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Alright, welcome back.This is part three of lecture four, whichis on Social Epidemiologic Theory.Here, we're going to have a little moduleon what I call Jim Coleman's Theory ofSociety.Now, Jim Coleman is a late, a deceasedsociologist, who wrote this book in 1990called The Foundations of Social Theory,or.It was published in 1990, and it's a bigbook.And the joke has always been, Oh, you'restill reading Coleman's Theory.It was controversial at the time, andsome people like it and some peopledon't.I think it has some important elementsfor understanding how society works, andtherefore, has important elements forsocial epidemiologic theory.Lots of components in this big book.The key idea, first and foremost, is that

Coleman wants to understand how thesocial system works.So this is what I was getting at earlierin the last module.A good theory for social epidemiologyought to, in my opinion, help usunderstand how society or the socialsystem works.We can literally ask, why is theresociety at all?Why not pure anarchy?The war of all against all, as thephilosopher Thomas Hobbs used to lament.

Why is there society?Who benefits, and why?Relatedly, why do we have social norms?What's a social norm?The social norm is to smoke cigarettes,to wear a seatbelt, to behave in thisway, to not chew with your mouth open.All kinds of social norms that are bigand small, where do they come from?Why do they emerge?How are they maintained, and who benefitsby them?In my view, these kinds of questions are

critical to understand how society worksand particularly how society works toproduce population health.Coleman's Theory or.Big book is focused on the rules of thegame.It's not an individual person, John Doeor Jane Smith, but rather the rules andincentives in the system in which theyoperate.

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Where are the incentives?Why would someone behave in a certainway, and not another due to theincentives.We'll talk more about this in a latermodule, these rules of the game.But that's the focus.Coleman also describes individual andgroup or corporate actors.This is an important distinction.We have persons, like you and me.Then we have groups of persons, perhapsExxon Corporation, the federalgovernment, a club, a sports team.These are groups.So there's individuals that make upgroups, and both act.So both are actors.We have an individual actor and a groupactor.And one of the great mysteries, one ofthe great areas of research is why doindividuals in groups behave the way theydo for often the benefit of the group and

not necessarily a benefit of themselves.Coleman spends a great deal of time onstudying the critical issues that wedescribed before in this class.Of the macro to micro, and the micro tomacro transitions.How does society get into people?How do people change?And then how does the changed peoplere-emerge and affect society.That's that multilevel model stuff wetalked earlier.It's the group affecting the person, and

the person affecting the group.Coleman describes that a lot.It's worth studying.The last thing I really like aboutColeman's theory is it conforms, it'svery similar to the jargon and languageof modern economics, legal theory andpolitical science.This matters not just because that's aneat thing.But it matters because if socialepidemiologists want to sit at a tablewith policy makers.

The language of modern policy is notabout the ecology affecting individuals,but rather the legal, economic, andpolitical power situations that are goingon.Who benefits, who loses.And Coleman's theory is written inlanguage that is very similar in concept,in understanding, for modern economistand lawyers and political scientist.

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And I think that gives socialepidemiologist using the theory anadvantage.Alright some basics, now this is a bigbook.I'm just trying to give you a few ideasto get you started, to understand whythis might be useful for socialepidemiology.First, the idea is that persons act witha purpose.Everyone's trying to get something done.This does not mean that this is trueeverywhere and always.Of course, people act with habit andthere is addictions and even whim orfiat.But the basic idea of understandingsociety begins with understanding thatpeople by and large act with a purpose.In economics there's lots of strict, evenmathematical, components to rationality.Well, this isn't quite rationality.This is instead acting with a purpose,

trying to get something done.Second, there are actors and resources inthe system.Now again, actors can be individuals or agroup of individuals that we callcorporate actors.Both are actors in their own way.Actors have resources, these might bemoney, these might be skills orabilities.These can be all kinds of things that arevaluable resources.And what happens, in the theory, is that

these individuals who have stuff, theyhave resources, have interest in theirown resources and perhaps someone else'sresources.And we have control or.Property ownership of some of theseresources and not others.And so what happens in this theory, isthere's this great exchange.You have apples.I have oranges.And we trade, a simple trade.You might have excellent skills as a

carpenter.I might need a carpenter.And so we trade.you might be a big employer.I need a job.We exchange my labor for your paycheck,back and forth we go.So, the basic idea is there's thisexchange going on, everywhere and always.Which leads us to the rules of the game

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and the incentives for doing things.This whole theory can be viewed as a bigold market transaction.It's a little more nuanced, or a littlemore social than what a pure economistmight talk about.But, for now, we can just imagine it as abig market exchange, where all kinds ofpeople.And groups or corporations, areexchanging things.Importantly, sometimes this exchange isfair.You get an apple, I get an orange.Other times, it's not fair.I have money, you need money, I canexploit you, exploit your labor.So fairness.Becomes something of interest, and notsomething to be said, to be not to bediscussed.We can understand political power by theperson's resources and their interestsover those resources.

So, those ideas of coercion and powerbecome an important part in understandinghow society works and later on we candecide whether we think that's fair orjust.What does this all mean?How about some implications for health?First, we've talked about healthdisparities before.With Colemans framework we can ask, Whobenefits from health disparities?How could there be anything but healthdisparities given a system?

That is, if we change the system that'sproducing health disparities will somegain and some lose?Who have to give up what to remedy ormitigate health disparities?These questions become quite clear, andaddressable, and approachable, throughthe lens of Coleman's social theory.We talk about norms for binge drinkingand college students, or cigarettesmoking, or not wearing seatbelts, ormotorcycle helmets on a, on a motorcycle.Where do these norms come from, who's

benefiting, and who's interests are thereto maintain, or to repeal, or even turnover?There's some fascinating work done onChinese foot binding in years past.Where did the norm for foot-binding comefrom?Why was it maintained for many centuries?And why was it nearly eliminated in ageneration or two?

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These are the kinds of things thatColeman's theory can help us address.Finally, we talk about changing thehealth producing system.Maybe it's the health care system, suchas the current Affordable Care Act,sometimes called Obamacare.What does it mean we want to have such abig change, how does a social systemreact, whose going to fight for it, whosegoing to rebel against it and what can wepredict about the outcome of this greatmixing of resources, power, interest andcontrol?These are the kind of questions thatColeman theory can help us illuminate.And I think it's a useful approach tounderstanding social epidemiology.It's not, of course, perfect though.First, Coleman's Theory is not complete.He wrote merely about the foundations, somore work needs to be done.Second, Coleman's emphasis on individualpurpose of actions.

This is by and large how things operatebut there's also habit, there's alsowhim, there's also addiction.And so these other kinds of behaviorsplay a big role in health particularly.So the, utility for Coleman's purpose ofaction, doesn't fit perfectly well withunderstanding health.Finally, of course, Coleman's theoryreally says nothing at all about health.It's not a formal theory of socialepidemiology.It's a theory of how society works.

I think that's useful but much more workneeds to be done to understand how it'sthe workings of society translate intobetter or worse health for individualsand populations.It should be fun to work on this into thefuture.