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Welcome back.This is the third module or part tolecture one.And in this section, we're going to talkbriefly about what this central questionsof social epidemiology are.In a future whole lecture, we're going togo into great depth about socialepidemiologic research and activity.Here, I just want to give you a briefintroduction to the landscape tofamiliarize you with what's happening.Again, the basic question for socialepidemiology is, how does this socialsystem or society or social arrangementseffect health?This is in contrast to our model ofRobinson Crusoe.Remember this fictitious character issomeone on a island with no other people.His health is determined affected byisland weather, maybe a typhoon, germs,bacteria on a rock.

That he might cut his toe on.Social epidemiology is not about aRobinson Crusoe model of health.It's about a social systems model ofhealth.Let me now give you a brief introductioninto the kinds of research that goes on.The basic question is, again, how does asocial system effect the health ofpopulations?There are two ways this can happen.Directly, simply put there's some sort ofsocial arrangement, perhaps of bonding,

that affects health.Having emotional support can improveone's health.That's a direct effect of the socialsystem on health.There's also indirect effects.And these are things, like the socialsystem is putting toxic dumps in onearea, and not another.The social system is putting persons inan area, a condition, of circumstance ofgreat stress which harms their immunesystem.

Which makes them more susceptible todisease and infections and so forth, thanother persons.This is an indirect effect of the socialsystems on health.Remember our classic example.Here we have some exposure causingdisease.This is a basic epidemiologic question.And a social epidemiologists might ask,

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how do social interactions, familystructures, social support, bonding,these kinds of questions?How did they directly affect one'spropensity for disease of ability tofight it off?I think, though, the bigger question forsocial epy is this one.How does social systems createdifferential exposures acrof, acrossdifferent groups of people?So, why are some persons exposed to moretoxic chemicals than others?Why are some people having strongerimmune systems than others?These are questions about how the socialsystem is altering the conventional wayswe understand we get sick.The flu virus, for example, havingMcDonald's in one area and not another,and changes in obesity.These kinds of questions are the indirecteffects of the social system on health.There's been lots of work in social

epidemiology, as I mentioned earlier, init's current form, we could trace it backto say, the 1980s.The classic textbook however, came out inthe year 2000 and this is by Berkman andKawachi.It's still a very valid read.Richard Wilkinson has written extensivelyhis interests tends to be on how socialinequality, the gap between the rich andthe poor.The advantage and the disadvantage,effect health.

There's been volumes of the journal,American Journal of Epidemiology, andothers, devoted directly to the questionsof social epidemiology.Michael Marman, as I mentioned earlier,distinguished scholar, also writes abouthow social policy, social systems affecthealth.These are all books still worth readingtoday.Ichiro Kawachi, also interested in howsocial inequality affects health.These questions tend to dominate this

sort of work in social epidemiology.Of course, there's trends, but theseremain essential questions.Nancy Krieger takes these questions andtakes it a step further.How is it exactly that inequality ordifferences between the rich and thepoor, how does this actually get into ourbodies?How does it happen physiologically that

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inequality makes some people more sickthan others?Let's talk about the broad determinantsof health, and I want to use the worddeterminant a little loosely.Obviously, things are probabilistic.That is, just being exposed does not makeyou sick.But in any case, what are the broad macroideas?And I have after determinants, a questionmark.Because what might be macro to you, couldbe meso or micro to me.First, global economic forces, how doesinternational trade offer wealth ofresources to one country?Global economic trade can also havedirect consequences, transferring germsand cargo packages.Religion, how does religion affecthealth?Religion is a global economic force.Different types of religions, different

people believe different things.And practice according to their religion,different diets, different behaviors.So religion is a macroeconomic, excuseme, a macro-cultural force that has a bigimpact on health.Relatedly, mass culture.How do we understand what's good, what'sbad?These things are mass globalizationaspects, and they all have an impact onhealth at the macro level.Ideas of macro forces need not just be

ideas themselves, but they can betechnologies.Such as, how does the internet, how doesFacebook, how does the ability tocommunicate by email and YouTube and allthe rest, and a course like this.How does this affect our understandingand ultimately our actual health?Macro determinants.A little below macro, we might call themmiddle or meso level.What are some meso levels determinants ofhealth?

