Social Determinants Of Disease Research Articles

Conceptual frameworks for the integration of genetic and social epidemiology in complex diseases

Uncovering the root causes of complex diseases requires complex approaches, yet many studies continue to isolate the effects of genetic and social determinants of disease. Epidemiologic efforts that under-utilize genetic epidemiology methods and findings may lead to incomplete understanding of disease. Meanwhile, genetic epidemiology studies are often conducted without consideration of social and environmental context, limiting the public health impact of genomic discoveries. This divide endures despite shared goals and increases in interdisciplinary data due to a lack of shared theoretical frameworks and differing language. Here, we demonstrate that bridging epidemiological divides does not require entirely new ways of thinking. Existing social epidemiology frameworks including Ecosocial theory and Fundamental Cause Theory, can both be extended to incorporate principles from genetic epidemiology. We show that genetic epidemiology can strengthen, rather than detract from, efforts to understand the impact of social determinants of health. In addition to presenting theoretical synergies, we offer practical examples of how genetics can improve the public health impact of epidemiology studies across the field. Ultimately, we aim to provide a guiding framework for trainees and established epidemiologists to think about diseases and complex systems and foster more fruitful collaboration between genetic and traditional epidemiological disciplines.

Precision Population Cancer Medicine in Cancer of the Uterine Cervix: A Potential Roadmap to Eradicate Cervical Cancer.

With the success of the Human Genome Project, the era of genomic medicine (GM) was born. Later on, as GM made progress, there was a feeling of exhilaration that GM could help resolve many disease processes. It also led to the conviction that personalized medicine was possible, and a relatively synonymous word, precision medicine (PM), was coined. However, the influence of environmental factors and social determinants of diseases was only partially given their due importance in the definition of PM, although more recently, this has been recognized. With the rapid advances in GM, big data, data mining, wearable devices for health monitoring, telemedicine, etc., PM can be more easily extended to population-level health care in disease management, prevention, early screening, and so on.and the term precision population medicine (PPM) more aptly describes it. PPM's potential in cancer care was posited earlier,and the current authors planned a series of cancer disease-specific follow-up articles. These papers are mainly aimed at helping emerging students in health sciences (medicine, pharmacy, nursing, dentistry, public health, population health), healthcare management (health-focused business administration, nonprofit administration, public institutional administration, etc.), and policy-making (e.g., political science), although not exclusively. This first disease-specific report focuses on the cancer of the uterine cervix (CC). It describes how recent breakthroughs can be leveraged as force multipliers to improve outcomes in CC - by improving early detection, better screening for CC, potential GM-based interventions during the stage of persistent Human papillomavirus (HPV) infection and treatment interventions - especially among the disadvantaged and resource-scarce populations. This work is a tiny step in our attempts to improve outcomes in CC and ultimately eradicate CC from the face of the earth.

More to Offer Than Direct Clinical Benefit: FDA's Vaccine Licensure Process Ignores Population Health and Social Determinants of Disease.

The current US Food and Drug Administration (FDA) licensure process underestimates the potential benefits of vaccines at both the individual and population levels by considering only direct clinical outcomes of vaccination. While all approved vaccines do protect the person who takes them from poor clinical outcomes for a specific infectious disease, many vaccines also have the potential to offer measurable, direct nonclinical benefits. For example, coronavirus disease 2019 (COVID-19) vaccinations for school-aged children may prevent school absenteeism. Also, by preventing infection or reducing its length and severity, some vaccines also protect-to some extent-the patient's immediate contacts from contracting the same disease. These nonclinical and population-level benefits are not considered as part of the FDA's current vaccine approval process, but they could be. We argue that the FDA's structured benefit-risk assessment framework, used for vaccine approvals, can and should consider both clinical and nonclinical benefits of vaccination when sufficient evidence exists to make an informed assessment. Including them could incentivize vaccine developers to measure additional vaccination effects, inform population health, and address health inequalities-including inequalities in the social determinants of health.

