A Critical Approach to Macrosocial Determinants of Population Health: Engaging Scientific Realism and Incorporating Social Conflict

Abstract

The advancement of theory and research on macrosocial determinants of health has been identified as a promising path for future social epidemiology. In this com-mentary, we outline how macrosocial epidemiology can ad-vance in two critical ways: (1) engaging scientific realism, and (2) incorporating social conflict. The first describes how sci-entific realism can be effectively applied within macrosocial epidemiology to identify the specific contexts in which social mechanisms are triggered, which in turn, generate health outcomes. Engaging scientific realism fosters a deeper under-standing on how and why macrosocial factors, processes, and institutions are causally linked to population health. The sec-ond makes the case to incorporate a social conflict paradigm into macrosocial epidemiology. Thinking in terms of social conflict allows us to view social structures as inequality-generating mechanisms, and re-orients our public health ef-forts toward social change, including for example, taking action on unequal political, economic, and cultural relations.