Commentary: Social epidemiology— a promising field

J Siegrist

Institute of Medical Sociology, Heinrich Heine University of Duesseldorf, Universitatstrasse 1, D-40225 Duesseldorf, Germany. E-mail: siegrist{at}uni-duesseldorf.de

The history of science tells us that the rise and fall of scientific disciplines depends on the successes and failures of respective research programmes rather than on the claims expressed and pressures exerted by individual members or groups. In this process, disciplines may even overcome their original paradigm by developing new cross-fertilizations, as is the case, for instance, in molecular biology. At a less prominent level, social epidemiology has evolved as one such cross-fertilization where theoretical and methodological knowledge and expertise derived from social and behavioural sciences (in particular sociology and psychology) have been introduced into epidemiology and public health research on determinants of human health and disease. In its short history social (or psychosocial) epidemiology has witnessed remarkable scientific progress. To mention just a few examples, a social gradient has been identified for a broad range of highly prevalent chronic diseases, and explanations of this gradient have been successfully advanced using models of health-related behaviour and of psychobiological stress research.13 Measures of innovative sociological and psychological concepts were introduced into prospective epidemiological investigations, and their direct and indirect effects on disease incidence were estimated.

Examples of newly discovered protective or risky psychosocial conditions for chronic diseases include social support,4 social network,5 high demand and low control at work,6 effort-reward imbalance,7 hostility,8 self-efficacy9 and optimism,10 among others. Above and beyond this prospectively established evidence some of these concepts have been associated with markers of psychobiological or pathophysiological mechanisms linking social environment and cognitive/affective processes in individuals with their physical responses.1113

Instead of evaluating this body of knowledge Zielhuis and Kiemeney14 put their energy into identifying a few authors who have used the term ‘social epidemiology’ in a broad way that does not reflect mainstream science. So what?

It is probably time to approach the problem of causality in biomedical epidemiology in a more critical way than is the case in the Zielhuis and Kiemeney article. Clearly, the causality criteria established by Hill15 in 1965 remain an important achievement, but we can no longer disregard epistemological advances taking place in contemporary biology and in a growing number of biomedical fields where modern systems theory calls into question simple notions of causality.16 It may well be that biopsychosocial research on health and illness is better equipped to face these challenges than traditional biomedical epidemiology.

References

1 Albrecht GL, Fitzpatrick R, Scrimshaw SC (eds). Handbook of Social Studies in Health and Medicine. London: Sage Publication, 2000.

2 Berkman L, Kawachi I (eds). Social Epidemiology. New York: Oxford University Press, 2000.

3 Marmot M, Wilkinson R (eds). Social Determinants of Health. Oxford: Oxford University Press, 1999.

4 Cassel J. The contribution of the social environment to host resistance. Am J Epidemiol 1976;104:107–15.[ISI][Medline]

5 Berkman L, Syme SL. Social networks, host resistance, and mortality: a nine year follow-up study of Alameda county residents. Am J Epidemiol 1979;109:186–93.[Abstract]

6 Karasek R, Theorell T. Healthy Work. New York: Basic Books, 1990.

7 Siegrist J. Adverse health effects of high effort/low reward conditions. J Occupat Health Psychol 1996;1:27–41.

8 Williams RB. Neurology, cellular and molecular biology, and psychosomatic medicine. Psychosom Med 1994;56:208–15.

9 Banduara A. Self-efficacy: The Exercise of Control. New York: Freeman, 1995.

10 Taylor SI, Seeman TE. Psychosocial resources and the SES-health relationship. Ann New York Acad Sci 1999;896:210–25.[Abstract/Free Full Text]

11 McEwan BS. Protective and damaging effects of stress mediators. N Engl J Med 1998;338:171–79.[Free Full Text]

12 Schnall PL, Belkic K, Landbergis P, Baker D (eds). The workplace and cardiovascular disease. Occup Med: State of the Art Reviews 2000;15: 1–334.[ISI]

13 Steptoe A. Psychophysiological bases of disease. In: Johnston DW, Johnston MM (eds). Comprehensive Clinical Psychology. Vol. 8: Health Psychology. New York: Pergamon Press, 1998, pp.3978–94.

14 Zielhuis GA, Kiemeney LALM. Social epidemiology? No Way. Int J Epidemiol 2001;30:43–44.[Free Full Text]

15 Hill AB. The environment and disease: association or causation? Proc R Soc Med 1965;58:295–300.[ISI][Medline]

16 Weiner H. Perturbing the Organism. The Biology of Stressful Experience. Chicago: Chicago University Press, 1992.