The goal of research in social epidemiology is not simply conceptual clarification or theoretical understanding, but more importantly it is to contribute to, and enhance the health of populations (and so, too, the people who constitute those populations). Undoubtedly, understanding how various individual risk factors such as smoking and obesity affect the health of people does contribute to this goal. However, what is distinctive of much on-going work in social epidemiology is the view that analyses making (...) use of individual-level variables is not enough. In the spirit of Durkheim and Weber, S. Leonard Syme makes this point by writing that just “as bad water and food may be harmful to our health, unhealthful forces in our society may be detrimental to our capacity to make choices and to form opinions” conducive to health and well-being. Advocates of upstream (distal) causes of adverse health outcomes propose to identify the most important of these “unhealthful forces” as the fundamental causes of adverse health outcomes. However, without a clear, theoretically precise and well-grounded understanding of the characteristics of fundamental causes, there is little hope in applying the statistical tools of the health sciences to hypotheses about fundamental causes, their outcomes, and policies intended to enhance the health of populations. This paper begins the process of characterizing the social epidemiological concept of fundamental cause in a theoretically respectable and robust way. (shrink)

Social epidemiology has made a powerful case that health determined not just by individual-level factors such as our genetic make-up, access to medical services, or lifestyle choices, but also by social conditions, including the economy, law, and culture. Indeed, at the level of populations, evidence suggests that these “structural” factors are the predominant influences on health. Legal scholars in public health, including those in the health and human rights movement, have contended that human rights, laws, and legal (...) practices are powerfully linked to health. Social epidemiology and health-oriented legal scholarship are complementary in their focus and their research needs. Legal scholarship has identified plausible ways in which legal and human rights factors could be influencing health, but empirical evidence has been limited. (shrink)

Social epidemiology has made a powerful case that health determined not just by individual-level factors such as our genetic make-up, access to medical services, or lifestyle choices, but also by social conditions, including the economy, law, and culture. Indeed, at the level of populations, evidence suggests that these “structural” factors are thepredominantinfluences on health. Legal scholars in public health, including those in the health and human rights movement, have contended that human rights, laws, and legal practices are (...) powerfully linked to health. Social epidemiology and health-oriented legal scholarship are complementary in their focus and their research needs. Legal scholarship has identified plausible ways in which legal and human rights factors could be influencing health, but empirical evidence has been limited. (shrink)

In the foundational piece in this issue of the journal, “Integrating Law and Social Epidemiology,” Burris, Kawachi, and Sarat present a model for understanding the relationship between law and health. This article uses the case of a specific health condition, the human immunodeficiency virus infection, as an opportunity to flesh out this schema and to test how the model “fits” the world of the HIV pandemic. In applying the model to this communicable disease, we hope to illustrate the (...) multitude of ways that laws affect the course of the pandemic as well as the course of an individual’s vulnerability or resilience to the disease, and how the complexities of an individual’s life dealing with the virus interface with the world of laws and legal institutions. (shrink)

Commentary on Angelo E. Volandes & Michael K. Paasche-Orlow, Health Literacy, Health Inequality and a Just Healthcare System.

Corresponding Author, Health Policy & Ethics Fellow, Chronic Disease Prevention & Control Research Center, Department of Medicine, Baylor College of Medicine, 1709 Dryden, Suite 1025, Houston, TX 77030, USA. Tel.: 713.798.5482; Fax: 713 798 3990; Email: danielg{at}bcm.edu ' + u + '@' + d + ' '//--> . Abstract This article defends a broad model of public health, one that specifically addresses the social epidemiologic research suggesting that social conditions are primary determinants of health. The article proceeds by (...) critiquing one of the strongest arguments in favor of a narrow model, advanced by Mark Rothstein. The critique sets up the argument that a model of public health that does not address what actually causes health and disease is unlikely to improve public health. Assessing the substantial evidence regarding the social determinants of health, the article engages the policy paradox that precludes utopian prescriptions but demands more than mere expedience. CiteULike Connotea Del.icio.us What's this? (shrink)

Journal of Social Philosophy, EarlyView.

I argue that the orthodox account of probabilistic causation, on which probabilistic causes determine the probability of their effects, is inconsistent with certain ontological assumptions implicit in scientific practice. In particular, scientists recognize the possibility that properties of populations can cause the behavior of members of the populations. Such emergent population‐level causation is metaphysically impossible on the orthodoxy.

The present article identifies how social determinants of health raise two categories of philosophical problems that also fall within the smaller domain of ethics; one set pertains to the philosophy of epidemiology, and the second set pertains to the philosophy of health and social justice. After reviewing these two categories of ethical concerns, the limited conclusion made is that identifying and responding to social determinants of health requires inter-disciplinary reasoning across epidemiology and philosophy. For the (...) reasoning used in epidemiology to be sound, for its scope and (moral) purpose as a science to be clarified as well as for social justice theory to be relevant and coherent, epidemiology and philosophy need to forge a meaningful exchange of ideas that happens in both directions. (shrink)

