Population Health: Challenges for Science and Society
David Mechanic, Institute for Health, Health Care Policy and Aging Research,
The Milbank Quarterly - Volume 85 Issue 3 - Page 533-559, September 2007
PDF file [27p.] at: http://www.blackwell-synergy.com/doi/pdf/10.1111/j.1468-0009.2007.00498.x
“…….The emphasis on risk factor intervention at the individual level has predominated in efforts to reduce mortality and promote health. Interest in social and other nonmedical interventions, particularly socioeconomic status (SES) influences, has increased in recent years.
This article focuses on the interaction of social structure and socioeconomic status with other influences in complex pathways to affect health, and their contribution to health disparities. It examines both social class as an explanation of health differences and competing hypotheses concerning prenatal and early nutrition and cognitive capacity.
Although education is associated with income, wealth, occupation, and other SES indicators and may not be the most important SES determinant, it influences a variety of pathways to health outcomes and offers strategic leverage for intervention because of social and political consensus on its value beyond health….”
Annual Matilda White Riley NIH Lecture in the Behavioral and Social Sciences
2006 National Institutes of Health
Available as .Doc file: http://obssr.od.nih.gov/NR/rdonlyres/0ACBBE62-4B36-4004-8399-9DC56F274FC7/0/Mechanic2006.doc
“….I begin by discussing the importance of social selection, and then illustrate how varying influences from early nutrition to broad social factors affect population health and social disparities. I conclude with some thoughts on intervention strategies.
Studies of population health depend substantially on epidemiological inquiries of different cohorts under varying social and environmental circumstances and careful theory and hypotheses are essential.
In this era of computer power and data mining, there is much descriptive epidemiology that is atheoretical, and often lacks even biological and psychosocial plausibility. Such work has rightfully earned a compromised reputation. Alvan Feinstein has noted that such efforts are unable to distinguish truth from false alarms and contribute to an epidemic of apprehension. Underlying many false results is failure to deal realistically with the influence of social selection.
In population health research, where randomized controlled trials are usually impossible, impractical or unethical, we depend on longitudinal studies using multivariate statistical designs, instrumental variables as commonly used in economics, or on natural experiments when such opportunities become available. Taking account of selection biases is imperative but it is important as well to understand how selection processes shape health outcomes…..”
* * * *
This message from the Pan American Health Organization, PAHO/WHO, is part of an effort to disseminate
information Related to: Equity; Health inequality; Socioeconomic inequality in health; Socioeconomic
health differentials; Gender; Violence; Poverty; Health Economics; Health Legislation; Ethnicity; Ethics;
Information Technology - Virtual libraries; Research & Science issues. [DD/ IKM Area]
"Materials provided in this electronic list are provided "as is". Unless expressly stated otherwise, the findings
and interpretations included in the Materials are those of the authors and not necessarily of The Pan American
Health Organization PAHO/WHO or its country members".
PAHO/WHO Website: http://www.paho.org/
EQUITY List - Archives - Join/remove: http://listserv.paho.org/Archives/equidad.html
IMPORTANT: This transmission is for use by the intended recipient and it may contain privileged, proprietary or confidential information. If you are not the intended recipient or a person responsible for delivering this transmission to the intended recipient, you may not disclose, copy or distribute this transmission or take any action in reliance on it. If you received this transmission in error, please notify us immediately by email to firstname.lastname@example.org, and please dispose of and delete this transmission. Thank you.