Advancing the Social Epidemiology Mission of the American Journal of Epidemiology

Abstract

Social epidemiology is concerned with how social forces influence population health. Rather than focusing on a single disease (as in cancer or cardiovascular epidemiology) or a single type of exposure (e.g., nutritional epidemiology), social epidemiology encompasses all the social and economic determinants of health, both historical and contemporary. These include features of social and physical environments, the network of relationships in a society, and the institutions, politics, policies, norms and cultures that shape all of these forces. This commentary presents the perspective of several editors at the Journal with expertise in social epidemiology. We articulate our thinking to encourage submissions to the Journal that: 1) expand knowledge of emerging and underresearched social determinants of population health; 2) advance new empirical evidence on the determinants of health inequities and solutions to advance health equity; 3) generate evidence to inform the translation of research on social determinants of health into public health impact; 4) contribute to innovation in methods to improve the rigor and relevance of social epidemiology; and 5) encourage critical self-reflection on the direction, challenges, successes, and failures of the field.

future, population health, social epidemiology

Abbreviations

 
• COVID-19

  coronavirus disease 2019

Editor’s note:  The opinions expressed in this article are those of the authors and do not necessarily reflect the views of the American Journal of Epidemiology.

Social epidemiology is concerned with the influence of social forces on population health and health equity. In contrast to a disease focus (e.g., cancer or cardiovascular epidemiology) or a focus on a single type of exposure (e.g., nutritional epidemiology), social epidemiology encompasses both historical and contemporary social and economic determinants of health. These determinants include features of social and physical environments, networks of relationships in a society, and the institutions, politics, policies, norms and cultures that shape them.

The American Journal of Epidemiology has a history of publishing groundbreaking studies within social epidemiology that spawned new fields of inquiry; for example, the contribution of the social environment to host resistance (1), the association of social networks with population health (2), the influence of neighborhood contexts on health (3, 4), and the use of natural experiments to shed new light on old questions. The Journal has also engaged actively with the ongoing challenges and debates in our discipline: debates that have served to refine our own mission within the field (5–10), debates on theories and methods (11, 12), and debates about questions raised by social epidemiologists that have broad impact—most recently, whether the potential outcomes approach to causation is inherently conservative and inimical to the radical social change needed to address social injustice (13–17).

In the two decades following the publication of the textbook Social Epidemiology (18), we have witnessed exponential growth in the output of researchers who call themselves social epidemiologists. This trend can be expected to continue during the coronavirus disease 2019 (COVID-19) era, as the pandemic intersects with almost every topic of inquiry in the field, including racial/ethnic disparities, gender disparities, the effects of economic recessions on health, occupational hazards, income inequalities, social isolation, housing and residential segregation, and immigrant health.

As part of our editorial service to the Journal, we have come together to outline our vision for social epidemiology in its pages. The Journal’s centennial is a remarkable achievement for the field of epidemiology, particularly so for social epidemiology. Currently, nearly one-third of annual submissions to the Journal address the social determinants of health, positioning the Journal well to continue in its leadership role in promoting the science of social epidemiology. The Journal has a particular responsibility to promote rigorous social epidemiology, and we suggest that by advancing the following lines of inquiry, it can fulfill that responsibility.

PROMOTE EMPIRICAL RESEARCH ON THE DETERMINANTS OF HEALTH INEQUITIES AND SOLUTIONS TO ADVANCE HEALTH EQUITY

Social epidemiology is motivated by fundamental values of social justice and health equity. The field of social epidemiology achieves the incorporation of these values into public health research and practice through rigorous, falsifiable tests of hypotheses that can advance, and when necessary overturn, theoretical assumptions. Theoretical debates about the causes of health inequities need to be resolved through reproducible and replicable science. We envision the Journal prioritizing the following issues of current importance to the field: research on the role of social hierarchies, privilege, and absolute resources; the measurement of race and ethnicity in epidemiologic research (19); the interpretation of racial and ethnic inequalities in health; the mechanisms linking race and ethnicity and structural racism to health (20); the relevance (or lack of relevance) of genomics for understanding health inequalities (21); the influence of social networks and social policy contexts on health inequities; the unfolding of inequities across the life course and across generations (22); and advancing the science and translation of research on intersectionality and health. For many of these issues, much remains to be learned about the ways in which social processes become physiologically embedded, and how that knowledge can be used to improve population health.

EXPAND KNOWLEDGE OF EMERGING AND UNDERRESEARCHED SOCIAL DETERMINANTS OF POPULATION HEALTH

The challenges to population health evolve over time, as does our recognition of these threats. The Journal aims to promote research documenting emerging topics such as the social determinants of the opioid epidemic, COVID-19, and the role of misinformation and institutional distrust in shaping health and health-related behaviors. The Journal also aims to promote research in domains that may be long-standing but have received disproportionately limited attention in epidemiology, such as the health consequences of human rights violations perpetrated by governments, including mass incarceration, police violence, immigrant detentions, and family separations. Additionally, work on nongovernment (e.g., corporate, school, or hospital) policies merit attention. The emergence of the COVID-19 pandemic revealed the critical role of social epidemiology to our understanding of the health impacts of mitigation efforts (e.g., physical distancing), workplace policies (e.g., regulating use of personal protective equipment or providing sick leave), and widespread economic and social disruptions; it also demonstrated the importance of strengthening connections between social epidemiology and infectious disease epidemiology given that both focus on “dependent happenings” (23). Expertise on the structural determinants of health should be used to expand the existing knowledge base on disparities in vaccination coverage and participation to address and hopefully mitigate disparities in COVID-19 vaccination (24, 25). Regardless of the disease focus, the major emphasis of this work should be to inform how social phenomena continue to evolve over time and thereby point toward the identification of systems or policies for intervention.