Recent approaches to the social epistemology of belief formation have appealed to an epidemiological model, on which the mechanisms explaining how we form beliefs from our society or community along the lines of infectious disease. More specifically, Alvin Goldman (2001) proposes an etiology of (social) belief along the lines of an epistemological epidemiology. On this “contagion model,” beliefs are construed as diseases that infect people via some socio-epistemic community. This paper reconsiders Goldman’s epidemiological approach in terms of (...) epistemic trust. By focusing on beliefs as diseases, Goldman misconstrues and underestimates the central role that epistemic trust plays in their formation (maintenance, revision, etc.). I suggest that we put trust, accordingly, as the center of an epidemiological model of social doxology—epistemic trust, rather than beliefs, is the disease with which one is infected. So, contra Goldman, beliefs themselves aren’t the disease—they are symptoms. Trust, on this approach, can be viewed as a pathology. This point connects Annette Baier’s (1994) work on moral trust—taking a cue from her “pathologies of trust.” The real pathology centered in social doxology is the epistemic trust manifested by those beliefs. Accordingly, I shall explore (and tentatively defend) an epidemiological model for such “pathological” epistemic trust inspired by Baier’s work on moral trust, one which can more adequately account for the infectious epistemic trust at work in social belief formation. (shrink)

Philosophy of epidemiology has recently emerged as a distinct branch of philosophy. The field will surely benefit from pluralism, reflected in the broad range of topics and perspectives in this special issue. Here, I argue that a healthy pluralistic field of philosophy of epidemiology has social responsibilities that require the field as a whole to engage actively with research on social determinants of health and health disparities. Practicing epidemiologists and the broader community of public health scientists (...) have gradually acknowledged that much of their attention ought to be paid to these, i.e. inequitable between-population health variations that largely reflect the world’s inequitable distribution of resources and social conditions. The paper illustrates how and why health disparities and social determinants of health, through no ill will, become de facto secondary concerns in Alex Broadbent’s field-defining Philosophy of Epidemiology, showing the ease with which these topics can be incidentally sidelined. As means for philosophy of epidemiology to meet its social responsibility obligations, I suggest philosophy of epidemiology expand its attention to two particular lines research. First, the paper discusses Geoffrey Rose’s concept of “causes of incidence”—causes of disparities between populations—and argues for the importance of engaging with these causes. Second, the paper argues for the value of engaging with Bruce Link and Jo Phelan’s “fundamental causes” model of how flexible social resources serve as buffers from harms, generating a plethora of shifting and locally-contingent health effects. (shrink)

Toxic speech inflicts damage to mental and physical health. This process can be chronic or acute, temporary or permanent. Understanding how toxic speech inflicts these harms requires both an account of linguistic practices and, because language is inherently social, tools from epidemiology. This paper explores what we can learn from two epidemiological models: a common source model that emphasizes poisons, and a propagated transmission model that better fits contagions like viruses.

In little more than a decade, the AIDS epidemic has exerted a profound effect on morbidity and mortality among young adults and children in many parts of the world. One of the more dramatic aspects of AIDS is that it seems to have arisen almost spontaneously as a new epidemic, spreading rapidly within at-risk populations in a way that is unprecedented for the serious infectious diseases of recent memory. Tuberculosis, on the other hand, had only recently been considered a disease (...) of historical importance but of diminishing relevance to current public health priorities, especially in industrialized countries. Over the past decade, however, and in parallel with the AIDS epidemic, there has been a resurgence of tuberculosis in many of the same populations most affected by HIV infection. This has had important implications for clinical practice, public health, and the development of appropriate health policy. A number of elements have converged to promote the development of HIV-related tuberculosis, including biologic, social, and environmental factors. These will be discussed both to provide a context for understanding the relationship between the two epidemics, and as a basis for suggesting strategies for tuberculosis control in the AIDS era. (shrink)

Epidemiology is a field torn between practices of surveillance and methods of analysis. Since the onset of COVID-19, epidemiological expertise has been mostly identified with the first, as dashboards of case and mortality rates took centre stage. However, since its establishment as an academic field in the early 20th century, epidemiology’s methods have always impacted on how diseases are classified, how knowledge is collected, and what kind of knowledge was considered worth keeping and analysing. Recent advances in digital (...) epidemiology, this article argues, are not just a quantitative expansion of epidemiology’s scope, but a qualitative extension of its analytical traditions. Digital epidemiology is enabled by deep and digital phenotyping, the large-scale re-purposing of any data scraped from the digital exhaust of human behaviour and social interaction. This technological innovation is in need of critical examination, as it poses a significant epistemic shift to the production of pathological knowledge. This article offers a critical revision of the key literature in this budding field to underline the extent to which digital epidemiology is envisioned to redefine the classification and understanding of disease from the ground up. Utilising analytical tools from science and technology studies, the article demonstrates the disruptive expectations built into this expansion of epidemiological surveillance. Given the sweeping claims and the radical visions articulated in the field, the article develops a tentative critique of what I call a fantasy of pathological omniscience; a vision of how data-driven engineering seeks to capture and resolve illness in the world, past, present and future. (shrink)

