This document defines key concepts in social epidemiology. It discusses how social epidemiology studies the social determinants of health and uses epidemiological methods and social science to promote public health. It defines terms like chronic illness, infectious disease, risk factors, rates of disease prevalence and incidence, and approaches to addressing health disparities. The epidemiological triangle is also introduced as a model for studying disease with factors of the host, agent, and environment.

1. Social Epidemiology:
Social and Behavioral
Concepts
Nicole Kunkel

2. Purpose
➔ Effectively communicate terminology used
in social epidemiology in a manner by
which the general population can
understand.
➔ Improve knowledge and awareness of the
general population regarding social
epidemiology concepts.

3. Social Epidemiology
➔ “Comprehensive study of health, well-being, social conditions or problems,
and diseases and their determinants”
➔ Use of epidemiology and behavioral/social science to improve and promote
health
◆ Epidemiology: branch of medicine dealing with incidence, distribution,
and possible control of disease and related health factors
➔ Used to develop interventions, programs, policies, and institutions that
promote public health
➔ Studies: social distribution and social determinants of different states of
health
➔ Understanding: social variables and conditions can determine which
factors affect illness and health
◆ Emphasis: social factors

4. Chronic Illness
➔ A persistent or long-lasting disease that progresses slowly and is usually
controlled, but cannot be cured
➔ Alternation between symptomatic periods and periods of remission or
stability
◆ Remission: periods of relative health with little to no symptoms in
between symptomatic periods or episodes
◆ Some chronic illnesses have acute episodes with abrupt symptom
changes in between remission periods
● Acute episode/occurrence: abrupt onset of intense symptoms,
usually within a short duration
➔ Usually applied when the course of the disease lasts longer than 3 months
➔ Ex: Cancer, Ulcerative Colitis, HIV/AIDS, Epilepsy, Sickle Cell Anemia

5. Infectious Disease
➔ Caused by pathogenic microorganisms (bacteria, viruses, parasites, fungi)
➔ Can be spread and transmitted directly or indirectly
◆ Person to person
◆ Animal/Insect to person
◆ Ingestion of contaminated food or water
➔ Vaccines effectively prevent the spread of some infectious diseases
◆ Ex: Measles, chickenpox, smallpox, whooping cough
➔ Frequent and thorough handwashing prevents spread and transmission
➔ Recent rise of infectious diseases, especially in poverty-stricken countries
with environments conducive to spread and transmission

6. Risk & Protective Factors
Risk Factor
➔ Variable associated with an
increased probability of disease,
infection, or health behavior
problem
◆ Increased likelihood of
negative/undesirable outcome
➔ Host or environmental relation
➔ Immutable factors: age, race,
gender, ethnic background
➔ Adjustable factors: Change with
intervention
◆ Ex: attitudes, behaviors
Protective Factor
➔ Variable associated with a reduced
probability of disease, infection, or
health behavior problem
◆ Increased likelihood of
positive/desirable outcome
➔ Ex: family history, healthy
home/family environment, social
support, routine doctor visits, access
to resources
★ Both have cumulative effect on
development/reduced
development of health problems

7. Morbidity Rate
➔ Indicates rates of a disease,
behavior, or health problem
Morbidity Rate:
Total # of cases of disease/behavior
Estimated total population at the midpoint of time period
Mortality Rate:
Total # of deaths from disease/behavior
Estimated total population at the midpoint of time period
X 100,000
Morbidity & Mortality Rates
Mortality Rate
➔ Indicates rates of death from a specific
disease, behavior, or health problem
➔ Statistics collected by each country routinely:
basic information on health status
◆ Collected via death certificates and
coded by underlying cause of death
➔ Higher in young children, then decrease
➔ Increase again with age
◆ After age 40, increases by twofold for
every decade
➔ Young children (<4) and older adults (>65) at
highest risk during epidemics and outbreaks

8. Prevalence & Incidence Rates
Incidence Rate
➔ New cases: the current rate at which
a disease/health problem is being
reported
◆ Used to calculate morbidity
Prevalence Rate
➔ Existing case rates of a disease or
health problem in a population; the
spread or distribution of the problem
in a population
Incidence Rate:
# of people who contract the disease/condition in specified time period
# of people exposed to risk during this period
Prevalence Rate:
# of people with the disease or condition at that time
# of people in the population at risk at that time

