Exploring Health Inequity Through Social Epidemiology: How Social Factors Shape Public Health
Situated at the intersection of science, healthcare, law, and society, public health is an inherently complex field that examines the nuances of human behavior. Add unpredictable pathogens and environmental changes to the mix, and it’s evident why this discipline calls for highly trained professionals and a dynamic approach. However, many branches and specialties account for these nuances — and social epidemiology is among the most impactful.
Offering much-needed insight into the many ways in which social factors shape public health outcomes, social epidemiology moves beyond the bounds of biology and behavior to examine the outsized role of inequity. This epidemiological practice has not always received the attention it deserved — but as the public health field places a greater emphasis on health disparities, that may change.
To reveal the powerful potential of social epidemiology, below we discuss: What is social epidemiology, and why is it important? We also highlight several top methods in social epidemiology, along with meaningful examples of social epidemiology that highlight what this study has already accomplished.
What Is Social Epidemiology?
It is easier to understand social epidemiology after first grasping the bigger picture of epidemiology. As a crucial discipline within the broader field of public health, epidemiology describes the spread of disease and its impact on various populations. Meanwhile, social epidemiology reveals how social structures and environmental factors shape health behaviors and outcomes while also prompting significant health inequities.
An overview published in the Annual Review of Public Health explains that this practice places an "explicit emphasis on the social production of disease," adding that the ensuing "explanatory paradigm" is "critically important for interventions to improve population health."
Core Principles of Social Epidemiology
As an interdisciplinary practice, social epidemiology draws on a wealth of research and frameworks to explain how health inequities might arise — and how they impact both at-risk individuals and larger populations. In particular, this branch of epidemiology stresses the following concepts:
- Social determinants of health (SDOH) – As strictly non-medical concerns, the social determinants of health involve a variety of conditions describing how people live, work, and interact with one another. This encompasses everything from income and employment to housing, education, social support, and, of course, access to healthcare services.
- Multilevel analysis of health outcomes – Epidemiologists understand that SDOH-related factors can operate at many different levels. This concept acknowledges that all levels are relevant and warrant consideration when investigating diseases or designing public health initiatives. This multilevel approach involves a hierarchical structure, in which epidemiological factors are assessed on an individual basis (including concerns such as age or genetic predisposition) and then at the group level (referencing local environmental exposures or cultural practices). Additional levels may involve overarching healthcare policies or other practices that can impact large populations.
The Importance of Social Epidemiology
Revealing how social structures influence both the distribution of disease and health outcomes, social epidemiology holds major implications for everything from research to policy development. Without this nuanced understanding — and without an underlying intention to address health disparities — interventions or policies could easily fall prey to issues such as poor resource allocation or inaccurate data interpretation.
Understanding Health Disparities
Social epidemiology acknowledges that health is not determined exclusively by biological factors (such as exposure to viruses or bacteria) but rather depends, to a significant extent, on the social forces that shape communities. This is why the same virus or the chemical agent can have such a profoundly different impact within different locations or populations. Health disparities can quickly emerge, showing differences in access to healthcare and, ultimately, playing out in an unequal burden of disease.
Based on these insights, public health professionals can develop interventions that are tailored to specific communities. Social epidemiology can increase the likelihood that these interventions sufficiently address a range of underlying health concerns and, as a result, live up to their full potential.
Influence on Public Health Policies
In addition to shaping public health professionals' understanding of the numerous factors that impact the spread and severity of disease, social epidemiology provides powerful insights for policymakers, who may otherwise make offhand assumptions about which rules or regulations are likely to prove most effective. Specific policies can address many of the social determinants of health, thereby making populations more resilient in the event of an outbreak. This can also influence emergency response and resource allocation.
Addressing Social Inequalities
Offering a reliable framework through which researchers and public health professionals can understand the factors underlying health disparities, social epidemiology gives us the tools and insights needed to actually address social inequity. This begins with fully understanding the impact of SDOH on health outcomes but must also involve ongoing advocacy for structural changes that can address the systematic issues prompting health disparities.
Global Health Implications
Social epidemiology offers a wealth of insight into local and regional health concerns, but it also holds considerable implications for improving health outcomes on a global scale. While specific communities may be more vulnerable to certain diseases, a spillover effect is still possible, in which other communities are made more vulnerable through direct transmission and due to overarching strains on healthcare systems.
The impact of globalization cannot be overstated, allowing pathogens to spread rapidly while also exacerbating inequality due to disparities in health policies. Social epidemiology strives for a greater understanding of these global factors and how they can influence specific populations.
