Theories for social epidemiology in the 21st century: an ecosocial perspective.

'Both thinking and facts are changeable, if only because changes in thinking manifest themselves in changed facts. Conversely, fundamentally new facts can be discovered only through new thinking.' Ludwick Fleck (1935) Genesis and Development of a Scientific Fact. 1,pp.50–51 'Once we recognize the state of the art is a social product, we are freer to look critically at the agenda of our science, its conceptual framework, and accepted methodologies, and to make conscious research choices.' Richard Levins and Richard Lewontin (1987) The Dialectical Biologist. 2,p.286 Theory In social epidemiology, to speak of theory is simultaneously to speak of society and biology. It is, I will argue, to speak of embodiment. At issue is how we literally incorporate, biologically, the world around us, a world in which we simultaneously are but one biological species among many—and one whose labour and ideas literally have transformed the face of this earth. To conceptualize and elucidate the myriad social and biological processes resulting in embodiment and its manifestation in populations' epidemiological profiles, we need theory. This is because theory helps us structure our ideas, so as to explain causal connections between specified phenomena within and across specified domains by using interrelated sets of ideas whose plausibility can be tested by human action and thought. 1–3 Grappling with notions of causation, in turn, raises not only complex philosophical issues but also, in the case of social epidemiology , issues of accountability and agency: simply invoking abstract notions of 'society' and disembodied 'genes' will not suffice. Instead, the central question becomes: who and what is responsible for population patterns of health, disease, and well-being, as manifested in present, past and changing social inequalities in health? Not surprisingly, theorizing about social inequalities in health runs deep. One reason is that it is fairly obvious that population patterns of good and bad health mirror population distributions of deprivation and privilege. Comments to this effect can be found in the Hippocratic corpus 4 and in early texts of ancient Chinese medicine. 5 Shared observations of disparities in health, however, do not necessarily translate to common understand-ings of cause; it is for this reason theory is key. Consider only centuries of debate in the US over the poor health of black Americans. In the 1830s and 1840s, contrary schools of thought ask: is it because blacks are intrinsically inferior to whites?— the majority view, or because they are enslaved?—as argued …