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Welcome back everybody, week 4.Now we're on the downhill.This week we're going to talk about thetopic of theory, more specifically SocialEpi Theory.In this lecture, this week, we have 4modules.It'll be on the shorter side this time,we've been doing a lot of work.So these will be quicker and shorter.And hopefully fun.So I'm looking forward to walking that,walking through that with you.The four modules for this week are,social theory background.We're going to talk about that now.And then we're going to get into the,what's called the social ecologicalmodel.And it goes by several names.And I'll try to explain that.When we get that module.Then we're going to talk about what I

call Coleman's theory.Which is by a late scholar named James orJim Coleman.And then finally, I'm going to have asection or module on something calledgame theory.I want to introduce you to some ideasthat I think are important for socialepidemiologist to understand.In all of these modules, they're justgoing to be little tidbits.There's volumes written about this stuff.so my goal for this lecture is to help

you understand some of the landscape ofsocial epi-theory, if you will, to getyou started, and so, that's the goal.This week, we're going to try somethingdifferent in terms of assignment.A little experiment in this new on-lineformat.Instead of giving you a readingassignment and offering a quiz, whichwe've been doing as you know, I'm goingto ask you to search the web, Google ifyou want, for evidence, for parts ofdifferent theories that you think.

Would fit into a social epidemiologictheory framework.Now the hope is that through the modulesof this week, I give you some guidance onstuff that I think should be involved ornot involved.But this is an experiment, and what wewant to do is to then have you, all thestudents, post on our discussion boards,on the Coursera discussion boards

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elements or ideas for social epi theory,and then we'll discuss theminteractively.And I'll try to play a role as well.But that student interaction is socritical to the success of a course suchas this.I thought this was an optimal time to trythis and if it fails we'll just back off,but let's try it together.And I'll give you more directions as wego on in the next modules.So, this first module we're going to calltheory background and I hope to give yousome.Insights, some sense of what does it meanwhen someone like me says we're going totalk about theory.So let's try to do that.Well what is theory?Simply put, theory, in this case socialepi-theory, is like a road map.It's literally like a map that one mightuse to drive from point A to point B.

It gives us guidance.It says, here are the road stops, hereare the landmarks, here's where the roadis.Here's where not to go, perhaps.Technically, theory tells us where tolook.What does that mean?Well, for social epi it means, what kindof things should we be looking at?As you know, socioeconomic status, race,one's place in the world, internationallocation, other aspects of the social

system.Social epi theory will guide us as towhere to look for what variables, whatmeasures will be moving or interacting orcausing one another.Theory also helps us have a framework forunderstanding.It helps us under-, say, well this ispart of our understanding or this is now.It's akin to saying, well if we had a mapof the world.That was the size of the world, it wouldbe perfectly accurate but it would not be

very helpful because you couldn't fold itup and put it in your pocket or in yourglove box of your car.So to have something that's simplified,that's smaller, that isn't necessarilyperfectly accurate but helps us, if you'dfollow the metaphor.Get from point A to point B, that's whattheory does.And we want to explore what kinds of

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variables, constructs, measures willguide us into a deeper understanding ofhow the social system affects health.Theory also helps us illuminate and if,if we're lucky, if we work hard, mitigatean important problem called confirmationbias.Well what's that?Well confirmation bias is the biggestproblem for science.And that is having a conclusion, and thenlooking for data to confirm yourconclusion.That's confirmation bias.And so the problem with that is.We might say this kind of thing causesthat disease.And then we look for evidence thatconfirms that.It may be true.But what that does is exclude otherexplanations for that very same cause.And in science, we want to entertain allexplanations until we can rule them out

vis-a-vis the scientific method.So theory helps us get there.This is why theory is the integral partof the scientific process or scientificmethod.We cannot just look to the world fordata.We always come to the world of data withsomething in mind.And that something in mind whether it'sformal or informal is theory.And so we want to be more clear, we wantto be more concise about what theory is

so we're clear on what we're doing whenwe look to the world of data.And then of course use that data toanalyze it and maybe make predictionsabout what we can expect in terms ofhealth outcomes.But there's some cautions.We want to be clear in our work.In our reading of whether we're trying todevelop theory for its own sake.Is our goal to develop a sophisticatedtheory and test it and see if that's howthe world works?