Compounding vulnerabilities: Syndemics and the social determinants of disease in the past

ObjectiveThis article explores the theory and utility of a syndemic approach for the study of disease in the past. Syndemic principles are examined alongside other theoretical developments within bioarchaeology. Two case studies are provided to illustrate the efficacy of this approach: Tuberculosis and vitamin D deficiency in 18th and 19th century England, and malaria and helminth infections in Early Medieval England. MaterialsPublic health studies of present syndemics, in addition to published bioarchaeological, clinical and social information relating to the chosen case studies. MethodsThe data from these two historical examples are revisited within a syndemic framework to draw deeper conclusions about disease clustering and heterogeneity in the past. ResultsA syndemic framework can be applied to past contexts using clinical studies of diseases in a modern context and relevant paleopathological, archaeological, and historical data. ConclusionsThis approach provides a means for providing a deeper, contextualised understanding ancient diseases, and integrates well with extant theoretical tools in bioarchaeology SignificanceSyndemics provides scholars a deep-time perspective on diseases that still impact modern populations. LimitationsMany of the variables essential for a truly syndemic approach cannot be obtained from current archaeological, bioarchaeological, or historical methods. Suggestions for further researchMore detailed and in-depth analysis of specific disease clusters within the past and the present, which draws on a comprehensive analysis of the social determinants of health.

Intersecting Pandemics of HIV and SARS-CoV-2: Commentary on the Special Issue.

Purpose of ReviewThis editorial introduces this special Global Health Section on the interface of the HIV/AIDS and COVID-19 pandemics.Recent FindingsAuthors of articles in this special issue take on a variety of topics that capture how the acute COVID-19 pandemic affected global efforts towards HIV control, and how co-infection, stigma, and social determinants of disease have affected populations on multiple continents.SummaryTwo historic pandemics -- HIV/AIDS and COVID-19 -- have affected the world in our lifetimes at a level reminiscent of the 1918-1919 H1N1 influenza pandemic. We have much to learn from both experiences to optimize pandemic disease control, prevention, and management.

Back to the future: Covid-19 and the recurring debate over social determinants of disease, and health.

Since the 1980s, a large literature has developed on the social determinants of health, primarily non-communicable diseases for which mortality and morbidity can be shown to change across a socioeconomic gradient. Primarily regional or national in focus, they are joined, today, with an increasing focus on international health and the effect of inequalities between nations effect disease generation and spread. Similar and earlier literatures first considered socioeconomic factors influencing disease incidence and intensity primarily at local and regional levels. One such literature was primarily “sanitarian,” focusing on general infrastructure needs (safe water, for example) to create a beter health environment. A second, primarily nineteenth century literature focused on social inequalities and the epidemic diseases in specific populations. This paper seeks to review these separate foci and then combine them into a more comprehensive understanding of both the general and specific determinants of health and disease at local, national, and international scales of address. It notes that while disease dynamics have been long known that current literatures typically consider socioeconomic determinants at local, national, and global scales as a new phenomenon.

Obesity in early onset breast cancer in African American patients.

Obesity is a modifiable risk factor in breast cancer patients and is predictive of disease outcomes in early-onset breast cancer survivors. The purpose of this review is to summarize the current evidence in the association between early-onset breast cancer and obesity, specifically in African-American women. Reviewing the molecular mechanisms and social determinants of disease in this population can provide a foundation for future interventions in prevention, detection, and treatment aiming at improving outcomes for young breast cancer patients.

Exemplary medical care or Trojan horse? An analysis of the 'lifestyle medicine' movement.

