III. Defining Features of Social Epidemiology

A Population Perspective

Individual risk is not considered in isolation

Geoffrey Rose's Concepts

Distinguishes individual approach vs. population approach

◼ Individual approach: Why do some people

have hypertension? “High risk”

◼ Population approach: Why do some

populations have much hypertension while in

others it is rare?

High risk approach (pros and cons)

Identify risk factors in the population. Prescribe medications or interventions specific to the high-risk population

• pros: individual adherence to an individual-risk factor change is high

• cons: Not everyone at risk will go on to develop the disease. As a result, the high-risk approach does not change the overall prevalence of a disease in the population

Population approach (pros and cons)

The focus is not what high-risk individuals need to do differently, but what is driving the

underlying distribution of the disease. Prevention activities should target whole populations regardless of the variation in individuals’ risk status

• pros: Radical: Attempts to remove the underlying causes that makes the disease common. Thus changes the prevalence of the disease in the population

• cons: Very little advantage to a single individual. Poor motivation of subject and clinician

Describe a population-level approach to illness and disease, and how it  differs from an individual-approach (high -risk approach)

Health outcome: disease X

Risk factor: stress

Population: students taking two public health classes

• individual approach: focuses on people who are the highest risk (most stressed out students)

  • intervention: shows those most stressed out students stress coping strategies

• population approach: compare % of disease prevalence of class A (60%) to class B (40%)

  • intervention: for class A (has more disease prevalence), remove midterm + make attendance non-graded (applied to everyone, regardless of their stress level)

In what ways is behavior influenced by social context?

Behaviors are socially patterned, cluster together, and are influenced by social context through:

• 1) shaping norms

• 2) enforcing social control

• 3) providing opportunities

• 4) producing/reducing stress

Multilevel Analyses

Includes individual and group level variables

(example in image)

Development and Life Course Perspective

Three lifecourse theories

1. Early development and childhood: the importance of early life exposures in shaping cognition and brain

2. Accumulated exposure: Most adult disease is not likely the result of early childhood or prenatal exposure but rather the result of a lifetime of accumulated exposures

3. Adult social conditions/social trajectory model: Early life exposures do not directly affect adult health. They influence adult social conditions, which, in turn, affect adult health.

General Susceptibility to Disease

Social conditions create vulnerability to disease in general, rather than to any specific disorder.

General susceptibility hypothesis

adverse social and environmental conditions increase a person's vulnerability to a broad, generalized range of diseases, rather than causing a single, specific illness

• Whether individuals developed one disease or another depended on their behavioral or environmental exposures as well as their biological or genetic makeup.

• But they became ill or died at earlier ages or whether specific socially defined groups had greater rates of disease depended on socially stressful conditions