Epidemiological studies usually do not pose high risk to participants. At the same time they provide valuable knowledge and improve public and individual health. In many countries, studies involving human subjects are subject to ethics review. Research shows that the process of obtaining ethical approval from institutional research boards or research ethics committees is sometimes costly, time-consuming and seriously delays important research projects. In this article we consider arguments against and in favor of ethics review of epidemiological studies. On the (...) one hand, it seems that minimal risk epidemiological studies should not be a subject to ethics review, since any delay of an important study has its death toll and health costs. In this perspective, the calculus of costs and benefits supports rejecting the whole existing approach. Nevertheless, we argue that institutional research boards or ethics research committees protect research participants from wrongs and up till now are the best tools of social and political control over the research enterprise. (shrink)

In a scenario characterized by unpredictable developments, such as the recent COVID-19 pandemic, epidemiological models have played a leading part, having been especially widely deployed for forecasting purposes. In this paper, two real-world examples of modeling are examined in support of the proposition that science can convey inconsistent as well as genuinely perspectival representations of the world. Reciprocally inconsistent outcomes are grounded on incompatible assumptions, whereas perspectival outcomes are grounded on compatible assumptions and illuminate different aspects of the same object (...) of interest. In both cases, models should be viewed as expressions of specific assumptions and unconstrained choices on the part of those designing them. The coexistence of a variety of models reflects a primary feature of science, namely its pluralism. It is herein proposed that recent over-exposure to science’s inner workings and disputes such as those pertaining to models, may have led the public to perceive pluralism as a flaw—or more specifically, as disunity or fragmentation, which in turn may have been interpreted as a sign of unreliability. In conclusion, given the inescapability of pluralism, suggestions are offered as to how to counteract distorted perceptions of science, and thereby enhance scientific literacy. (shrink)

Although epidemiology as a scientific study of disease in populations claimed an independent disciplinary status already in the mid–nineteenth century, its history in the twentieth century can be seen as a continuous and often contentious attempt to define the field’s social and intellectual boundaries vis-à-vis a variety of neighboring scientific fields and public health practices. In a period dominated by laboratory biomedical sciences, epidemiologists repeatedly tried to spell out how their discipline met the requirements of scientificity despite its (...) focus on disease as a collective phenomenon and its reliance on nonlaboratory methods. This article asks about the relationship between the changing institutional and intellectual contexts of British epidemiological practice and the epidemiologists’attempts to define both science in general and epidemiology in particular. An examination of the epidemiologists’boundary-making endeavors is also used to reflect on the circumstances in which scientists engage in the discourse of disciplinary demarcations. (shrink)

Contemporary infectious disease surveillance systems aim to employ the speed and scope of big data in an attempt to provide global health security. Both shifts - the perception of health problems through the framework of global health security and the corresponding technological approaches – imply epistemological changes, methodological ambivalences as well as manifold societal effects. Bringing current findings from social sciences and public health praxis into a dialogue, this conversation style contribution points out several broader implications of changing disease (...) surveillance. The conversation covers epidemiological issues such as the shift from expert knowledge to algorithmic knowledge, the securitization of global health, and the construction of new kinds of threats. Those developments are detailed and discussed in their impacts for health provision in a broader sense. (shrink)

Epidemiology is a core science of public health, focusing on research related to the distribution and determinants of both positive and adverse health states and events and on application of knowledge gained to improve public health. The American College of Epidemiology (ACE) is a professional organization devoted to the professional practice of epidemiology. As part of that commitment, and in response to concerns for more explicit attention to core values and duties of epidemiologists in light of emerging (...) issues and increased scrutiny of epidemiology, the College developed, adopted, and published a set of Ethics Guidelines. The structure of the ACE ethics guidelines is in four parts: (1) a brief statement of core values and duties of epidemiologists, coupled with the virtues important to professional practice; (2) concise statements of key duties and obligations; (3) exposition of the duties and obligations with more applications; and (4) a brief summary and conclusion. The Guidelines have been published on the ACE website and in the official College journal Annals of Epidemiology. The guidelines contain (and maintain) core elements that define the discipline of epidemiology and its fundamental duties, but they are also intended to be dynamic and evolving, responsive to a changing professional and social environment. (shrink)

Cultural epidemiology is a theoretical framework that enables historical studies to be informed by cognitive science. It incorporates insights from evolutionary psychology (viz. cultural evolution is constrained by universal properties of the human cognitive apparatus that result from biological evolution) and from Darwinian models of cultural evolution (viz. population thinking: cultural phenomena are distributions of resembling items among a community and its habitat). Its research program includes the study of the multiple cognitive mechanisms that cause the distribution, on a (...) cultural scale, of representations and material cultural items. By a detailed analysis of the social cognitive causal chain that occurred in the past, one can find out – and specify – which are the factors of attraction that account for cultural stability as well as historical cultural change. After reviewing recent research and developments in cognitive history, I present the concept of cultural attractor and explain why cultural attractors are historically variable. In doing so, I emphasize the role of historically constituted cognitive mechanisms, which account for much of historical cultural developments. I argue that the framework of cultural epidemiology can better account for these important historical phenomena than either evolutionary psychology accounts of culture or dual inheritance theory. I conclude that describing and explaining the history of cultural attractors is a good research goal for historians. (shrink)

