The role of macrosocial determinants in shaping the health of populations

Abstract

The roots of epidemiology, coincident with the origin of public health, lie in exploring how social conditions may influence health and how these conditions may be manipulated so as to improve the health of populations (Mc Leod, 2000; Halliday, 2000; Hamlin & Sheard, 1998). However, in the last half century, with the advent of antibiotics as treatments for infectious diseases, the shift from infectious disease to chronic disease considerations, and the focus on genetic determination of disease, epidemiologic inquiry has grown increasingly concerned not with the social determination of population health, but rather with the individual exposures or characteristics that influence individual risk of health and disease (March & Susser, 2006). It is the central tenet of this book that social factors that lie beyond the individual and that affect whole populations, factors that we term "macrosocial", should remain central in our thinking about the production of health and disease, and that public health research and practice would be well served by an improved understanding of how these macrosocial factors shape population health. Setting the stage for the chapters to follow, in this introductory chapter we explore the challenges faced by most current inquiry concerned with the determination of health and argue that epidemiologic inquiry about macrosocial factors can help improve our understanding of population health and potentially guide the development of more effective public health interventions. We note that this introduction, and this book, adopt very much an "epidemiologic" perspective. We mean this to refer to a central concern with the determination of health and disease and to inquiry aimed at understanding those factors that may influence health. Although the field formally constituted as "epidemiology" today is certainly most concerned with these questions, we do not mean to endorse an exclusive reliance on the methods of epidemiology and certainly do not intend to exclude the role of other disciplinary perspectives. As the chapters in this book amply illustrate, we suggest that disciplines such as economics, sociology, and health policy, among many others, play a central role in our understanding of the determination of health and of how those interested in the health of populations may fruitfully identify areas of intervention that can improve health.