9. Prevalence Rate
➔ Increased rate:
◆ long duration or short remission periods
◆ when incidence increases
◆ increased likelihood of contraction from
high-risk individuals via poor general
health
➔ Decreased rate:
◆ improved rate of cure
◆ short duration of illnesses
◆ fatality rates increase
◆ decline of infection rate
◆ immigration of healthy
population/emigration of ill population
Incidence Rate
➔ Estimate of the probability of an
individual, belonging to an exposed
population, developing a disease
during a specific time period
➔ Calculation of new cases that occur
within a specific time frame
➔ Incidence rate is used to calculate
prevalence rate
◆ P= I x D
● P: Prevalence rate
● I: Incidence rate
● D: Average duration of
disease
Prevalence & Incidence Rates

10. Case Fatality Rate
➔ Expresses severity of symptoms and the likelihood that the
disease/behavior/health problem will result in death
➔ Percentage of people diagnosed with the disease, who die within a
specified time period after onset, in which the disease is diagnosed as
underlying cause of death
➔ Case fatality rate vs. mortality rate:
◆ Mortality rate: denominator is total population
◆ Case fatality rate: denominator is number of people who have the
disease of interest
Case Fatality Rate:
# of deaths from the disease/behavior within a specific time period after onset
Total # of cases identified during the same time period

11. Survival Rate
➔ Number of patients over a specific time period who are still alive at the end
of said time period
➔ Usually reported after longer periods of time
◆ More appropriate for chronic illnesses with long incubation periods
➔ Usually calculated as one or five year cumulative survival rate:
Cumulative survival rate:
# of patients surviving
total # of cases at the beginning of the period

12. Self-Efficacy
➔ Key element in how people change
behavior that goes beyond the
mechanistic conditioning process of
change
◆ Gives individuals a role in their own
change
➔ A person’s belief in his or her ability to
take action and confidence to overcome
obstacles

13. Reciprocal Determinism
➔ Behavior is part of a continuous interactive cycle that includes individuals
and their social environment
➔ Interactive process: a person acts based on individual factors or
social/environmental cues, receives a response from the environment,
adjusts behavior accordingly, and acts again.

14. Health Disparities
➔ The differences in health status between the majority population and population subgroups
◆ Ex: race, ethnicity, socioeconomic status
➔ Exist in terms of:
◆ Quality health care
◆ Access to health care
◆ Levels and types of care
◆ Clinical conditions (cancer, mental health, etc.)
➔ Identified in several health outcomes:
◆ Life expectancy
◆ Overall life status
◆ Infant mortality
◆ Cancer
◆ HIV/AIDS
◆ Violence
◆ Diabetes

15. Health Disparities: Causes
➔ Causes of health disparities:
◆ Socioeconomic status
◆ Lack of access to resources
◆ High poverty levels
◆ Immigration
◆ Cultural beliefs/attitudes
◆ Lack of health care coverage
◆ Mistrust towards
government/physicians
◆ Discrimination
◆ Environmental risks
◆ Social exclusion
◆ Lack of cultural competence
◆ Housing segregation
◆ Neighborhood
characteristics and physical
environment

16. ➔ Individual approach
◆ address individual knowledge and awareness among a specific population
◆ Use theories to structure education and intervention
➔ Social, community, and group approaches
◆ Community mobilization or advocacy
● Ex: improve access to healthcare, remove environmental risk affecting
a minority community
◆ Health communications strategies, social network, and cultural approaches
● Used to address shared norms, beliefs, and attitudes of a population
◆ Community mobilization with ecological approaches
● Used as part of a coordinated community strategy in order to reduce
socioeconomic disparities
Addressing Health Disparities

17. Addressing Health Disparities
➔ Organizational theory
◆ Improve organizations or systems, resulting in improved access and care
for disparities populations
◆ Local, state, or national level
➔ Multilevel approaches
➔ Lack of coordination hinders improvement in health disparities:
communication is key

18. Epidemiological Triangle
➔ Basic model developed in order to study
health problems
➔ 3 factors: Host, Agent, and Environment
➔ Disease is produced by exposure of a
susceptible host to a noxious agent in the
presence of environmental factors that aid or
hinder agents of disease

19. Epidemiological Triangle
➔ Host: the person/animal harboring the infectious agent, acted upon by
noxious noninfectious agent, or has experienced event/behavior of interest
◆ the “who” of the triangle
➔ Agent: infectious microorganism, chemical, or vulnerable substance
◆ the “what” of the triangle
◆ Ex: lead, radiation, excess/deficiency of nutritional elements such as
calories, carbs, or iron
➔ Environmental Factors: external conditions that promote or hinder the
action of an agent on a susceptible host
◆ the “where” of the disease
◆ Ex: drought, high temperatures, rain

20. Impact Application
➔ Slideshare: upload of presentation to public presentation database
➔ Studyblue: upload of presentation to public study material site