The impending implementation of pre-exposure prophylaxis has prompted complicated bioethical and public health ethics concerns regarding the moral distribution of antiretroviral medications to ostensibly healthy populations as a form of HIV prevention when millions of HIV-positive people still lack access to ARVs globally. This manuscript argues that these questions are, in part, concerns over the ethics of the knowledge production practices of epidemiology. Questions of distribution, and their attendant cost-benefit calculations, will rely on a number of presupposed, and therefore, (...) normatively cultural assumptions within the science of epidemiology specifically regarding the ability of epidemiologic surveillance to produce accurate maps of HIV throughout national populations. Specifically, ethical questions around PrEP will focus on who should receive ARVs given the fact that global demand will far exceed supply. Given that sexual transmission is one of the main modes of HIV transmission, these questions of ‘who’ are inextricably linked to knowledge about sexual personhood. As a result, the ethics of epidemiology, and how the epidemiology of HIV in particular conceives, classifies and constructs sexual populations will become a critical point of reflection and contestation for bioethicists, health activists, physicians, nurses, and researchers in the multi-disciplinary field of global health. This paper examines how cultural conundrums within the fields of bioethics and public health ethics are directly implicated within the ethics of PrEP, by analyzing the problems of population inaugurated by the construction of the men who have sex with men epidemiologic category in the specific national context of South Africa. (shrink)

Epidemiological models directly shape policy responses to public health crises. We argue that they also play a less obvious but important role in solving certain coordination problems and social dilemmas that arise during pandemics. This role is both ethically and epistemically valuable. However, it also gives rise to an underappreciated dilemma, as the features that make models good at solving coordination problems are often at odds with the features that make for a good scientific model. We examine and develop (...) this dilemma in the context of the COVID-19 pandemic, and suggest extensions to other domains. (shrink)

The epidemiologist Bradford Hill famously argued that in epidemiology, specificity of association (roughly, the fact that an environmental or behavioral risk factor is associated with just one or at most a few medical outcomes) is strong evidence of causation. Prominent epidemiologists have dismissed Hill’s claim on the ground that it relies on a dubious `one-cause one effect’ model of disease causation. The paper examines this methodological controversy, and argues that specificity considerations do have a useful role to play in (...) causal inference in epidemiology. More precisely, I argue that specificity considerations help solve a pervasive inferential problem in contemporary epidemiology: the problem of determining whether an exposure-outcome correlation might be due to confounding by a social factor. This examination of specificity has interesting consequences for our understanding of the methodology of epidemiology. It highlights how the methodology of epidemiology relies on local tools designed to address specific inference problems peculiar to the discipline, and shows that observational causal inference in epidemiology can proceed with little prior knowledge of the causal structure of the phenomenon investigated. I also argue that specificity of association cannot (despite claims to the contrary) be entirely explained in terms of Woodward’s well-known concept of “one-to-one” causal specificity. This is because specificity as understood by epidemiologists depends on whether an exposure (or outcome) is associated with a `heterogeneous’ set of variables. This dimension of heterogeneity is not captured in Woodward’s notion, but is crucial for understanding the evidential import of specificity of association. (shrink)

This article examines how digital epidemiology and eHealth coalesce into a powerful health surveillance system that fundamentally changes present notions of body and health. In the age of Big Data and Quantified Self, the conceptual and practical distinctions between individual and population body, personal and public health, surveillance and health care are diminishing. Expanding on Armstrong’s concept of “surveillance medicine” to “quantified self medicine” and drawing on my own research on the symbolic power of statistical constructs in medical encounters, (...) this article explores the impact of digital health surveillance on people’s perceptions, actions and subjectivities. It discusses the epistemic confusions and paradoxes produced by a health care system that increasingly treats patients as risk profiles and prompts them to do the same, namely to perceive and manage themselves as a bundle of health and security risks. Since these risks are necessarily constructed in reference to epidemiological data that postulate a statistical gaze, they also construct or make-up disembodied “individuals on alert”. (shrink)

Humans have been using fire for hundreds of millennia, creating an ancestral expansion toward the nocturnal niche. The new adaptive challenges faced at night were recurrent enough to amplify existing psychological variation in our species. Night-time is dangerous and mysterious, so it selects for individuals with higher tendencies for paranoia, risk-taking, and sociability. During night-time, individuals are generally tired and show decreased self-control and increased impulsive behaviors. The lower visibility during night-time favors the partial concealment of identity and opens more (...) opportunities for disinhibition of self-interested behaviors. Indeed, individuals with an evening-oriented chronotype are more paranoid, risk-taking, extraverted, impulsive, promiscuous, and have higher antisocial personality traits. However, under some circumstances, such as respiratory pandemics, the psychobehavioral traits favored by the nocturnal niche might be counter-productive, increasing contagion rates of a disease that can evade the behavioral immune system because its disease cues are often nonexistent or mild. The eveningness epidemiological liability hypothesis presented here suggests that during the COVID-19 pandemic, the evening-oriented psychobehavioral profile can have collectively harmful consequences: there is a clash of core tendencies between the nocturnal chronotype and the recent viral transmission-mitigating safety guidelines and rules. The pandemic safety protocols disrupt much normal social activity, particularly at night when making new social contacts is desired. The SARS-CoV-2 virus is contagious even in presymptomatic and asymptomatic individuals, which enables it to mostly evade our evolved contagious disease avoidance mechanisms. A growing body of research has indirectly shown that individual traits interfering with social distancing and anti-contagion measures are related to those of the nocturnal chronotype. Indeed, some of the social contexts that have been identified as superspreading events occur at night, such as in restaurants, bars, and nightclubs. Furthermore, nocturnal environmental conditions favor the survival of the SARS-CoV-2 virus much longer than daytime conditions. We compare the eveningness epidemiological liability hypothesis with other factors related to non-compliance with pandemic safety protocols, namely sex, age, and life history. Although there is not yet a direct link between the nocturnal chronotype and non-compliance with pandemic safety protocols, security measures and future empirical research should take this crucial evolutionary mismatch and adaptive metaproblem into account, and focus on how to avoid nocturnal individuals becoming superspreaders, offering secure alternatives for nocturnal social activities. (shrink)

