Macrosocial Determinants of Population Health: Edited by Sandro Galea

Abstract

, 2007, 502 pp., $69.95 (Hardcover) The explanandum (or ''outcome variable'') of epidemiology remains population health, but in just the last few years the permissible set of explanans (or ''causal factors'') has grown not only in number but in kind. Today, genetic epidemi-ologists routinely focus on single nucleotide polymorphisms, while social epidemiologists are increasingly comfortable discussing macrosocial or upstream factors. Some may worry that this expansion undermines disciplinary cohesion by forcing subdisciplines to compete for scarce resources and/or by presenting consumers with a mix of explanations for the very same phenomena. Others may embrace the expansion as a sign of disciplinary maturity, strength, and promise: How can a collective effort to elucidate all of the mechanisms (both distal and proximal) of health be anything but helpful? Whatever one's take, this ambitious new volume edited by Professor Sandro Galea (1) certainly aims to expand the set by discussing macrosocial determinants of health and the benefits, if not necessity, of their inclusion in epidemiologic analyses. For Galea, macrosocial determinants are factors that lie beyond the individual and are thus distal-quite distal-to individual health outcomes. Examples include culture, the economy, and corporate structures. Presumably because they reside at a more meso-or middle level, friendships, families, schools, neighborhoods, and so forth are not viewed as mac-rosocial phenomena. Consistent with the population health strategy of Rose (2) and contemporary views about the domain of social epidemiology (3), macrosocial determinants of health are properly focused on the health of populations and are thought to provide opportunities for public health intervention through policy or perhaps cultural change. The 502-page text comprises 20 independently authored chapters categorized into three sections: determinants, methods, and, simply put, interventions. The first section (determinants) includes separate chapters addressing globalization , urbanicity, corporate practices, political economy, climate change, global governance, macroeconomics, culture , taxation, patent law, migration, and the mass media. Each of these topics is conceptual or definitional in nature; there is little empirical analysis linking these factors to specific health outcomes or distributions. The second section (methods) includes chapters on the identification of ecologic effects, ecologic studies, causal inference, cross-sectional time-series estimators, and aggregation issues. These chapters largely stand alone; they do not dovetail or explicitly address the phenomena outlined in the text's previous section. The final section (improving population health) contains two chapters, the first offering a framework for macrosocial intervention and the second offering case studies of the same. Each section concludes with a brief sum-mary/integrative chapter by the editor.