Abstract
In the past two decades, public health researchers have taken renewed interest in investigating the role of social factors in health. This holds substantial promise in terms of identifying manipulable social factors that are amenable to policy intervention. Most existing empirical and conceptual epidemiologic work, however, has focused on the more proximal social determinants, such as interpersonal relations. These factors, although perhaps easier to study epidemiologically, are much less relevant to policy makers than more “macrosocial” factors such as taxation policies. Limited epidemiologic attention to macrosocial determinants of health is ironic given that macrosocial factors such as the rapid industrialization and urbanization in the 19th century contributed to the organization of public health practice and, tangentially, to academic public health research. We suggest here that greater investment in the study of macrosocial determinants has the potential to make a significant and unique contribution to the greater public health agenda and should be a prominent aspect of social epidemiologic inquiry in the coming decades.
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References
Ackernecht EH . Rudolf Virchow: Doctor, Statesman, Anthropologist. Madison, WI: University of Wisconsin Press; 1953.
Berkman LF, Glass T, Brissette I, Seeman TE . From social integration to health: Durkheim in the new millennium. Soc Sci Med. 2000;51 (6):843–857.
Coleman W . Death is a Social Disease: Public Health and Political Economy in Early Industrial France. London: University of Wisconsin Press; 1982.
Engels F . The Condition of the Working Class in England. First published, Germany, 1845. English translation first published in 1886; republished with some revisions, and edited by Victor Kiernan. New York, NY: Penguin Books; 1987.
Hamlin CS . The history of methods of social epidemiology to 1965. In: Oakes JM, Kaufman JS, editors. Methods in Social Epidemiology. San Francisco: John Wiley & Sons, Inc; 2006, pp. 21–44.
Berkman LF, Kawachi I . A historical framework for social epidemiology. In: Berkman LF, Kawachi I, editors. Social Epidemiology. New York: Oxford University Press; 2000.
Cassel J . The contribution of the social environment to host resistance: the fourth Wade Hampton Frost lecture. 1976. Am J Epidemiol. 1995;104:107–123.
Galdston I . Social medicine; Its Derivations and Objectives. New York: Commonwealth Fund; 1949.
Krieger N . Theories for social epidemiology in the 21st century: an ecosocial perspective. Int J Epidemiol. 2001;30:668–677.
Syme SL . Historical perspective: the social determinants of disease – some roots of the movement. Epidemiologic Perspectives Innovations. 2005;2 (2).
Marmot MG . Stress, social and cultural variations in heart disease. J Psychosom Res. 1983;27 (5):377–384.
Marmot M . Socioeconomic determinants of CHD mortality. Int J Epidemiol. 1989;18 (3 Suppl 1):S196–202.
Link BG, Phelan J . Social conditions as fundamental causes of disease. J Health Soc Behav. 1995; Extra Issue: 80–94.
Geronimus AT . To mitigate, resist or undo: addressing structural influences on health…. Am J Public Health. 2000;90 (6):867–871.
Szreter S . The population health approach in historical perspective. Am J Public Health. 2003;93 (3):421–431.
Baltrus PT, Lynch JW, Everson-Rose S, Raghunathan TE, Kaplan GA . Race/ethnicity, life-course socioeconomic position, and body weight trajectories over 34 years: the Alameda County Study. Am J Public Health. 2005;95 (9):1595–1601.
Krieger N . Discrimination and health. In: Berkman L, Kawachi I, editors. Social Epidemiology. New York: Oxford University Press; 2000.
Williams DR . Race, socioeconomic status, and health. The added effects of racism and discrimination. Ann NY Acad Sci. 1999;896:173–188.
Lallukka T, Martikainen P, Reunanen A, Roos E, Sarlio-Lahteenkorva S, Lahelma E . Associations between working conditions and angina pectoris symptoms among employed women. Psychosom Med. 2006; (2):348–354.
Kanjilal S, Gregg EW, Cheng YJ, Zhang P, Nelson DE, Mensah G, et al. Socioeconomic status and trends in disparities in 4 major risk factors for cardiovascular disease among US adults, 1971–2002. Arch Intern Med. 2006;166 (21):2348–2355.