The rise of non-communicable diseases, many of which share common risk factors of smoking, alcohol, poor diet, and physical inactivity, has resulted in calls to develop and expand lifestyle medicine, giving ‘hope to those suffering from chronic illness’ (https://bslm.org.uk/). It has been argued that lifestyle medicine should be recognised as a new medical specialty,1 with primary care leading. There are numerous drivers for lifestyle medicine (Box 1). Our analysis does not aim to argue against the importance of these drivers as many of them are well informed. Instead we seek to balance existing discussions with aspects that, in our opinion, have been less well considered. With this in mind, we focus on the unintended consequences of uncritical endorsement and application of lifestyle medicine including the infiltration of pseudoscience, profiteering, and the potential for widening health inequalities by a continued focus on the ‘individual’. We stress the need for greater attention to public health and community-level interventions and a more critical approach to current practice. | Prevention is better than cure. | || | The patient is an active partner, not a passive recipient. | | Lifestyle medicine treats the root cause (behaviours) of chronic disease, which medicine often overlooks. | | Lifestyle risk factors are the primary cause of non-communicable disease and must therefore be addressed. | | It is better to treat with lifestyle changes than to use potentially unnecessary drugs with the risk of side effects. | | Lifestyle medicine is cost-effective compared with conventional medicine. | | Professional satisfaction is greater, especially compared with usual approaches to chronic disease management (for example, the ‘tick box’ approach of the Quality and Outcomes Framework in England). | | Because of weakening of public health through defunding within local government, individual approaches are necessary. | | Public Health England has been perceived as not being sufficiently independent of government or industry. | Box 1. Key drivers for lifestyle medicine Medical practice guidelines often advise on ‘lifestyle factors’. These are usually in the form of individual behaviours that impact on health, framed as modifiable, often related to smoking, alcohol intake, physical activity, diet, and, to a lesser degree, sleep quality, stress, and social factors. However, translation of guidelines into achievable real-world benefits outside clinical trials is challenging. The British Society of Lifestyle Medicine (BSLM) describes lifestyle medicine as ‘an established approach that focuses on improving the health and wellbeing of individuals and populations … It requires an understanding and acknowledgement of the physical, emotional, environmental and social determinants of disease.’ (https://bslm.org.uk/). Society membership is open to registered health professionals, who can take a diploma, and associate membership is available to others, such as reflexologists, homeopaths, herbalists, and naturopaths. Some have …

Understanding of and perceptions towards cardiovascular diseases and their risk factors: a qualitative study among residents of urban informal settings in Nairobi

ObjectivesThe study explored the understanding of and perception towards cardiovascular disease (CVD) and risk factors, and how they influence prevention and development of the conditions, care-seeking and adhering to treatment.SettingInformal...

“Human Nature” and the Biology of Everyday Life

ABSTRACTAnthropologists are well poised to contribute to an immanent theory of human physiological experiences that accounts for the broad social and environmental influences that shape individual and community experiences of health and disease. This article forwards a theory of “the biology of everyday life” as a means to conceptualize the interactions between institutional expectations of behavior, cultural norms, and biological plasticity. Drawing on a wide variety of research on human sleep, this article shows how the expression of sleep needs vary within and between societies and are shaped primarily not by innate biological drives but cultural norms embedded in the institutions that comprise the infrastructure of everyday life. Embracing perspectives from laboratory scientists, social theorists, and ethnographers, the biology of everyday life offers a way to conceptualize human nature not as a set of drives but a supple interaction of physiological plasticity, cultural expectations, and social organization. [plasticity, social determinants of disease, epigenetics, sleep]

Rethinking prevention: Shifting conceptualizations of evidence and intervention in South Africa’s AIDS epidemic

In recent years, statements about the ‘end of AIDS’ and an ‘AIDS-free world’ have dominated headlines about the epidemic. This contemporary moment of extraordinary optimism has been prompted in significant part by developments in the field of HIV prevention. New approaches to prevention include techniques that are markedly different from older strategies; new prevention techniques are targeted and relentlessly biomedical, and have increasingly displaced older behavior change programs and broad based social measures. HIV/AIDS, which was long called a ‘social epidemic’ marked by unprecedented human rights struggles and community action, has increasingly become dominated by a discourse and practice of discrete interventions and their calculable efficacy. This article aims to explain the shift in conceptualizations and practices of prevention, and the changed understanding of the epidemic. How did prevention become about access to drugs? How did the discourse around HIV/AIDS move from a concern with social determinants of disease and human rights to matters of efficiency, efficacy, and measurable impact? The article argues that a conjunction of new biomedical technologies, changing managerial logics of donors and governments, and emergent evidentiary practices have led to the ascent of new approaches to prevention. To support this argument, it traces prevention strategies over the last three decades in the context of South Africa’s HIV/AIDS epidemic. The South African story, while unique and historically situated, nonetheless serves as a lens through which to understand broad based transformations underway in HIV/AIDS and in global health writ large.

