Papers of the Week: 25/2012

Clearly much water (23 weeks worth, apparently) has passed under the bridge since I last posted on new papers crossing my rss/email desk.  So here are the latest batch:

1. I am more than a little fascinated by the interplay of race, SES, gender and any other stratifier you can mention in determining infection risks.  And in the field of STIs, I appear not to be the only one.  One angle on this is to look at multiple low-power identities and see how they interact.  For example, here‘s a paper that focuses on the intersection of race/ethnicity and sexual orientation.  Risks definitely rise with multiple minority statuses, but the pattern is non-simple and varies by sex.  It’s never as simple as you’d think.
2. More on concurrent partnerships in Africa.  A recent study found no association between (self-reported) concurrent partnerships and HIV incidence in rural South Africa and while it is generally accepted that concurrency can theoretically drive an HIV epidemic, empirical evidence remains scant that it does so.  One reason for this may be that while concurrency is risky, its prevalence is low.  This idea is supported by a paper out of Malawi from last year which finds that concurrency is long-lasting when it occurs, but that it occurs infrequently (only in 9% of the sample).  Lots more evidence is needed on this, but these are the right questions to be asking.
3. This one is only “new to me”. Dynamic models of sexual relationships (and other contact networks, I think that sexual networks are simpler than most) need to be a big new field in ID Epi.  If that’s going to happen we (public health people) are going to need to read lots of network analysis stuff (aside: here‘s an intro from Nick Christakis and collaborator Kirsten P Smith (meta-aside: Smith’s disseration from Penn looks really interesting – international comparisons of STI rates, but I can’t see it published yet).  If you want more theoretical details, James Moody – one of the key people behind the Add Health network work mentioned in the above article – wrote a paper in Social Forces a decade ago, which outlines things nicely.  Beach reading, if I ever made it to the beach.  And enjoyed reading once there.

Next time I’ll try and make these papers a little more up-to-date, but this’ll have to do for now.

Why does this blog exist? (in a shallow sense)

One of the main impetuses (aside: why can’t it be impeti?) for my efforts to set up this blog, was that when I googled “social epidemiology” or “social epidemiology blog“, I was severely underwhelmed by what I found. And don’t even get me started on the wikipedia page.  Even looking for “‘social determinants of health’ blog” brings up individual entries, not blogs devoted to the subject.

This was a shame, if not entirely a surprise.  A couple of years back, a group of students in the Department of Society, Human Development and Health at HSPH thought it would be a great idea to set up a group blog (à la scatterplot, among others).  This effort – under the moniker societyandhealth – was sadly rather shortlived.  I think this was partly due to it being started shortly before summer break and partly due to each of us having a slightly different idea what the site might do.

In large part, I think that the lack of material or coherence on the web reflects the breadth of the field and perhaps uncertainty regarding its epistemology.  I have heard it argued that public health in general, and social epidemiology must be a normative science and an activist discipline: if we find things that are causing ill-health, a failure to act on these through communication and policy change is little short of criminal.  Such arguments resonate with the efforts of Mayor Bloomberg.

On the other hand, there is still only a limited amount of actual evidence for health being associated with social conditions – certainly compared to more traditional risk factors such as behaviours and environmental exposures.  Thus there is a more positive science angle that says we need to run more, and better, studies to figure out which exposures cause which outcomes and through which mediating pathways.

It is also notable that social epidemiology aims to shift the discussion regarding causation in public health by changing what is a valid cause of health. (On which topic, if you haven’t heard of this book, you should get thee to a bookshop asap).  It is therefore an aggressive force for epistemological change.  And this is something I love about the field.  It does, however, often make it hard to nail down what is covered within its remit, since that keeps changing too.

All of which makes for a very interesting field, but not an easy one to follow online. Which could probably also be said of this blog post.  My point, however, is that in the absence of a blog devoted to social epidemiology and the social determinants of health, I thought that I might as well cast off from the shore and see where the currents take me.  I think we’re still within sight of the point of embarkation, but hopefully soon there’ll be new lands to discover, and maybe even pirates to fight.   But enough with the extended meataphor.  For now.

P.S.  If I’ve abused the term epistemology, my apologies.  In philosophy as is so much else, a little vocabulary is a very dangerous thing.