1. Social Causation of Disease Medical model of disease causation Sociological model It is impossible to explain the levels of disease in any population without differentiation by social factors

2. Social Production of Disease Infectious vs. chronic disease Point is that all the “medicine’ given in this century in developed countries has not been the major contributing factor in the decline in infectious disease or the improvement in logevity Epidemiological transition (Markides and Coriel)

3. Social Causation of Disease Definitions Mortality Morbidity Epidemiological transition Life expectancy Chronic and acute disease Cause and effect

4. Social Causes Factors involved Age Gender Income Education Marital status Social networks Race and ethnicity

5. Cause and Effect Increased longevity is a direct result of declining mortality Social problems with increased longevity include dependency and stress on social and healthcare provision systems, governments and families

6. Social Causation Medical heresy that we cannot “cure” disease from medical model Public health measures responsible for declines in infectious disease Medical causation does not factor in self-care and prevention Medical causation assumes that all improvements in health are from application of the scientific paradigm

7. Causation Temporal sequence Correlation Spuriousness

8. Multifactor Causation Malthus 1798 Food supply will be outstripped by population increase resulting in mass famine and annihilation Why did it not happen? Effect of technology not factored in

9. Dubos, Weinstein If it isn’t one thing that kills you, it is another The decrease in acute, infectious disease has merely unmasked a different causation for mortality and morbidity Chronic disease dominates in developed countries Chronic disease is more closely related to social causation than infectious disease

10. Genes Important to but not determinative of disease Social factors affect gene elaboration

11. Why the debate? Medical profession has power Certainty of medical (scientific) model Challenge to governments and individuals to act rationally about social issues that affect health Changing social behaviors harder than changing science and using science to make change

12. Mortality Decline Fueled by decline in infectious disease Male mortality in developed countries higher than female mortality Is this genetic factor? Is there a maximum of average longevity?

13. Developing World Most common killers are still acute/infectious Can be transmitted to developed world by globalization and transport Acute illness threat to developed world gradually reappearing Examples TB, AIDS, Malaria, Sleeping sickness

14. Epidemics Plagues occur because people are not immune examples Black Death AIDS TB SARS, West Nile, other viruses

15. Multiple Disease Causation The point of all this is that disease causation has multiple causes, some genetic, some medically etiologic, some social and some a combination of the three OGOD—one gene, one disease is simplistic Equally one cause one disease is also simplistic

16. DNA DNA codes for proteins, proteins are enzymes, form fats, form cell structures, instruct cell structures, etc. Proteins act in an environment—diet, stress, hormones, water Causation of disease may be tied to internal and external as well as evolutionary social processes

17. Example Perinatal mortality Depends on education of the mother, professional management of the pregnancy period and clean surroundings Largest effect on mortality of mother or child?

18. Summary Medicine has not really “caused” the decline in disease (Infectious) Public health is an extension of germ theory and has had the most effect on declines in mortality Chronic from infectious disease transition at least in the West

19. Summary Developing countries lag in public health and therefore in infection control and mortality decline A threat to us because of this Genes, public health, social factors all affect health and illness levels and remedy for health issues is ALWAYS multi-factorial