Successes, challenges and needs regarding rural health medical education in continental Central America: a literature review and narrative synthesis

Central American countries, like many others, face a shortage of rural health physicians. Most medical schools in this region are located in urban areas and focus on tertiary care training rather than on community health or primary care, which are better suited for rural practice. However, many countries require young physicians to do community service in rural communities to address healthcare provider shortages. This study aimed to: (a) synthesize what is known about the current state of medical education preparing physicians for rural practice in this region, and (b) identify common needs, challenges and opportunities for improving medical education in this area. A comprehensive literature review was conducted between December 2013 and May 2014. The stepwise, reproducible search process included English and Spanish language resources from both data-based web search engines (PubMed, Web of Science/Web of Knowledge, ERIC and Google Scholar) and the grey literature. Search criteria included MeSH terms: 'medical education', 'rural health', 'primary care', 'community medicine', 'social service', in conjunction with 'Central America', 'Latin America', 'Mexico', 'Guatemala', 'Belize', 'El Salvador', 'Nicaragua', 'Honduras', 'Costa Rica' and 'Panama'. Articles were included in the review if they (1) were published after 1984; (2) focused on medical education for rural health, primary care, community health; and (3) involved the countries of interest. A narrative synthesis of the content of resources meeting inclusion criteria was done using qualitative research methods to identify common themes pertaining to the study goals. The search revealed 20 resources that met inclusion criteria. Only four of the 20 were research articles; therefore, information about this subject was primarily derived from expert opinion. Thematic analysis revealed the historical existence of several innovative programs that directly address rural medicine training needs, suggesting that expertise is present in this region. However, numerous challenges limit sustainability or expansion of successful programs. Common challenges include: (a) physicians' exposure to rural medicine primarily takes place during social service commitment time, rather than during formal medical training; (b) innovative educational programs are often not sustainable due to financial and leadership challenges; (c) the majority of physician manpower is in urban areas, resulting in few rural physician role models and teachers; and (d) there is insufficient collaboration to establish clinical and educational systems to meet rural health needs. Recurring suggestions for curricular changes include: (a) making primary care training a core component of medical school education; and (b) expanding medical school curricula in cross-cultural communication and social determinants of disease. Suggestions for health system changes include: (a) improving living and working conditions for rural physicians; and (b) establishing partnerships between educational, governmental and non-governmental organizations and rural community leadership, to promote rural health training and systems. Expertise in rural medicine and training exists in continental Central America. However, there are numerous challenges to improving medical education to meet the needs of rural communities. Overcoming these challenges will require creative solutions, new partnerships, and evaluation and dissemination of successful educational programs. There is a great need for further research on this topic.

Integrating Anthropology in Medical Education: Opportunities, Challenges, and Lessons

An increased awareness of the social determinants of disease and the role of social factors in patient health outcomes may open up opportunities for applied anthropologists in the field of medicine and other health sciences. Recent trends in medical education call for both increasing future physicians' competencies in social and behavioral sciences, as well as teamwork and communication. Cuff and Vanselow (2004:4) noted that:Skills in the behavioral and social sciences are essential for the prevention of many chronic diseases and for effective management of patients with these diseases… In addition good communication skills and the cross-disciplinary education discussed in this report will improve their ability to relate to their colleagues in medicine, as well as other professionals.

Camp PathOLogical: An Innovative Summer School Program for High School Students Addressing Health Disparities, Social Determinants of Disease and Related Clinical/Translational Research

Abstract This resource provides the material necessary to implement a 5-week inquiry-based informal science education summer program focused on the enrichment, awareness, and literacy of biomedical...

Is It Possible for Critical Social Sciences to Trespass the Biomedical Sciences Bunker in a Neoliberal Era?

The biomedical scientific institution is one principal cogwheel for the meanings construction neoliberal machine. Despite the official recognition of the social determinants of disease by the medical institution, critical social sciences are not taken seriously in this field where the tolerated social sciences paradigm is positivistic, looking for biological answers and ‘hard’ evidence to embodied social problems. In this paper I look at the chances of critical social sciences to affect the medical field in present neoliberal context. I argue that, at present time, it seems not possible for a progressive critical social sciences to effectively penetrate the medical field. This is not to say that critical social sciences have not chance at all to penetrate the health culture. I sketch then some possibilities to penetrate the health culture pinpointing out the role of Qualitative Inquiry in this quest.