AbstractDuring the Covid-19 pandemic, ethicists and researchers proposed human challenge studies as a way to speed development of a vaccine that could prevent disease and end the global public health crisis. The risks to healthy volunteers of being deliberately infected with a deadly and novel pathogen were not low, but the benefits could have been immense. This essay is a history of the three major efforts to set up a challenge model and run challenge studies in 2020 and 2021. The (...) pharmaceutical company Johnson and Johnson, the National Institutes of Health in the United States, and a private-public partnership of industry, university, and government partners in Britain all undertook preparations. The United Kingdom’s consortium began their Human Challenge Programme in March of 2021.Beyond documenting each effort, the essay puts these scientific and ethical debates in dialogue with the social, epidemiological, and institutional conditions of the pandemic as well as the commercial, intellectual, and political systems in which medical research and Covid-19 challenge studies operated. It shows how different institutions understood risk, benefit, and social value depending on their specific contexts. Ultimately the example of Covid-19 challenge studies highlights the constructedness of such assessments and reveals the utility of deconstructing them retrospectively so as to better understand the interplay of medical research and research ethics with larger social systems and historical contexts. (shrink)

Background: Health systems globally face ncreasing challenges from health crises and epidemic threats, necessitating the pivotal role of epidemiological teams in emergency response. This study investigates the significance of collective competence within these teams, focusing on their ability to collect, analyze, and manage laboratory data effectively. Methods: A cross-sectional descriptive study design was used to survey epidemiological teams in Saudi Arabia. A structured questionnaire was developed based on existing literature and distributed electronically to participants. Data analysis was performed using the (...) Statistical Package for the Social Sciences (SPSS), using descriptive and inferential statistics to summarize participant characteristics and explore associations between variables. Results: A total of 208 epidemiological teams member completed the questionnaire, yielding insights into their The Role of Collective Competence in Epidemiological Teams. The findings reveal high levels of agreement regarding the effectiveness of management approaches, knowledge sharing, and team collaboration, with the average score exceeding 4.0 on a 5-point scale. Notably, team efficacy was found to significantly enhance the efficiency of laboratory data collection and analysis, accounting for approximately 25.9% of the variance in efficacy. Discussion: These findings underscore the need to invest in developing team competencies within epidemiological teams to improve emergency response capabilities. The study provides practical insights into enhancing team collaboration and coordination, ultimately contributing to more effective public health interventions in future health crises. (shrink)

Recent research in epidemiology has identified a number of factors beyond access to medical care that contribute to health disparities. Among the so-called socioeconomic determinants of health are income, education, and the distribution of social capital. One factor that has been overlooked in this discussion is the effect that stigmatization can have on health. In this paper, I identify two ways that social stigma can create health disparities: directly by impacting health-care seeking behaviour and indirectly through the (...) internalization of negative interpersonal judgments. I then argue that social arrangements that foster self-respect can reduce the impact of stigmatization on health disparities. I conclude by showing how John Rawls' conception of justice can be used to address the intersection of stigma, health, and self-respect, in contrast to critics of his position, who have seen him as excessively focused on the allocation of material goods. (shrink)

Pre-existing medical conditions and co-infections are common to all human populations, although the natures of the pre-existing conditions and the types of co-infections vary. For these reasons, among others, the arrival of a highly infectious pathogenic agent may differentially affect the disease burden in different sub-populations, as a function of varying combinations of endemic disease, chronic disease, genetic or epigenetic vulnerabilities, compromised immunological status, and socially determined risk exposure. The disease burden may also vary considerably by age cohort and socio-economic (...) status. The social consequences of infection, the medical sequelae, and the paths of recovery from infection may also vary, according to these variables. As a result, different sub-populations may have different experiences of a disease process, including when and how an epidemic comes to an end. This essay suggests that historians' engagement with path-breaking biological and medical anthropological research will allow new approaches to understanding disease processes that will enrich the study of epidemics and their endings. It is organized in three sections. The first discusses some general approaches to and assumptions about epidemics that are used by many historians. The second introduces new perspectives on the study of historical epidemics opened up by the medical anthropological concept of syndemic disease interactions and by an engagement with biological scientific perspectives. It briefly discusses two rural epidemics-one of anemia caused by the syndemic interaction of hookworm and malaria co-infections in early 20th-century British Malaya, and the other of rebound infections caused by the loss of acquired immunity to falciparum malaria in mid-20th-century Liberia-that illustrate, respectively, the utility of the concept of syndemic disease interactions and the centrality of immunological status in understanding epidemic outbreaks in these discrete populations. The third section addresses some of the research considerations involved in moving beyond the single pathogen model of epidemic disease. (shrink)

