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Russo psa2014

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Social and biological mechanisms of diseases

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Russo psa2014

  1. 1. Social and biological mechanisms of disease Federica Russo Universiteit van Amsterdam Joint work with Mike Kelly (NICE) and Rachel Kelly (Harvard)
  2. 2. Mechanisms of Disease 2
  3. 3. Overview The background on disease mechanisms Biological causes, the proximal-distal distinction, and current views on social causes Lifeworlds and mixed mechanisms How the social enters disease aetiology, examples of integration When the social was proximal Rehabilitate old, holistic views of health and disease 3
  4. 4. THE BACKGROUND 4
  5. 5. Biological causes of diseases The conceptualisation of disease The outcome of exposure to a pathogen or other noxious factor Pathogens Cause disease Initiate mechanisms that lead to disease A heir of the germ theory of disease and of the isolation of bacterial ‘Biologisation’ of disease Complications Multiple pathogens at work etc 5
  6. 6. The proximal – distal distinction Biological causes are proximal, social causes are distal Distal causes do not exert direct influence on health Hence, social causes are at best classificatory devices, but not active causes in disease aetiology 6
  7. 7. Social causes of disease A number of accounts try to bring in social causes Engel; Susser & Susser; Thisted, Cockerman; Rose; Marmot & Wilkinson; Galea; … They either use the social to classify diseases, or the social is not integrated in disease mechanisms Krieger’s web of causation comes quite close, but does not sufficiently emphasises the explanatory import of social factors 7
  8. 8. Against the proximal – distal distinction. For an integrated aetiology of disease. Integration means explaining disease with mixed mechanisms. 8
  9. 9. LIFEWORLDS AND MIXED MECHANISMS 9
  10. 10. The social world. And health. Sociology attempts to explain and predict human behaviour Societies manifest observable patterns of change Humans are thinking and acting beings Their thought and action take place within the constraints imposed by social structures How is behaviour linked to health? 10
  11. 11. Initiates and mediates exposure to toxins, hazards, pathogens, etc Drives health states of individuals and populations Is the product of the interaction between human agency and social structure 11
  12. 12. An integrated pathogenic approach The ‘social’ and the ‘biological’ are integrated in the aetiology of disease Behavioural factors are active parts of disease mechanisms Disease mechanisms are mixed Social and biological factors are on a par Social factors are not mere classificatory devices The social and the biological together explain disease 12
  13. 13. EPIGENETICS An example 13
  14. 14. The epigenome reflects acquired and inherited genetic modifications Recent studies show how socio-environmental pressures are linked to epigenetic changes in the short term One generation distance Pregnancy 14 Epigenetic changes due to social and environmental pressures Disease Environm ent Behaviou ral factors Epigenetic changes
  15. 15. DISEASES CAUSED BY ALCOHOL CONSUMPTION An example 15
  16. 16. Alcohol consumption is part of the lifeworld of individual and of groups It varies across friends, family, social groups, populations, age groups, etc Just reducing exposure to the ‘pathogen’ does not reduce the burden of disease Broader interventions on lifeworlds are needed 16 Alcohol-related diseases are not just caused by alcohol consumption Disease Environm ent Behaviou ral factors Biological factors
  17. 17. WHEN THE SOCIAL WAS PROXIMAL Moving forward is moving back to the origins 17
  18. 18. The original public health vision Public health interventions targeted social factors John Snow Rudolf Carl Virchow William Duncan William Tennant Gairdner … Social inequalities, health inequalities In the past. And today. 18
  19. 19. TO SUM UP 19
  20. 20. Health and disease are complex phenomena Biological and social aspects studied in detailed However … Biological and social components of disease Different roles Proximal – distal Classificatory – explanatory An integrated aetiology of disease Puts biological and social factors on a par Points to a concept of ‘mixed mechanism’ where both are ‘active’ causes to explain disease A further step for philosophy of science Shed light on the (informational?) nature of the mixed aetiology of disease 20

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