Linking the social environment to illness in farm animals

Disease is one of the single largest issues facing food animal agriculture today. Risk factors for various diseases in cattle, swine and chickens include aspects of both the physical and social environment. In this paper we review literature linking the social environment to illness in farm animals, drawing from a conceptual framework developed primarily in the human and laboratory animal literature. To date, researchers have identified various social determinants of disease, have linked social stressors to biological intermediaries and clinical signs of disease, and have established individual behavioural and neuroendocrine differences in susceptibility to disease. Further, ill animals reduce social behaviours as part of a suite of ‘sickness behaviours’. In animal agriculture, the social environment is controlled by management practices implemented on individual farms. Globally, farm sizes are growing, but there is no clear link between farm size and disease incidence. Rather, researchers have tied specific grouping practices, such as moving cows between groups, to increased disease risk, and have begun to determine the biological chain connecting the social world to biological determinants of disease. Studies with farm animals have also established individual variation in behavioural and neuroendocrine response to these practices. Some individuals are more reactive to changes in their social environment than others; however, there remains no consensus on how to recognize these at-risk animals. Additionally, despite the potential role in disease detection, little farm animal work has investigated whether a reduction in social behaviours could be used as early predictors of disease. We end the review by urging further farm animal research to determine the relationship between the social environment and disease, utilizing the concepts and methodologies that have been developed in the human and laboratory animal literature.

The Prevention and Control of HIV/AIDS, TB and Vector-borne Diseases in Informal Settlements: Challenges, Opportunities and Insights

Today’s urban settings are redefining the field of public health. The complex dynamics of cities, with their concentration of the poorest and most vulnerable (even within the developed world) pose an urgent challenge to the health community. While retaining fidelity to the core principles of disease prevention and control, major adjustments are needed in the systems and approaches to effectively reach those with the greatest health risks (and the least resilience) within today’s urban environment. This is particularly relevant to infectious disease prevention and control. Controlling and preventing HIV/AIDS, tuberculosis and vector-borne diseases like malaria are among the key global health priorities, particularly in poor urban settings. The challenge in slums and informal settlements is not in identifying which interventions work, but rather in ensuring that informal settlers: (1) are captured in health statistics that define disease epidemiology and (2) are provided opportunities equal to the rest of the population to access proven interventions. Growing international attention to the plight of slum dwellers and informal settlers, embodied by Goal 7 Target 11 of the Millennium Development Goals, and the considerable resources being mobilized by the Global Fund to fight AIDS, TB and malaria, among others, provide an unprecedented potential opportunity for countries to seriously address the structural and intermediate determinants of poor health in these settings. Viewed within the framework of the “social determinants of disease” model, preventing and controlling HIV/AIDS, TB and vector-borne diseases requires broad and integrated interventions that address the underlying causes of inequity that result in poorer health and worse health outcomes for the urban poor. We examine insights into effective approaches to disease control and prevention within poor urban settings under a comprehensive social development agenda.

Historical perspective: the social determinants of disease – some blossoms

This commentary accompanies an historical perspective by Len Syme about social epidemiology. It is a very personal account of the impacts of Syme's work and teaching on the field in general, and on me in particular.

Historical perspective: S. Leonard Syme's influence on the development of social epidemiology and where we go from there.

This article accompanies Len Syme's "Historical Perspective: The social determinants of disease – some roots of the movement." It describes some of Len's role in the development of social epidemiology through mentoring investigators and influencing training programs. It also discusses some challenges for the field and ways to move forward.

Historical Perspective: The social determinants of disease - some roots of the movement.

This is an account of the early days of research on social determinants as I experienced them. I describe my time as one of four Fellows in a new training program in Medical Sociology at Yale University and how I came to be the first Sociologist employed in the U.S. Public Health Service. I then became the first Executive Secretary of a new Study Section at NIH dealing with a small number of research grant proposals in the field of Epidemiology. My account deals with some of my experiences in this developing field, culminating with my appointment as the first Sociologist to become a Professor of Epidemiology in a School of Public Health.