GENERATE EVIDENCE TO ACCELERATE THE TRANSLATION OF RESEARCH ON SOCIAL DETERMINANTS OF HEALTH INTO PUBLIC HEALTH IMPACT

Social epidemiology, as all branches of epidemiology, is concerned with translation in the real world—this concern underpins recent debates on the utility of the potential outcomes approach to causal inference for generating practicable knowledge about social determinants (13–17). We welcome such debate as well as evaluations of specific translational efforts, such as the health effects of social policies regulating education, housing, income stability, or other resources beyond medical care. The benefits of partnership with community members and organizations should be addressed. In addition to cluster-randomized or quasi-randomized interventions on social factors, systems, or programs, we encourage the use of innovative designs to address causal questions that play out over long time periods such as the reproduction of health inequities across generations. We recognize that science translation, particularly translation of findings from social epidemiology, may require changes to social, economic, and health policies, and that scientific findings are only one of many inputs into policy. Our responsibility, then, is to ensure that these findings are generated from studies using the strongest designs and subjected to the rigorous peer review that the Journal has become known for. Doing so, social epidemiology can fulfill its mission to provide credible evidence to guide population health policies of governments, organizations, and communities. The Journal can contribute to this mission by continuing to provide a forum for engaging on issues surrounding translation (26), the relevance (or not) of epidemiologic studies for policy (27), the intersection between science and advocacy (28), and the collaboration with those leaders who recognize health disparities as persistent and avoidable (29).

CONTRIBUTE TO THE INNOVATION IN METHODS TO IMPROVE THE RIGOR AND RELEVANCE OF SOCIAL EPIDEMIOLOGY

Social epidemiology has been at the leading edge of expanding the standard methodological repertoire in epidemiology, in part through our close collaborations with our colleagues in methods development and in part through borrowing techniques used in other disciplines. Areas that we see as likely to be of growing importance in social epidemiology include natural experiments, econometric methods, decomposition methods, spatial analysis, artificial intelligence/machine learning, applications of new data streams such as social media, and principled approaches to evidence triangulation and data integration (30, 31). Innovations in measurement are particularly important for the future of social epidemiology; examples include deriving information from novel data sources and applying rigorous methods to document, validate, or improve measurement of complex social constructs such as racism. Innovations in sampling should maximize the inclusiveness of epidemiologic studies and generate the broadest possible inferences. Ongoing debates about the tension between representative samples, minimizing potential selection bias, and other study goals have special relevance for social epidemiology (32). These innovations should also be evaluated, critically examined for their limitations, and revised to strengthen the methodology, as in the case of rapid growth of instrumental variables methods in epidemiology (33).

CRITICAL SELF-REFLECTION ON THE DIRECTION, CHALLENGES, SUCCESSES, AND FAILURES OF THE FIELD

Social epidemiology as a discipline has been engaged in self-reflection from its inception in work published in the Journal and elsewhere. This is a strength of the field: Disciplines that do not find ways to challenge their established paradigms risk irrelevance. For example, there are considerable debates about the usefulness of randomized trials in social epidemiology (34), the issues noted above concerning the use of potential outcomes models for causal inference in social epidemiology, and, relatedly, the nature of social interventions (35). A central part of critical self-reflection as a discipline is developing and adopting best practices for fostering a diverse community of researchers (36).

INVITATION

We invite authors to submit work in these domains, or, in the tradition of social epidemiology, debate their importance relative to other domains in the years to come. As Galea and Link (6) argued in their commentary on the future of social epidemiology in 2013, social phenomena are relevant to nearly all epidemiology, and as Kawachi questioned, presaging our title, “Isn’t all epidemiology social?” (5). We believe that continued advancement of dynamic and critical research in social epidemiology is essential for the advancement of epidemiology as a whole and for population health.

ACKNOWLEDGMENTS

Author affiliations: Social and Behavioral Sciences Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, United States (Stephen E. Gilman); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States (Stephen E. Gilman); Department of Epidemiology, Gillings School of Public Health, University of North Carolina, Chapel Hill, North Carolina, United States (Allison Aiello); Boston University School of Public Health, Boston, Massachusetts, United States (Sandro Galea); Center for Epidemiologic Research, Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island, United States (Chanelle J. Howe); Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States (Ichiro Kawachi); Department of Epidemiology and Biostatistics, Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, United States (Gina S. Lovasi); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States (Lorraine T. Dean); Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis, Minnesota, United States (J. Michael Oakes); Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada (Arjumand Siddiqi); Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States (Arjumand Siddiqi); and Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, United States (M. Maria Glymour).

S.G. was supported by the Intramural Research Program of the Eunice Kennedy Shriver National Institute of Child Health and Human Development. A.S. was supported by a Canada Research Chair in Population Health Equity.

This commentary was presented at the annual meeting of the Society for Epidemiologic Research [virtual], December 16–18, 2020.

Conflict of interest: none declared.