The notion of ‘causal web’ emerged in the epidemiological literature in the early Sixties and had to wait until the Nineties for a thorough critical appraisal. Famously, Nancy Krieger argued that such a notion isn’t helpful unless we specify what kind of spiders create the webs. This means, according to Krieger, (i) that the role of the spiders is to provide an explanation of the yarns of the web and (ii) that the sought spiders have to be biological and (...) class='Hi'>social. This paper contributes to the development of the notion of causal web, elaborating on the two following points: (i) to catch the spiders we need multi-fold evidence—specifically, mechanistic and difference-making—and (ii) for the eco-social to be explanatory, the web has to be mechanistic in a sense to be specified. (shrink)

BackgroundThe pandemic of Coronavirus Disease 2019 has burdened an unprecedented psychological stress on the front-line medical staff, who are at high risk of depression. While existing studies and theories suggest that factors such as gratitude, social support, and hope play a role in the risk of depression, few studies have combined these factors to explore the relationship between them.ObjectiveThis study examined the mediating roles of social support and hope in the relationship between gratitude and depression among front-line medical (...) staff during the pandemic of COVID-19.MethodsThis study used the Gratitude Questionnaire, the Perceived Social Support Scale, the State Hope Scale, and the Center for Epidemiologic Studies Depression Scale to examine the gratitude, social support, hope, and depression among 344 front-line medical workers in Wuhan, which was the hardest-hit area of COVID-19 in China.ResultsThe results showed that the prevalence of mild depressive disorder was 40.12% and the prevalence of major depressive disorder was 9.59% among front-line medical staff during the pandemic of COVID-19; gratitude has a direct and negative effect on depression. Gratitude was negative predictors of depression through the mediating variables of social support and hope [βgratitude–social support–depression = −0.096, 95%CI; βgratitude–hope–depression = −0.034, 95%CI], as well as via an indirect path from social support to hope [βgratitude–social support–hope–depression = −0.089, 95%CI ].ConclusionThe study findings indicate that gratitude as a positive emotion can reduce depression in medical staff by promoting social support and hope, respectively. Gratitude also reduced depression in health care workers through a chain mediating effect of social support and hope. Overall, gratitude can directly foster social support and hope, and protect people from stress and depression, which has implications for clinical interventions among front-line medical staff during the pandemic of COVID-19. (shrink)

This paper delineates a postmodern discourse analysis that is positioned within a semiotic theory of language. This theory of language foregrounds the performative aspects of language usage and provides the theoretical space from which to theorize the interrelationship between social organizations or structure and social agents or individuals. Our version of discourse analysis contends that social structure is enacted (production and reproduction) through the employment of various vocabularies: social structure is not something outside of, behind, or (...) underneath these performances, and we argue that social organization is not produced by external structures operating upon or causing people to adopt certain behaviours. Rather, social structure is an effect of taking up practices and reproducing and modifying them. From this perspective, individuals are constituted by being recruited into and reproducing discursive practices. Hence, by looking at the actual employment of language – its tactical, practice dimensions – one can avoid the usual binary of seeing the person as either the autonomous origin of his or her experience or the ideological pawn of social determination. This methodology calls into question how the narratives or stories that individuals recount are imbricated within relational plays of power, and concomitantly, how subjects reauthorize their own positions. We assert that the methodological challenges of research addressing social injustice cannot be reduced to either: (i) interpersonal relationships between researcher and participants, or (ii) relegated to ‘social structures’ acting upon or outside of individuals. (shrink)

BackgroundHIV molecular epidemiology is increasingly recognized as a vital source of information for understanding HIV transmission dynamics. Despite extensive use of these data-intensive techniques in both research and public health settings, the ethical issues associated with this science have received minimal attention. As the discipline evolves, there is reasonable concern that existing ethical and legal frameworks and standards might lag behind the rapid methodological developments in this field. This is a follow-up on our earlier work that applied a predetermined (...) analytical framework to examine the perspectives of a sample of scientists from the fields of epidemiology, public health, virology and bioethics on key ethical issues associated with HIV molecular epidemiology in HIV network research.MethodsFourteen in-depth interviews were conducted with scientists from the fields of molecular epidemiology, public health, virology and bioethics. Inductive analytical approaches were applied to identify key themes that emerged from the data.ResultsOur interviewees acknowledged the potential positive impact of molecular epidemiology in the fight against HIV. However, they were concerned that HIV phylogenetics research messages may be incorrectly interpreted if not presented at the appropriate level. There was consensus that HIV phylogenetics research presents a potential risk to privacy, but the probability and magnitude of this risk was less obvious. Although participants acknowledged the social value that could be realized from the analysis of HIV genetic sequences, there was a perceived fear that the boundaries for use of HIV sequence data were not clearly defined.ConclusionsOur findings highlight distinct ethical issues arising from HIV molecular epidemiology. As the discipline evolves and HIV sequence data become increasingly available, it is critical to ensure that ethical standards keep pace with biomedical advancements. We argue that the ethical issues raised in this study, whether real or perceived, require further conceptual and empirical examination. (shrink)