5 Examples of Social Epidemiology in Action
The nuances of social epidemiology are not necessarily straightforward from a theoretical standpoint, but many familiar health concerns and intervention bring key concepts to life. To that end, we have highlighted a few of the most recognizable examples of social epidemiology in action:
1. Socioeconomic Status and Cardiovascular Disease
Extensive research reveals a strong link between socioeconomic status (an individual's access to both resources and prestige) and cardiovascular disease, as well as the core risk factors for developing cardiovascular disease. Social epidemiology provides a valuable framework for understanding why socioeconomic status (SES) has such a significant impact on cardiovascular outcomes — and what can be done to alleviate these disparities.
These insights have helped to shape Project RED (Re-Engineered Discharge), in which discharge best practices aim to reduce hospital readmission rates. Project RED resources identify several risk factors that can compromise follow-up care (thereby increasing the potential for readmission), including transportation challenges and unstable housing.
Promising studies uncover that, upon implementing research-backed practices promoted through Project RED, readmission rates and even mortality rates decrease substantially for patients who were initially admitted due to cardiovascular concerns.
2. Racial and Ethnic Health Disparities
Aside from highlighting the role of SES in health outcomes, social epidemiology shines a light on racial disparities:
- Maternal and infant mortality rates are higher among African Americans.
- Additionally, cardiovascular disease especially tends to disproportionately affect African Americans, who are more likely to deal with hypertension.
- Certain subgroups of Asian Americans are more prone to hypertension or specific types of cancer.
- The Hispanic population is disproportionately impacted by type 2 diabetes and HIV/AIDS.
Many promising programs and interventions aim to address these disparities; namely, the Michigan Alliance for Innovation on Maternal Health (MI AIM) reveals the potential for improving outcomes through advocacy. Recognizing the impact of chronic concerns on maternal and infant outcomes, MI AIM strives to implement safety protocols (known as bundles) meant to address the often race-oriented drivers of maternal morbidity.
As a report from the Alliance for Early Success points out, "Putting policies in place that specifically address the disparate outcomes driven by the legacy of structural racism is real progress."
3. Social Networks and Mental Health
Emerging research demonstrates not only that loneliness is alarmingly prominent these days but also that this has a significant impact on both physical and mental health. Social epidemiology drives a greater understanding of support systems and how they influence mental health. This practice can also reveal which populations are most susceptible to fragmented social systems and associated mental health concerns.
Seniors, in particular, have been highlighted as being more vulnerable to social isolation. Public health programs aim to address this by offering a variety of services that seniors can use to feel more connected and supported. For example, the Institute on Aging's Friendship Line acts as a "warm-line," both offering help in the midst of crises as well as providing general emotional support and even making outgoing calls.
San Mateo County in California has taken this a step further, with the Board of Supervisors declaring loneliness a public health crisis. Although this resolution will not directly increase funds for programs targeting loneliness, it does signal the intention to uncover opportunities and implement initiatives capable of promoting social connection.
4. Neighborhood Environment and Obesity
An expanding body of research links obesity to many chronic health concerns as well as reveals that obese individuals may suffer worse outcomes in response to acute issues such as COVID-19. Social epidemiology emphasizes the role of SES in shaping obesity rates, along with environmental factors that can either prevent obesity or exacerbate it.
Walkable neighborhoods are especially impactful, as these allow residents to be physically active throughout the day. Access to high-quality produce is also essential, but unfortunately, many communities qualify as food deserts — in which full-service grocery stores are out of reach and residents may be more inclined to eat processed products from convenience stores or fast-food restaurants.
Complete Streets aims to address one of the core facets underscoring obesity by helping all types of populations lead physically active lifestyles. These transportation and design policies aim to meet the unique needs of pedestrians and cyclists by resolving safety concerns that might limit individuals' willingness to explore their communities on foot or by bike.
5. Education and Health Literacy
As with healthcare access and health outcomes, health literacy varies widely across populations and may be limited in low socioeconomic households or communities. Unfortunately, this lack of insight can prevent individuals from making informed decisions about their own health and well-being. Social epidemiology reveals how educational campaigns can improve the public's understanding of key health concerns.
For example, educational efforts have proven highly effective in reducing the rates of sexually transmitted diseases (STDs) and convincing people to avoid cigarettes and other products that contain nicotine. The U.S. Department of Health and Human Services has referenced the necessity for expanded health literacy with the Healthy People 2030 initiative, which highlights the need to "eliminate health disparities, achieve health equity, and attain health literacy to improve the health and well-being of all."
Addressing Health Disparities Through Social Epidemiology
In addition to helping researchers, policymakers, and community members understand the social nuances of public health, social epidemiology equips passionate professionals with the actionable insights needed to take action to address health disparities. Opportunities for making a difference include:
Intervention Strategies
Social epidemiology reveals how the SDOH play out in a range of communities as well as opportunities to boost health outcomes by addressing specific manifestations of health inequity. Policy interventions, in particular, provide much-needed services to at-risk populations, while community-based interventions ensure that culturally appropriate services are available. Environmental interventions can also have a significant impact, drawing on epidemiological research to improve urban planning and healthcare access.