Or are we aiming to develop theory tohelp us better understand mother natureor the empirical world?In our case, society and how it impactshealth.So it's perfectly reasonable, perfectlyreasonable to say that we have theoriesthat we want to test about the world.And see if they're true or not.But in public health, of which

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epidemiology and social epidemiologiespart.We typically want theories that helpguide us to do things.And the things we want to do are toimprove population health.So the theories we'll talk about in thisweek, in this module.Are theories that I hope help us actuallyimprove population health.Now, the traditional epidemiologictheory, we've talked about before.And it's a rather simplistic view of theworld, where we have an agent.Which is something like a virus or abacteria.We have an environment, in which theagent and the host of the agent exists,and this could be a farm, it could be acity, it could be a petri dish.And then we have the host, and that's theperson who is affected by the agent orthe disease and time is always moving.As we said in our earlier lectures, this

is a traditional theory of epidemiology.But notice that it does not incorporatethe critical aspects of how socialsystems affect health.So this traditional epidemiology modelwhich is well-known is not sufficient,it's not that it's wrong, it's just notsufficient for social epidemiology.Well, begs the question.What is social epidemiologic theory?It's important for me to tell you that Idon't think there is one.Currently, after 20 years of focused work

it's still a bit of a mish-mash.We're borrowing parts of theories fromother disciplines.That might be fine, but we're yet to havea cohesive story or theory of how socialsystems affect health.Lots of scholars write in theprofessional journals, we need moretheory.And I totally agree.The trouble is not much theory isforthcoming.Not much is helping us improve our

questions, improve where we look fordata.In fact, in epidemiology there is littletalk of theory per se.Most epidemiologists are very empirical.They tend to count stuff up and analysedata without much thought to what it iswe're counting, why it is we're counting,and what does this all mean in a largerlogical framework.

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Social Epi theory borrows from lots ofplaces.And we borrow from statistics, we try tounderstand how one variable might becorrelated with another.We borrow from economics.And as I said in our first lecture, Itend to borrow heavily from economics.That's due to my own training and,probably, biases.We certainly borrow from biology, andphysiology, and medicine.We have to understand, ultimately, howsociety gets into the body.We borrow, of course, from sociology,social norms, social systems, andpsychology.How do people think?What do things mean to people?And of course, anthropology.What are the cultural aspects?So these are the important components ofsocial epi theory.And as you read, or work, or think about

this stuff parts of this mish-mash becometo be put together.There's been some progress, and one ofthe more important papers I wish to pointout to you.And you can read this on your own if youwish.And this is by a scholar named NancyKrieger.And this is a paper in the InternationalJournal of EPI and of course it's calledTheories for Social Epidemiology.And in this paper, Krieger does several

important things and we'll talk moreabout that in later modules.I want to emphasize that in this contextand even in my regular classroom, there'sno time, there's not a place to discussall the components of various theoriesthat are very interesting.I just want to point out a few to you,for you if you want to to go out on yourown, and think about them, read aboutthem and maybe see if they canincorporate themselves into social epitheory for you.

And that's the theory of memes.The theory of agent-based models,something called systems theory, socialnetwork theory, and cultural theory.In my view, all of these are valid andinteresting parts of a social epi theory.I just don't have the time, in thisformat, to go through them all.It's extensive and so I'm going to try tonarrow in on the stuff I think you need

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to know the most.But a word of caution there are sometheories that I read about and see thatsome people seem to link to social epitheory and I want to argue to you orsuggest to you that these are not really.Social epi theories.The traditional ones are the theories ofindividual behavior.And there are several.And I just list a few on this slide.The theory of reasoned action, the healthbelief model.Social cognitive theory, and others.These are very important and validtheories, but they are theories about whyan individual behaves.Recall, we are interested in theories ofhow the system, the social system, if youwant, society works, and how societyproduces health.Also, ecological theories, which we'llexplain more in later slides, ecologicaltheories in and of themselves are not

social epi theory.A theory of pure biology is not a socialepi theory.And finally, theories where genes andgenetics are determining outcome, are notsocial epi theory.So be cautious, be aware of these thingsthat are and are not part of the socialepi framework, at least as I view it.Finally, one last word of caution.There is something called the Murphy'sLaw of Research.And that is, with enough research, enough

impirical or going-to-data research work,we will confirm our theories.This is a danger in all science, and Ithink it's really important to emphasizeas we're talking about theory today, forsocial epidemiology, that you be cautiousand remember that if you look hardenough, you'll find data to confirm yourtheory, or you'll find data that saysyour theory's wrong, but not believe thatdata.So this is a great tension in science.I don't have an answer for you, but I

want to make you aware of it.So on we'll go now with Theories forSocial Epidemiology.[SOUND]