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Explanation and Causal Models for Social Epidemiology

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Understanding Health Determinants

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Abstract

This chapter describes approaches to explaining the patterns of health described in Chap. 1. It opens by reviewing the concepts of understanding and explanation; it outlines the roles of theory, concepts, and conceptual models in explaining empirical findings. It then reviews varying conceptions of causality and discusses the role of chance in generating patterns of health; it clarifies the connection between risk factors and determinants of health. It describes the application of systems thinking in social epidemiology and reviews some traditional explanatory epidemiologic models – the epidemiologic triad, causal webs, INUS and Rothman’s ‘pies’ model. It discusses the limitations of these in understanding the mechanisms that generate social inequities in health. It then turns to review additional approaches to explanation, including complexity thinking and emergent phenomena, Chaos Theory, and Catastrophe Theory. It finishes by outlining ways to model dynamically interacting causal influences.

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Notes

  1. 1.

    To avoid potential confusion: mythos, here, does not refer to a popular brand of Greek beer.

  2. 2.

    Felix qui potuit rerum cognoscere causas (Virgil: Georgics, ii, 490).

  3. 3.

    Echoes, here, of the PICO framework for formulating clinical questions in evidence-based medicine.

  4. 4.

    A graph is ‘directed’ if all the arcs between variables are directional arrows; it is acyclic (or recursive) if there are no closed loops in the diagram. Recursive means that the causal influence acts only in one direction: variables affect only their descendants. (S. Greenland et al. Epidemiology 1999; 10: 39).

  5. 5.

    John Last attributed this to T.R. Dawber et al., Am J Public Health 1959; 49: 1349–56, but it is frequently ascribed to the subsequent textbook by B. MacMahon and T.F. Pugh, Epidemiology: Principles and Methods, Little Brown, Boston, 1970.

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  1. School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada

    Ian McDowell

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McDowell, I. (2023). Explanation and Causal Models for Social Epidemiology. In: Understanding Health Determinants. Springer, Cham. https://doi.org/10.1007/978-3-031-28986-6_2

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  • DOI: https://doi.org/10.1007/978-3-031-28986-6_2

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