In the last decades, Systems Biology (including cancer research) has been driven by technology, statistical modelling and bioinformatics. In this paper we try to bring biological and philosophical thinking back. We thus aim at making diferent traditions of thought compatible: (a) causality in epidemiology and in philosophical theorizing—notably, the “sufcient-component-cause framework” and the “mark transmission” approach; (b) new acquisitions about disease pathogenesis, e.g. the “branched model” in cancer, and the role of biomarkers in this process; (c) the burgeoning of (...) omics research, with a large number of “signals” and of associations that need to be interpreted. In the paper we summarize frst the current views on carcinogenesis, and then explore the relevance of current philosophical interpretations of “cancer causes”. We try to ofer a unifying framework to incorporate biomarkers and omic data into causal models, referring to a position called “evidential pluralism”. According to this view, causal reasoning is based on both “evidence of diference-making” (e.g. associations) and on “evidence of underlying biological mechanisms”. We conceptualize the way scientists detect and trace signals in terms of information transmission, which is a generalization of the mark transmission theory developed by philosopher Wesley Salmon. Our approach is capable of helping us conceptualize how heterogeneous factors such as micro and macro-biological and psycho-social—are causally linked. This is important not only to understand cancer etiology, but also to design public health policies that target the right causal factors at the macro-level. (shrink)

With the aim of ascertaining if child-to-parent offenders have impairments in the executive functions and psychological maladjustment, and to quantify the potential harm and epidemiology, a field study was designed. As for this, 76 juvenile offenders sentenced for child-to-parent violence were assessed in executive functions and psychological adjustment. The results showed valid responses for 75 juveniles and that data were not generally biased in line with defensiveness or malingering. In psychological adjustment, the results revealed a significantly higher maladjustment among (...) offenders on all the basic clinical scales with 23% more symptoms of hysteria than the normative population, 37% more of depressive symptoms, 44% more of hypochondriac symptoms, 68% more of psychopathic deviation symptoms, 46% more of paranoid symptoms, 26% more of psychasthenic symptoms, 24% more symptoms of schizophrenia, 17% more symptoms of hypomania, and 13% more symptoms of social introversion. Epidemiologically, the prevalence rates of clinical deterioration were significantly greater than expected in hypochondria, depression, hysteria, psychopathic deviation, paranoia, psychasthenia, and schizophrenia. As for the cognitive functions, the offenders exhibited impairments estimated at 62.0% in word reading, 47.9% in color naming, 45.8% in color-word, and 11.9% in interference and a significantly higher prevalence of caseness than expected in word reading, color naming, and color-word. The implications of the results for intervention are discussed. (shrink)

This paper poses the question of whether people have a duty to participate in digital epidemiology. While an implied duty to participate has been argued for in relation to biomedical research in general, digital epidemiology involves processing of non-medical, granular and proprietary data types that pose different risks to participants. We first describe traditional justifications for epidemiology that imply a duty to participate for the general public, which take account of the immediacy and plausibility of threats, and (...) the identifiability of data. We then consider how these justifications translate to digital epidemiology, understood as an evolution of traditional epidemiology that includes personal and proprietary digital data alongside formal medical datasets. We consider the risks imposed by re-purposing such data for digital epidemiology and propose eight justificatory conditions that should be met in justifying a duty to participate for specific digital epidemiological studies. The conditions are then applied to three hypothetical cases involving usage of social media data for epidemiological purposes. We conclude with a list of questions to be considered in public negotiations of digital epidemiology, including the application of a duty to participate to third-party data controllers, and the important distinction between moral and legal obligations to participate in research. (shrink)

Computer models and simulations have become, since the 1960s, an essential instrument for scientific inquiry and political decision making in several fields, from climate to life and social sciences. Philosophical reflection has mainly focused on the ontological status of the computational modeling, on its epistemological validity and on the research practices it entails. But in computational sciences, the work on models and simulations are only two steps of a longer and richer process where operations on data are as important (...) as, and even more time and energy-consuming than modeling itself. Drawing on two study cases—computational embryology and computational epidemiology—this article contributes to filling the gap by focusing on the operations of producing and re-using data in computational sciences. The different phases of the scientific and artisanal work of modelers include data collection, aggregation, homogenization, assemblage, analysis and visualization. The article deconstructs the ideas that data are self-evident informational aggregates and that data-driven approaches are exempted from theoretical work. More importantly, the paper stresses the fact that data are constructed and theory laden not only in their fabrication, but also in their reusing. (shrink)

The primary claim of this paper is that COVID-19 stigma must be understood as a structural phenomenon. Doing so will inform the interventions we select and prioritize for the amelioration of such stigma. Thinking about stigma as a macrosocial determinant of health driven by structural factors suggests that downstream remedies are unlikely to be effective in significantly reducing stigma. This paper develops and defends this claim, setting up a recommendation to use a “bundle” of legal and policy levers at meso- (...) and macro- levels to reduce the adverse and inequitable impact of COVID-19 stigma.Historians of public health have long pointed out that outbreaks of communicable disease track social fault lines (Rosenberg... (shrink)

