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A pluralistic and socially responsible philosophy of epidemiology field should actively engage with social determinants of health and health disparities

Abstract

Philosophy of epidemiology has recently emerged as a distinct branch of philosophy. The field will surely benefit from pluralism, reflected in the broad range of topics and perspectives in this special issue. Here, I argue that a healthy pluralistic field of philosophy of epidemiology has social responsibilities that require the field as a whole (not any individual work therein) to engage actively with research on social determinants of health and health disparities. Practicing epidemiologists and the broader community of public health scientists have gradually acknowledged that much of their attention ought to be paid to these, i.e. inequitable between-population health variations that largely reflect the world’s inequitable distribution of resources and social conditions. The paper illustrates how and why health disparities and social determinants of health, through no ill will, become de facto secondary concerns in Alex Broadbent’s field-defining Philosophy of Epidemiology, showing the ease with which these topics can be incidentally sidelined. As means for philosophy of epidemiology to meet its social responsibility obligations, I suggest philosophy of epidemiology expand its attention to two particular lines research. First, the paper discusses Geoffrey Rose’s concept of “causes of incidence”—causes of disparities between populations—and argues for the importance of engaging with these causes. Second, the paper argues for the value of engaging with Bruce Link and Jo Phelan’s “fundamental causes” model of how flexible social resources (money, prestige, etc.) serve as buffers from harms, generating a plethora of shifting and locally-contingent health effects.

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Notes

  1. Galea’s third critique, that epidemiologists have been too reluctant to engage with “big data,” is outside the scope of this paper (Valles 2018).

  2. Thanks to an anonymous reviewer for making these points.

  3. Other cases are more complex and have multiple special causes that operate together (Broadbent 2013, p. 157). The chapter also includes an addendum to the model in order to account for immunity and phenomena like asymptomatic carriers of M. tuberculosis (Broadbent 2013, p. 159).

  4. Probably so, but she and Broadbent are in agreement on matters such as the multifactorialism being frustrating (Krieger 1994) and opposition to the extreme narrowness of the Potential Outcomes Approach (Krieger and Davey Smith 2016).

  5. Meanwhile, DNA sequencing and genomic data computing resources gotten faster, cheaper and more widely available for use in genome-wide association studies, which search for links between genomic regions and any identifiable trait (including self-reported race). So it is increasingly unlikely that there are causally powerful genetic variants that simply haven’t been noticed yet, unless they are very rare variants (and hence less capable of explaining large population-level disparities) (Price et al. 2015).

  6. I thank an anonymous reviewer for suggesting this line of thinking.

  7. Attempting to pick apart complex causal networks in order to highlight the action of one single causal factor can lead to over-simplifications and other errors. Broadbent expresses some related concerns in Chapters 6–8 of his book, which delve into making/assessing predictions. For instance, he attempts to restrain those who would over-interpret available evidence to make causal claims about the fraction of an effect that is attributable to a particular cause; among other reasons, we would need to know what other factors would be at work in the counterfactual world in which the target cause is hypothetically absent (Broadbent 2013, p. 127).

  8. I thank an anonymous reviewer for this insight.

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Correspondence to Sean A. Valles.

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Valles, S.A. A pluralistic and socially responsible philosophy of epidemiology field should actively engage with social determinants of health and health disparities. Synthese 198, 2589–2611 (2021). https://doi.org/10.1007/s11229-019-02161-5

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Keywords

  • Causes of incidence
  • Fundamental cause
  • Philosophy of epidemiology
  • Population health
  • Social determinants of health