Collaborative Approaches
As a multidisciplinary and highly collaborative practice, social epidemiology calls for coordination with other fields such as education, urban planning, health services, and even the media to develop and enhance interventions. Collaboration ensures that public health strategies are informed by a broad array of perspectives and therefore tailored to fully address the many social determinants of health.
Evaluation and Monitoring
Public health programs informed by social epidemiology can be difficult to measure and track. Through careful evaluation and monitoring, however, metrics such as disease incidence, utilization rates, or health-related quality of life (HRQOL) can reveal whether programs live up to their full potential — or where adjustments may be needed. Evaluation can also help public health programs adapt to address emerging health concerns.
The Role of Education in Social Epidemiology
Education both shapes social epidemiology and allows core epidemiological concepts to have a positive impact on vulnerable communities. We have already discussed the value of health literacy, and this is one of many ways in which education can boost health outcomes.
Education as a Social Determinant of Health
As one of the most impactful social determinants of health, education can help many individuals overcome (or at least fully address) concerns such as limited income or environmental issues. Meanwhile, a lack of educational resources can create new barriers. For example, those with limited English language proficiency may struggle to make full use of available health services. This could prove downright deadly in the midst of natural disasters or public health emergencies.
To that end, social epidemiology provides a deep dive into not only health literacy but also the bigger picture of education and its far-reaching impact on communities. Specific implications include:
Influence on Health Behaviors
Research reveals that higher levels of education are more likely to lead to healthy lifestyle choices, even after income is taken into account. Literacy, for example, makes it easier to understand public health recommendations and nutritional information while also increasing individuals' ability to evaluate the risks associated with various behaviors like smoking or consuming alcohol.
Economic Opportunities
It's no secret that educational attainment is closely linked to lifetime income and wealth — but this, in turn, has a major impact on health outcomes. As discussed above, those with higher socioeconomic status are better able to access critical health services and may also find it easier to adopt healthy behaviors such as exercising at the gym or purchasing organic produce. The long-term impact of financial stress is not to be discounted, as this has a documented effect on blood pressure and mental health.
Psychosocial Benefits
Encouraging a greater sense of autonomy, education can carry substantial intrinsic benefits that impact other areas of life. Educational services and environments also foster valuable social connections, which can limit the potential for loneliness and the myriad of health concerns linked to social isolation.
Education and Health Disparities
Education (or lack thereof) can contribute greatly to existing health disparities across many populations. Social epidemiology strives to understand the complex interplay between education and health outcomes. Concerns worth noting include:
Inequities in Access to Education
From poverty to discrimination, many issues prevent students from making full use of available educational services. These issues may also manifest in lower-quality educational offerings, as seen in the significant disparities regarding teacher training and experience between low and high SES communities. Inequities may also shape access to education beyond the K-12 spectrum, making it more challenging to attend college or to take advantage of continuing education opportunities.
Impact on Vulnerable Populations
Revealing the central role of intersectionality in public health and social epidemiology, vulnerable populations (including many racial minorities) may face discrimination in educational settings. These issues may set the stage for higher dropout rates, thereby harming long-term financial opportunities as well as limiting chances to acquire greater health literacy.
Education as a Target for Public Health Interventions
Given the outsized impact of education on health outcomes, it is increasingly clear that improving access and quality of education will play a key role in helping vulnerable populations overcome systemic barriers. Opportunities include:
Promoting Health Equity
Research-backed insights on the role of education in public health can influence policy initiatives, ensuring that policymakers fully understand the role that the SDOH can play in shaping rules and regulations — and vice versa. Many programs can address the root causes of education-related health disparities. Early education, in particular, is incredibly impactful, forming the foundation for success throughout students' educational journeys.
Health Education Programs
Along with advocating for greater equity throughout the broad spectrum of public education, public health professionals also strive to expand the reach of health education programs, which can help disseminate important health information regardless of overarching educational barriers. Campaigns such as The Heart Truth, for example, raise awareness of cardiovascular concerns, working across numerous communities to encourage all types of people to lead heart-healthy lifestyles.
The Role of Education in Training Public Health Professionals
A graduate education is increasingly viewed as indispensable when seeking a career in public health. This provides ample opportunities to explore complex concepts while analyzing and integrating a growing wealth of research on the SDOH.
Developing Expertise in Social Epidemiology
By pursuing an online master’s degree in public health, students can delve into the practice of social epidemiology. Targeted coursework reveals how social concerns contribute to overarching public health issues while also using case studies and other immersive learning opportunities to bring these concepts to life. These insights increase the likelihood that aspiring public health professionals will integrate social epidemiological concerns into their work.
Research and Practice
While numerous studies provide valuable insight into the role of social factors in shaping health outcomes, additional research is needed. Through graduate-level opportunities, future public health leaders can develop high-level research skills and make good on their intention to contribute to the growing body of epidemiological research.