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

The DOI matches its Crossref record; 126 of the 131 references it cites were found in a registry or an index; 10 of the 122 sources its claims cite were checked for support.

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

Open access
Krieger, Nancy·2001·International Journal of Epidemiology

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’

Overview

Integrity signals

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Crossref · 10.1093/ije/30.4.668

Cites

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Claims the paper makes

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  • Probably not a substantial claim. 33
  • It may state two separate claims as one. 18
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  • Same journal volume is assigned to 1977 and 1987

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

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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).

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Metadata

Authors
Krieger, N.
Affiliations
Harvard University (US)
Corresponding author
Krieger, Nancy
Venue
International Journal of Epidemiology
Published
2001-08
Volume
30
Issue
4
Pages
668-677
ISSN
  • 0300-5771 (ISSN-L)
  • 1464-3685
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
  • Health Sciences › Medicine › Epidemiology › 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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