Social Epidemiology
Social Epidemiology has been defined as “the branch of epidemiology concerned with the way that social structures, institutions, and relationships influence health” (Berkman et al. 2014:2). Research along these lines goes by many names, including Population Health, Social Determinants of Health, Health Disparities, Health Inequalities, Health Demography, and Biodemography. In our model, the subfield of Social Epidemiology focuses on the social distribution and social causes of health-related outcomes and behaviors. Health-related outcomes typically include indicators of mental health, physical health, and mortality risk. Health-related behaviors usually refer to risk factors such as exercise, smoking, alcohol consumption, illicit drug use, and broader health lifestyles. Relevant language from the Committee on Certification in Medical Sociology (1986) includes “descriptions and explanations or theories relating to the distribution of diseases among various population groups” and “the role of social factors in the etiology of disease.”
Although the term “Social Epidemiology” is primarily associated with the field of public health, researchers across the health sciences examine the social distribution and social causes of health-related outcomes. Sociological social epidemiologists distinguish themselves by their emphasis on structural arrangements as determinants of health. Syme and Yen (2000:373) explain that while the social epidemiologist in public health “is fundamentally interested in learning about the nature of human disease by studying social characteristics,” the social epidemiologist in sociology “seeks to learn about the social characteristics of human populations by studying the occurrence of disease.” Social epidemiologists in public health believe that poor health is a problem to be solved or good health a goal to be achieved. Social epidemiologists in sociology believe that health is a consequence of social arrangements, especially those represented in social inequality, institutional ties, social relationships, and social roles (Mirowsky and Ross 2003). Social epidemiologists in public health primarily use analyses of health to direct health intervention programs and policy. Social epidemiologists in sociology primarily use analyses of health to shed light on the nature and function of social arrangements that cause or contribute to ill health.
Another important distinction is the use of theory. Although some health demography is descriptive rather than theoretical, most social epidemiology in sociology aims to document and explain health inequalities in the service of advancing sociological theory. Contemporary sociological social epidemiology is often informed by macro-structural theories of inequality, including, for example, fundamental cause theory (Link and Phelan 2000; Phelan and Link 2013), health lifestyle theory (Cockerham 2005; 2013), constrained choice theory (Bird and Rieker 2008), and life course theories (Ferraro and Shippee 2009; O’Rand 1996). What distinguishes these theories from those that dominate other subfields is their emphasis on broad structural and institutional factors that generate health inequalities.
While social epidemiology in sociology regularly engages in theoretical applications, social epidemiology in public health appears less enthusiastic about theory. In a recent review entitled “Social Epidemiology for the twenty-first Century,” Kawachi and Subramanian (2018:240) concluded that social epidemiology “is no longer just for mavericks in fields such as sociology or economics where ‘theoretical’ research is often privileged over ‘applied’ research.” This language is interesting to us since, in our judgment, the best analyses in sociological social epidemiology involve the use of theory. The conceptual framework provided by theory in social epidemiology in sociology is the medium through which reality is explained and understood. The use of sociological theory in empirical research is the key distinction between research conducted in sociology and public health. Social epidemiologists in public health are clearly able to distinguish their work from ours, but mainstream or generalist sociologists often view epidemiological research conducted in public health and sociology as typically “atheoretical,” “applied,” or simply “public health.”
Social Epidemiology can also be distinguished from the other major subfields within medical sociology (discussed in greater detail below). While social epidemiologists describe the social distribution and social causes of health-related outcomes and behaviors, social psychologists of health and illness focus on social psychological processes, especially those that mediate and moderate the social causes and social consequences of health-related outcomes and behaviors. The Social Psychology of Health and Illness encompasses a range of theories that intersect with processes related to stratification and culture (Carr and Umberson 2013; George 2001; Kessler et al. 1995; McLeod et al. 2014; Schnittker and McLeod 2005; Simon 2000). Social Epidemiology and the Social Psychology of Health and Illness are nevertheless related through a natural scientific division of labor. Social epidemiologists identify social distributions and social causes. Social psychologists of health and illness analyze the social psychological processes that explain and modify the broader social distributions and social causes.
Social Epidemiology is more easily distinguished from the Sociology of Medicine and Sociology in Medicine. The Sociology of Medicine focuses on a range of theoretical issues related to institutions of medicine (Cockerham 2017). Sociology in Medicine focuses on applied issues within institutions of medicine, including medical treatment, health professions, and the marketing of health care (Cockerham 2017; McIntire 1894/1991; Weitz 2017). Social Epidemiology emphasizes the structures that drive health patterns within and across populations. The Sociology of Medicine and Sociology in Medicine focus on health patterns and practices within institutions of medicine and related social institutions. The Sociology of Medicine and Sociology in Medicine can also overlap with Social Epidemiology. Health and health-related behaviors are often tied to institutions of medicine. For example, gendered experiences within institutions of medicine (e.g. access to care) can contribute to broader gender disparities in population health.
Another way to see the contributions of Social Epidemiology is to review an excellent application of the subfield. Using data from the 1996–1997 Community Tracking Study and the pooled 1972–2000 General Social Survey, Schnittker (2004) examined “synergistic interactions between income and education” in the prediction of overall health status. The key question is whether the established association between income and health varies by level of education. The results of the study showed that “those with more education have better health for all levels of income, and fewer income-based disparities exist among the well educated than among the less” (Schnittker 2004: 286). We classify this study as Social Epidemiology because it focuses on the structural distribution of health and is primarily (not exclusively) descriptive in nature. In the end, this study contributes to the sociological study of health by specifying the educational or human capital conditions under which income is more or less relevant for overall health status. This study is distinguished from public health because it engages theories derived from medical sociology and health economics to support its examination of the synergistic interactions between income and education. This work also emphasizes social structure rather than health processes or health-related interventions.
Social Psychology of Health and Illness
The Social Psychology of Health and Illness is concerned with social psychological processes, especially those that explain or modify the structural causes of health and health-related behaviors or through which their social consequences are realized. It corresponds most closely to the following description from the Committee on Certification in Medical Sociology (1986): “the behaviors or actions taken by individuals to maintain, enhance, or restore health or cope with illness, disease, or disability; people’s attitudes, and beliefs about health, disease, disability and medical care providers and organizations.” For some researchers in the Social Psychology of Health and Illness, health is a lens into more general social psychological processes; for others, social psychology offers theories and concepts that illuminate health-related processes. Regardless of orientation, social psychologists of health and illness direct our attention to proximate health-related processes, especially those at the level of interpersonal interaction.
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