Jacobsen BK, Thelle DS . Risk factors for coronary heart disease and level of education. The Tromso Heart Study. Am.J.Epidemiol. 1988;127 (5):923–932.
Adler NE, Marmot M, McEwen BS, Stewart S . Socioeconomic Status and Health in Industrial Nations. New York City, NY: New York Academy of Sciences; 1999.
Kawachi I, Kennedy BP, Wilkinson RG, editors. The Society and Population Health Reader: Income Inequality and Health. New York: The New Press; 1999.
Lindström M . Social capital, anticipated ethnic discrimination and self-reported psychological health: a population-based study. Soc Sci Med. 2008;66 (1):1–13. Epub 4 September 2004.
Stuber J, Galea G, Ahern J, Blaney S, Fuller C . The association between multiple domains of discrimination and self-assessed health: a multilevel analysis of Latinos and Blacks in four low-income neighborhoods. Health Serv Res. 2003;38 (6):1735–1759.
Mays VM, Cochran SD . Mental health correlates of perceived discrimination among lesbian, gay, and bisexual adults in the United States. Am J Public Health. 2001;91 (11):1869–1876.
Subramanian SV, Kawachi I . Whose health is affected by income inequality? A multilevel interaction analysis of contemporaneous and lagged effects of state income inequality on individual self-rated health in the United States. Health Place. 2006;12 (2):141–156. Epub 18 January 2005.
Lynch J, Harper S, Kaplan GA, Davey Smith G . Associations between income inequality and mortality among US states: the importance of time period and source of income data. Am J Public Health. 2005;95 (8):1424–1430. Epub 7 July 2005.
Subramanian SV, Kawachi I . The association between state income inequality and worse health is not confounded by race. Int J Epidemiol. 2003;32 (6):1022–1028.
Wolfson M, Kaplan G, Lynch J, Ross N, Backlund E . Relation between income inequality and mortality: empirical demonstration. BMJ. 1999;319 (7215):953–955.
Pearce N . Traditional epidemiology, modern epidemiology, and public health. Am J Public Health. 1996;86 (5):678–683.
McMichael AJ . Prisoners of the proximate: loosening the constraints on epidemiology in an age of change. Am J Epidemiol. 1999;149 (10):887–897.
Diez-Roux AV . Bringing context back into epidemiology: variables and fallacies in multilevel analysis. Am J Public Health. 1998;88 (2):217–223.
Kaplan GA . What's wrong with social epidemiology, and how can we make it better? Epidemiol Rev. 2004;26:124–135.
Commission on the Social Determinants of Health. A Conceptual Framework for Action on the Social Determinants of Health. Geneva: World Health Organization; 2007.
Galea S, Freudenberg N, Vlahov D . Cities and population health. Soc Sci Med. 2005;60 (5):1017–1033.
Kaplan GA . What is the role of the social environment in understanding inequalities in health. In: Adler NE, Marmot M, McEwen BS, Stewart S, editors. Socioeconomic Status and Health in Industrial Nations. New York City, NY: New York Academy of Sciences; 1999.
Marmor TR, Barer ML, Evans RG . The determinants of a population's health: What can be done to improve a democratic nation's health status. In: Evans RG, Barer ML, Marmor TR, editors. Why are Some People Healthy and Others Nt?. New York: Aldine de Gruyter; 1994, pp. 217–230.
McKinlay JB . A case for refocusing upstream: the political economy of illness. In: Conard P, editor. The Sociology of Health and Illness. New York: St. Martin's Press; 1997.
McKinlay JB . The promotion of health through planned sociopolitical change: challenges for research and policy. Soc Sci Med. 1993;36 (2):109–117.
Schulz A, Northridge ME . Social determinants of health: implications for environmental health promotion. Health Educ Behav. 2004;31 (4):455–471.
Starfield B . Pathways of influence on equity in health. Soc Sci Med. 2007;64:1355–1362.
Coburn D, Denn K, Mykhalovskiy E, McDonough P, Robertson A, Love R . Population health in Canada: a brief critique. Am J Public Health. 2003;93 (3):392–396.
