What is social epidemiology?
Branch of epidemiology that studies how social position and context affect human health.
4 features:
1. Population level perspective
2. Social context of behaviour
3. Multi level analyses
4. Development and life course perspective
What is classical epidemiology?
Clinical epidemiology
Focus on host and agent model
What is the difference between social and classical epidemiology?
Social epidemiology:
- Population level perspective
- Social context of behaviour
- Health is determined by social context
- Balance of opportunities and constraints
- Analytical approaches include pop. attributes, individual level outcomes, multilevel analysis, human development and life course perspectives
- Time as a factor include cumulative effects, delayed effects (childhood infant circumstances predict adult outcomes)
What is body mass index?
Follow s a normal distribution
A measure of obesity
What is psychosomatic illnesses?
A physical condition such as pain or immobility arising from emotional factors such as stress, anxiety or depression
What is social epidemics?
Rapid spread of symptoms. Y a process of emotional contagion within a social network
What are prospective cohort studies?
What does gradient in health mean?
Near universal finding that health and life expectancy improve and disease incidence falls as income, education level, quality of job or quality of neighborhood rise.
What does OECD stand for?
Organization for Economic Cooperation and Development
What is the Health Utilities Index?
A technique for measuring and comparing health related quality of life through aggregating the results of questionnaires across different dimensions like pain, mobility and emotional state
What developments in the 70s lead to the development of social epidemiology?
- Friendships, social support (Berkman & Syme)
- Partner effects
What are partner effects?
What developments in the 90s paved the way for social epidemiology?
Susser and Susser found that we need to consider contextual variables in epidemiology
Broader notions of health that trace disease to insurance status, attitudes and living environment
What are 2 examples of how health is tied to social context?
- Broken heart syndrome vs. socially constructed
- Brain development and endocrinology are socially sensitive
Why is high risk a bad term?
Cutoffs between healthy and unhealthy statuses are arbitrary and difficult to determine
Meanings vary across populations
Why are the distributional characteristics of health important?
Many people at low risk —> more cases of disease
Concentration in middle of distribution
A focus on high risk people will do little to the overall group
Moving the whole distribution would reduce the number of people at high risk
What are exceptions?
HIV —> Gay people and IV drug users are impacted most
What are Rose’s paradoxes
- Treating high risk people will do little to impact population health
- Individual level approach will impact little of population risk
- Population level approach will impact little of individual risk
How are driving accidents an example of Rose’s paradoxes in action?
Most risky drivers avoid accidents
Low risk drivers cause most accidents
What are the implications of Rose’s paradoxes?
Pop. Approach is better where risk is small and widespread
Solution: More than mean average
What are Rose’s conclusions?
Traditional risk factor approach
- fails to address majority of cases
- fails to address root causes
- fails to understand human behaviour
- Fails to incorporate an adequate concept of causality
Describe the Whitehall studies
Traditional risk factors account for no more than 40% of variation in heart disease
Gradient in health
Describe the Black Report
Huge growing gap in health between rich and poor
No progress in closing gap despite welfare program creation and NHS
Describe Wilkinson’s work
Comparative cross national analysis of wealthy countries
Income inequality matters more
Findings contradictory but remain influential
