The social epidemiologic concept of fundamental cause |
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Authors: | Andrew Ward |
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Institution: | (1) Health Policy and Management, School of Public Health, University of Minnesota, 420 Delaware Street S.E, Minneapolis, MN 55455-0392, USA |
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Abstract: | The goal of research in social epidemiology is not simply conceptual clarification or theoretical understanding, but more
importantly it is to contribute to, and enhance the health of populations (and so, too, the people who constitute those populations).
Undoubtedly, understanding how various individual risk factors such as smoking and obesity affect the health of people does
contribute to this goal. However, what is distinctive of much on-going work in social epidemiology is the view that analyses
making use of individual-level variables is not enough. In the spirit of Durkheim and Weber, S. Leonard Syme makes this point
by writing that just “as bad water and food may be harmful to our health, unhealthful forces in our society may be detrimental
to our capacity to make choices and to form opinions” conducive to health and well-being. Advocates of upstream (distal) causes
of adverse health outcomes propose to identify the most important of these “unhealthful forces” as the fundamental causes
of adverse health outcomes. However, without a clear, theoretically precise and well-grounded understanding of the characteristics
of fundamental causes, there is little hope in applying the statistical tools of the health sciences to hypotheses about fundamental
causes, their outcomes, and policies intended to enhance the health of populations. This paper begins the process of characterizing
the social epidemiological concept of fundamental cause in a theoretically respectable and robust way.
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Keywords: | Fundamental cause Social epidemiology Causality Necessary cause Sufficient cause Social-context variable |
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