Social Epidemiology . Second Edition. Edited by Lisa F. Berkman, Ichiro Kawachi, and M. Maria Glymour

Abstract

, a textbook that established a new perspective on epidemiologic science centered on the underlying social processes that unified the production of health and disease rather than on the etiology of specific diseases themselves. It gave form and function to the nascent field after which it was named. This first edition of Social Epidemiology was the first textbook that I was given as an undergraduate just learning about how social processes could pattern morbidity and mortality in populations, and it is one to which I continue to refer and by which I continue to be inspired today. Since the publication of the first edition, the field of social epidemiology has matured considerably. Its premises and principles have emerged as lingua franca in public health and medical curricula worldwide. The second edition of Social Epidemiology is the long-awaited update to that predecessor. Whereas the first edition signaled the field's arrival, the second deals with the inevitable questions of its adolescence-questions regarding its relationship with other fields in epidemiology and public health and its implications for broader public health policy. The second edition's 15 chapters build upon and update the 11 chapters in the first edition, with 2 new chapters on the intersection between social epidemiology and policy, 1 new chapter on the integration of social epidemiology and human biology, and 1 about behavioral economics for mitigating health inequalities. The updated chapters were mostly written by the same authors who wrote the originals, with the welcomed addition of several emerging leaders in the field. These chapters focus on socioeconomic status, discrimination, income inequality, working conditions, labor and employment policies, social networks, social capital and cohesion, affective states, behavior , and psychosocial interventions and their relations to population health. The epidemiologic literature in each of these areas has ballooned since the first edition, making it imperative for authors to update and synthesize a much larger body of evidence toward a coherent articulation of both what the field knows and, perhaps more importantly, what it does not. Most of the chapters are up to the task, with subtle updates in constructs and nomenclature throughout to capture nu-anced, if meaningful, shifts in perspective and positioning in the field. For example, the previous edition's chapter entitled "Social integration, social networks, social support and health" was renamed "Social network epidemiology," which echoes both the growth of formal social network analysis methods and the insights that they have yielded regarding the role of social connectedness in the production of population health. These chapters are well researched and tightly written, and they form the functional core of the book. They are required reading for newcomers to the field and experts alike. As a collective, the 4 new chapters attempt responses to 2 of social epidemiology's most challenging questions: "How do social exposures 'get under the skin' to cause pathophys-iology?" and "What are the implications of social epidemiology for policy-beyond the obvious conclusions that poverty and marginalization are generally bad for one's health?" Each of the chapters alone is generally well written, with important insights that draw from bodies of literature that are not commonly considered within the framework of social epidemiology. The chapter on biological mechanisms by Kubzansky et al. is particularly comprehensive, describing both the mechanisms by which various biological pathways may mediate the relation between social exposures and illness and their implications for social epidemiologic knowledge and future research. Yet overall, although the editors were certainly bold in responding to the field's interlocutors through these chapters , the response is restrained by a lack of framing, leaving it neither particularly cohesive nor comprehensive. Lacking is a framework that unifies these questions or their answers within a broader whole. Social epidemiology emerges from the critique that humans are not individual automata conceived of the biomedical model. Rather, we are highly interconnected individually, institutionally, and structurally. The flows of resources-social, cultural, and material-across these connections have important implications for the health of collectives and the individuals who comprise them. Social epidemiology then serves to reframe the problem of ill health from one founded in the behaviors and pathologies of individuals to one that is founded in the behaviors and patholo-gies of collectives-with important implications for where and how we ought to intervene. The second edition of Social Epidemiology offers a number of important insights for policy, but each plays as a separate, unconnected idea. Exemplary in this regard is the chapter on behavioral economics. There is no doubt that behavioral economics can be a valuable tool for health policy, even health policy expressly intended to reduce health disparities. The question remains, however, as to where and how behavioral economics emerges from the body of social epidemiologic research. The reader is left with the implicit conclusion that, in fact, social epidemiology has little to offer unto itself and we are better left co-opting the insights of other disciplines. Further , the thrust of leveraging behavioral economics for health 660 policy is that human rationality is bounded and that context may then be used to "nudge" human decision-makers toward healthier choices. However, if the key insights of social epidemiology are about the overlying social structures that influence human wellbeing, as the author acknowledges, focusing on be-havioral economics to shift individual behavior to mitigate health inequalities seems to miss the point. In search for a unifying framework, the editors missed a crucial opportunity to engage the growing body of work that connects systems thinking and social epidemiology (2-4). Framing the social production of population health as a complex system with clear points of intersection-between race, poverty, marginalization, neighborhoods, networks, patho-physiology, and health policy-would have allowed for a cohesive scaffolding from which could surface clear, unified discussions about the policy implications of social epidemiology at various levels, from physiology to political philosophy. Framing social epidemiology within the context of a broader system also answers a higher-order question about the future of the field. Social epidemiology has succeeded over the past 2 decades in penetrating the language of broader epidemiology and public health. The notion of "social determinants" is no longer foreign, thanks in large part to the editors and many of the authors who contributed to this textbook. However, it remains up to the community of social epidemiologists to continue to define the role that social epidemiology has to play in broader conversations, which will require us to continue to patch social epidemiology into the greater fabric of the whole of public health and health policy. This second edition of the definitive textbook of the field presented a unique opportunity to do so-one that is not fully leveraged because of the lack of a coherent organizing framework for the book itself. Nevertheless, the second edition of Social Epidemiology is a worthy update to the original, and it continues to be the seminal textbook in the field. My limited critiques are informed more by the high expectations that I have for the editors and authors rather than by the quality of the book itself. It is doubtlessly a contribution of very high merit and import. It will continue to inform and inspire trainees and practitioners alike, as the first edition did for me as an undergraduate and this second edition continues to do for me today. ACKNOWLEDGMENTS