[EQ] Proximal, Distal, and the Politics of Causation: What's Level Got to Do With It?

 

Proximal, Distal, and the Politics of Causation: What’s Level Got to Do With It?

 

Krieger Nancy
Am J Public Health – February 2008; 98:221-230. DOI: 10.2105/AJPH.2007.111278
American Journal of Public Health  - February 2008, Vol 98, No. 2

URL: http://www.ajph.org/

Abstract:
http://www.ajph.org/cgi/content/abstract/98/2/221?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&author1=krieger&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&sortspec=relevance&resourcetype=HWCIT

 

“….Causal thinking in public health, and especially in the growing literature on social determinants of health, routinely employs the terminology of proximal (or downstream) and distal (or upstream). I argue that the use of these terms is problematic and adversely affects public health research, practice, and causal accountability. At issue are distortions created by conflating measures of space, time, level, and causal strength.

 

To make this case, I draw on an ecosocial perspective to show how public health got caught in the middle of the problematic proximal–distal divide—surprisingly embraced by both biomedical and social determinist frameworks—and propose replacing the terms proximal and distal with explicit language about levels, pathways, and power….”

 

 

For reprints requests:
Nancy Krieger, PhD Professor, Department of Society, Human Development, and Health

Harvard School of Public Health

677 Huntington Avenue, Kresge 717 Boston, MA 02115 (USA)
email: vnkrieger@hsph.harvard.edu

web:     http://www.hsph.harvard.edu/faculty/NancyKrieger.html

 

 

 *      *      *     *

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 infosec@paho.org, and please dispose of and delete this transmission. Thank you.