Local, regional economic forces.Well, there could be global economicforces.But, how does your state deal withunemployment?How does your state deal with taxes?Nations and states, again a level belowthe global system.Racism, classes, sexism, is it truecertain mortgage companies prevented some

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people from living in one area oranother, the idea of redlining.And how did that alter exposures?How did that alter stress?These are questions at the mezo level, ofsocial determinance of health.Much related school systems, schoolsoffer a chance to climb the socialstructure, advance through class systems.That schools also offer opportunities forinfections and opportunities to haltone's ability to move through the socialsystem.Sports, everything else happens in theschools they are meso levels ofdeterminants of health.Much like schools are work places.Lots happens in the work places, there'slots of social epidemiological researchon how work places effect health.Finally, friendship networks.And in this case, since we're at the mesolevel, I'm talking broad friendshipnetworks.

Persons who might be distant friends ofyours, maybe Facebook friends of yours.And here, these friendship networks canhave subtle influences on health.Finally, the micro or very closedeterminants of health.What are they?Among them are families.Our families clearly affect how we live,and our health.They do so directly, perhaps offeringinfections or different types of food.And indirectly, offering social support.

Things that enhance our immune system, ornot.Friendship networks.Here, I'm talking about friendships thatare very close.Your most close friends, your bestfriends.These friends might induce you to smokecigarettes or not wear a seat belt.Or wear a seat belt and eat good food.Local, tight, very good friends have animpact on our health.More micro determinants.

Our neighborhood context, where we liveis there a toxic dump, is there a nicepark to exercise.These are all questions that socialepidemiologists address.The final microdeterminant in theseslides is what I'll call personal choice.This is the most difficult andcontroversial one, because some peoplecan say, it's all personal choice.

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Others can say, there's very littlepersonal choice.So, we'll come back to this in futurelectures.For now, let me just leave that.Micro determinants include thecontroversial question of personalchoice.Briefly, what kinds of socialepidemiologic studies are done?We'll talk about classes of studies.In future lectures, we'll dig in moredeeply.First are kinds of experiments.What's an experiment?An experiment is a technical type ofstudy where there's some sort ofintervention.And that intervention is given to personsat random, so the intervention might be apill, it might be a pill to reduce heartdisease.In an experiment that pill is given topersons at random and there's some

reasons that happens.And you can think about random as a cointoss, perhaps heads, the person gets it.Tails, the person does not.Those are the core elements of a trueexperiment.Something happening to persons at random.Another kind of study that socialepidemiologists work on are calledlongitudinal or cohort studies.Here, we follow a bunch of personsthrough time.There is no extra thing happening to

them.Stuff just happens to them.And then, we see what happens.So, cohort studies have neither theadvantage of something happening, andsomething done at random.Now, stuff does happen to people.Naturally, people are exposed to germs,they are exposed to different socialcircumstances.But the difference between a cohort studyand an experiment is, in the experimentalcondition, the researcher is controlling

who gets what, the cohort study does not.Finally and simply, the last class ofstudy is what we'll call across-sectional study.Here's sort of a common survey, a sliceof time, cross-section.These are studies that just look atthings at one point in time, not overtime but at one point in time.And these types of studies offer the

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weakest but not often.Not necessarily the worst, but theweakest sort of level of research data.So, we can draw conclusions about how thesocial system affects health.There's increasing work in methods,research techniques in socialepidemiology.Here's a book I co-edited with mycolleague Jay Kaufman.And more and more work in this area isbeing done.I'll dare say more work needs to be done.But by and large, the landscape of socialepidemiological research is investigatingmeso, middle, macro, high, and microforces with different kinds of studieswith different kinds of researchmethodologies.And we'll explore these ideas in detaillater in the course.