Shy CM . The failure of American epidemiology: witness for the prosecution. Am J Epidemiol. 1997;145 (6):479–484.
Susser M, Susser E . Choosing a future for epidemiology: I. Eras and paradigms. II. From black boxes to Chinese boxes. Am J Public Health. 1996;86:668–673; 674–8.
Commission on Social Determinants of Health. A Conceptual Framework for Action on the Social Determinants of Health (Draft). World Health Organization; 2007.
Hamlin C, Sheard S. . Revolutions in public health: 1848, and 1998? BMJ. 1998;317 (7158):587–591.
Rothman KH, Adami H-O, Trichopolous D . Should the mission of epidemiology include the eradication of poverty? Lancet. 1998;352:810–813.
Poole C, Rothman KH . Our conscientious objection to the epidemiology wars. J Epidemiol Community Health. 1998;52 (10):613–614.
Poole C . Ecologic analysis as outlook and method. Am J Public Health. 1994;84 (5):715–716.
Raphael D, Bryant T . The limitations of population health as a model for a new public health. Health Promotion Int. 2002;17 (2):189–199.
Rose G . Sick individuals an sick populations. Int J Epidemiol. 2001;30:427–432.
Morabia A . History of epidemiologic methods. Soz Praventiv Med. 2001;46 (1):3–4.
Susser M . Does risk factor epidemiology put epidemiology at risk? Peering into the future. J Epidemiol Community Health. 1998;52:608–611.
Marks HM . Epidemiologists explain Pellagra: gender, race, and political economy in the work of Edgar Sydenstricker. J Hist Med Allied Sci. 2003;58 (1):34–55.
Navarro V, Muntaner C, Borrell C, Benach J, Quiroga A, Rodriguez-Sanz M, et al. Politics and health outcomes. Lancet. 2006;368:1033–1037.
Raphael D . A society in decline: the poltical, economic, and social determinants of health inequalities in the United States. In: Hofrichter R, editor. Health and Social Justice. San Francisco: Jossey Bass; 2003, pp. 57–58.
Globalization and Health. BioMed Central. http://www.globalizationandhealth.com/info/about/.
Fruedenberg N, Galea S . Corporate practices. In: Galea S, editor. Macrosocial Determinants of Population Health. New York: Springer; 2007.
Sepe E, Ling PM, Glantz SA . Smooth moves: bar and nightclub tobacco promotions that target young adults. Am J Public Health. 2002;92 (3):414–419.
Slade J . Marketing policies. In: Rabin RL, Sugarman SD, editors. Regulating tobacco. New York: Oxford University Press; 2001, pp. 72–110.
Powell LM, Szczypka G, Chaloupka FJ, Braunschweig CL . Nutritional content of television food advertisements seen by children and adolescents in the United States. Pediatrics. 2007;120 (3):576–583.
Romley JA, Cohen D, Ringel J, Sturm R . Stud Alcohol Drugs. Alcohol and environmental justice: the density of liquor stores and bars in urban neighborhoods in the United States. 2007;68 (1):48–55.
Reed MB, Anderson CM, Vaughn JW, Burns DM . The effect of cigarette price increases on smoking cessation in California. Prev Sci. 2008;9 (1):47–54. Epub 7 February 2007.
Haw SJ, Gruer L . Changes in exposure of adult non-smokers to secondhand smoke after implementation of smoke-free legislation in Scotland: national cross sectional survey. BMJ. 2007;335 (7619):549.
Davey Smith G . Cultural climate, physical climate, life and death. Int J Epidemiol. 2006;35 (2):211–212.
United Nations. World Urbanization Prospects: the 2005 Revision. Available at: http://www.un.org/esa/population/publications/WUP2005/2005wup.htm, accessed 21 April 2007.
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To understand the effects of macrosocial determinants on health, the authors challenge epidemiologists to study elements of social policy, such as taxation. Such studies will make an increasingly important contribution to public health.
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Putnam, S., Galea, S. Epidemiology and the Macrosocial Determinants of Health. J Public Health Pol 29, 275–289 (2008). https://doi.org/10.1057/jphp.2008.15
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DOI: https://doi.org/10.1057/jphp.2008.15