This book examines how legal causation inference and epidemiological causal inference can be harmonized within the realm of jurisprudence, exploring why legal causation and epidemiological causation differ from each other and defining related problems. The book also discusses how legal justice can be realized and how victims’ rights can be protected. It looks at epidemiological evidence pertaining to causal relationships in cases such as smoking and the development of lung cancer, and enables readers to correctly interpret and rationally use the (...) results of epidemiological studies in lawsuits. The book argues that in today’s risk society, it is no longer possible to thwart the competence of evidence using epidemiological research results. In particular, it points out that the number of cases that struggle to prove a causal relationship excluding those using epidemiological data will lead to an increase in the number of lawsuits for damages that arise as a result of harmful materials that affect our health. The book argues that the responsibility to compensate for damages that have actually occurred must be imputed to a particular party and that this can be achieved by understanding causal inferences between jurisprudence and epidemiology. This book serves as a foundation for students, academics and researchers who have an interest in epidemiology and the law, and those who are keen to discover how jurisprudence can bring these two areas together. (shrink)

Through a study of the history of the concepts of wealth and poverty, this paper investigates the onset of a transition in the conceptual architecture of epidemiological research concerning social differences in mortality rates from 1858 to 1914. It raises the question as to what the concepts of wealth and poverty meant to those who used them and what objects of interventions the conceptual architecture surrounding the concepts enabled the researchers to create. It argues that a transition began in (...) the late 19th century in which an important framework for the understanding of causal relations behind the mortality patterns changed and that this change in turn influenced the scope of what was conceived as relevant objects of intervention. (shrink)

The final report of the WHO's Commission on the Social Determinants of Health is the first to apply social epidemiological analysis to global health.

This paper shows that epidemiology, an approach developed to study the social communication of biological information, can be instructively applied to the diffusion of "endemic" cultural beliefs. In particular, I examine whether exposure to information, or susceptibility to belief is more important in determining the distribution of food taboos in an oral society from the Democratic Republic of Congo. Matrix regression techniques are used on optimally scaled cultural similarity data to infer which social and psychological characteristics of (...) the participating individuals are correlated with a higher probability of taboo transmission between them. Results indicate that, despite a lack of mechanized transportation, access to information in this population is nearly universal. Constraints on belief adoption rather than on information flow are much more important in determining the intra-cultural distribution of food taboos. At least for one class of taboo, belief susceptibility is a function of an individual's social role rather than any intrinsic quality of the individual or the believability of the cultural trait. Nevertheless, the processes underlying the dissemination of both cultural traits and pathogens, considered as replicating units of information, appear close enough to justify using epidemiology as a common framework for investigating cultural and biological diffusion. (shrink)

Sir Dugald Baird sketches the history of abortion legislation in Great Britain from the beginning of the century. In his views the 1967 Abortion Act has been one of the most important and beneficial pieces of social legislation enacted in Britain in the last 100 years. It has, however, brought problems both of administration in the hospitals and to individual doctors and nurses, particularly when the patients are young single women and even schoolgirls. One of the consequences of the (...) Abortion Act has been a fall in maternal mortality and perinatal mortality rates. Abortion does not seem to be followed by serious emotional sequelae. Nevertheless recent changes in sexual mores have introduced new and serious social problems which are discussed in relation to the role of the doctor in his relationship with patients seeking abortion. (shrink)

Recent epidemiological reports of associations between socioeconomic status and epigenetic markers that predict vulnerability to diseases are bringing to light substantial biological effects of social inequalities. Here, we start the discussion of the moral consequences of these findings. We firstly highlight their explanatory importance in the context of the research program on the Developmental Origins of Health and Disease (DOHaD) and the social determinants of health. In the second section, we review some theories of the moral status of (...) health inequalities. Rather than a complete outline of the debate, we single out those theories that rest on the principle of equality of opportunity and analyze the consequences of DOHaD and epigenetics for these particular conceptions of justice. We argue that DOHaD and epigenetics reshape the conceptual distinction between natural and acquired traits on which these theories rely and might provide important policy tools to tackle unjust distributions of health. (shrink)

The Italian Twin Registry (ITR) has been carrying out several genetic-epidemiological studies. Collection and storage of biological material from study participants has recently increased in the light of biobanking development. Within this scenario, we aimed at investigating understanding, awareness and attitude towards blood/DNA donation of research participants. About these quite unknown dimensions more knowledge is needed from ethical and social perspectives.

The article discusses two areas at the intersection of social determinants of health research and social justice theory. The first section examines the affinity between social epidemiology and the capabilities approach. The second section examines how social epidemiology's expansion of the scope of the causal chain and determinants raises questions about epistemology and ontology in epidemiology as well as the field's link to the moral concern for human health.

The paper gives an explanation of some ontological and epistemological commitments of a cognitive research program dealing with the social representations, which has been coined by Dan Sperber, namely of the epidemiology of representations. Social representations are described as causal chains linking together mental representations and public productions. The importance of the psychological aspects and external, historical aspects is stressed as necessary in explaining social phenomena. The paper reviews critically Durkheim’s concept of social phenomena and (...) an epistemologically more plausible alternative is offered. (shrink)