations
Harvard University (US)
Corresponding author
Krieger, Nancy
ORCID
Krieger, Nancy
Venue
International Journal of Epidemiology
Publisher
Oxford University Press (OUP)
Published
2001-08
Volume
30
Issue
4
Pages
668-677
ISSN
  • 0300-5771 (ISSN-L)
  • 1464-3685
DOI
10.1093/ije/30.4.668
OpenAlex
W2111628008
Cited by
2,155
References
131
Citations by year
2026: 145 · 2025: 112 · 2024: 132 · 2023: 158 · 2022: 144 · 2021: 127 · 2020: 101 · 2019: 111 · 2018: 86 · 2017: 93 · 2016: 102 · 2015: 99 · 2014: 87 · 2013: 85 · 2012: 70
FWCI
16.46
Type
journal article
Language
en
Open access
Locations
  • International Journal of Epidemiology (publishedVersion)
  • PubMed (publishedVersion)
  • University Libraries (University of Maryland) (submittedVersion)
  • Digital Repository at the University of Maryland (University of Maryland College Park)
Topics
  • Social Sciences › Sociology and Political Science › Historical and modern epidemiology studies
  • Social Sciences › Health › Health disparities and outcomes
  • Social Sciences › Health › Public Health and Social Inequalities
Keywords
embodiment, health disparities, social determinants of health, causality, agency, accountability, race and health
MeSH terms
Epidemiology, Humans, Politics, Social Environment, Social Medicine, Environmental Medicine

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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

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Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-15.

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