J Epidemiol Community Health: first published as 10.1136/jech.55.10.693 on 1 October 2001. Downloaded from J Epidemiol Community Health 2001;55:693–700 693 Glossary A glossary for social epidemiology N Krieger Why “social epidemiology”? Is not all epidemi- Whether these biological expressions of social ology, after all, “social” epidemiology? In so far inequality are interpreted as expressions of as people are simultaneously social and biologi- innate versus imposed, or individual versus cal organisms, is any biological process ever societal, characteristics in part is shaped by the expressed devoid of social context?—or any very social inequalities patterning population social process ever unmediated by the corporal health.16 The construct of “biological expres- reality of our profoundly generative and mortal sions of social inequality” thus stands in bodies?12 Yet, despite the seeming truism that contrast with biologically deterministic formu- social as well as biological processes inherently lations that cast biological processes and traits shape population health—a truism recognised tautologically invoked to define membership in even in the founding days of epidemiology as a subordinate versus dominant groups (for scientific discipline in the early 19th century— example, skin colour or biological sex) as not all epidemiology is “social epidemiol- explanations for social inequalities in health. ogy”.34 Instead, “social epidemiology” (which first attained its name as such in English in 195035) is distinguished by its insistence on explicitly investigating social determinants of Discrimination population distributions of health, disease, and Discrimination refers to “the process by which a wellbeing, rather than treating such determi- member, or members, of a socially defined nants as mere background to biomedical group is, or are, treated diVerently (especially phenomena. Tackling this task requires atten- unfairly) because of his/her/their membership tion to theories, concepts, and methods of that group”(page 169).9 This unfair treat- conducive to illuminating intimate links be- ment arises from “socially derived beliefs each tween our bodies and the body politic; toward [group] holds about the other” and “patterns this end, the glossary below provides a selection of critical terms for the field. of dominance and oppression, viewed as expressions of a struggle for power and One brief note of explanation. Some entries 10 contain only one term; others include several privilege” (pages 125–6). related terms whose meanings are interde- People and institutions who discriminate http://jech.bmj.com/ pendent or refer to specific aspects of a broader adversely accordingly restrict, by judgement and action, the lives of those against whom they construct. Additionally, each entry is cast in 6 relation to its significance to social epidemiol- discriminate. At issue are practices of domi- ogy; explication of salience to other disciplines nant groups—both institutionally and is beyond the scope of this particular glossary. interpersonally—to maintain privileges they accrue through subordinating the groups they Biological expressions of social inequality oppress (intentionally and also by maintaining Biological expressions of social inequality refers to the status quo) and the ideologies they use to on September 28, 2021 by guest. Protected copyright. how people literally embody and biologically justify these practices, with these ideologies express experiences of economic and social revolving around notions of innate superiority 6 inequality, from in utero to death, thereby pro- and inferiority, diVerence, or deviance. Pre- ducing social inequalities in health across a dominant types of adverse discrimination are wide spectrum of outcomes.126Core to social based on race/ethnicity, gender, sexuality, epidemiology, this construct of “biological disability, age, nationality, and religion, and, expressions of social inequality” has been although not always recognised as such, social class. By contrast, positive discrimination (for Department of Health evident in epidemiological thought—albeit not and Social Behavior, always explicitly named as such—since the dis- example, aYrmative action) seeks to rectify Harvard School of cipline’s emergence in the early 19th century, inequities created by adverse discrimination. Public Health, 677 as exemplified by early pathbreaking research Social epidemiological analyses of health Huntington Avenue, (for example, conducted by Louis René consequences of discrimination require con- Boston, MA 02115, Villermé (1782–1863)) on socioeconomic gra- ceptualising and operationalising diverse ex- USA dients in—and eVects of poverty on— pressions of exposure, susceptibility, and resist- 378 Correspondence to: mortality, morbidity, and height. ance to discrimination, as listed below, Professor Krieger Examples include biological expressions of recognising that individuals and social groups ([email protected]) poverty and of diverse types of discrimination, may be subjected simultaneously to multiple— Accepted to publication for example, based on race/ethnicity, gender, and interacting—types of discrimination: (page 16 March 2001 sexuality, social class, disability, or age. 42)6 www.jech.com J Epidemiol Community Health: first published as 10.1136/jech.55.10.693 on 1 October 2001. Downloaded from 694 Krieger Aspects of discrimination: (2) pathways of embodiment, structured si- Type: defined in reference to constituent domi- multaneously by: (a) societal arrangements of nant and subordinate groups, and justifying power and property and contingent patterns of ideology production, consumption, and reproduction, Form: structural, institutional, interpersonal; and (b) constraints and possibilities of our legal or illegal; direct or indirect; overt or cov- biology, as shaped by our species’ evolutionary ert history, our ecological context, and individual Agency: perpetrated by state or by non-state histories, that is, trajectories of biological and actors (institutional or individuals) social development. Expression: from verbal to violent; mental, (3) cumulative interplay between exposure, physical, or sexual susceptibility, and resistance, expressed in path- Domain: for example, at home; within family; ways of embodiment, with each factor and its at school; getting a job; at work; getting distribution conceptualised at multiple levels housing; getting credit or loans; getting medical (individual, neighbourhood, regional or politi- care; purchasing other goods and services; by cal jurisdiction, national, inter-national or the media; from the police or in the courts; by supra-national) and in multiple domains (for other public agencies or social services; on the example, home, work, school, other public set- street or in a public setting tings), in relation to relevant ecological niches, Level: individual, institutional, residential and manifested in processes at multiple scales neighbourhood, community, political jurisdic- of time and space. tion, national, regional, global (4) accountability and agency, expressed in pathways of and knowledge about embodi- Cumulative exposure to discrimination: ment, in relation to institutions (government, Timing: intrauterine period; infancy; child- business, and public sector), communities, hood; adolescence; adulthood households, and individuals, and also to Intensity: severe to mild accountability and agency of epidemiologists Frequency: chronic; acute; sporadic and other scientists for theories used and Duration: timespan over which discrimina- ignored to explain social inequalities in health; tion is experienced a corollary is that, given likely complementary Responses to discrimination can similarly be causal explanations at diVerent scales and lev- analysed.6 els, epidemiological studies should explicitly name and consider the benefits and limitations Ecosocial theory of disease distribution of their particular scale and level of analysis. Ecosocial12and other emerging multi-level epi- More than simply adding “biology” to demiological frameworks11 12 seek to integrate “social” analyses, or “social factors” to “bio- social and biological reasoning and a dynamic, logical” analyses, the ecosocial framework historical and ecological perspective to develop begins to envision a more systematic integrated new insights into determinants of population approach capable of generating new hypoth- distributions of disease and social inequalities eses, rather than simply reinterpreting factors in health. The central question for ecosocial identified by one approach (for example, theory is: “who and what is responsible for popu- biological) in terms of another (for example, lation patterns of health, disease, and wellbeing, as social).1 manifested in present, past, and changing social http://jech.bmj.com/ inequalities in health?” Adequate epidemiologi- Embodiment cal explanations accordingly must account for A core concept for understanding relationships both persisting and changing distributions of between the state of our bodies and the body disease, including social inequalities in health, politic; see definition in entry on “ecosocial across time and space. To aid conceptualisa- theory” tion, ecosocial theory uses a visual fractal metaphor of an evolving bush of life inter- on September 28, 2021 by guest. Protected copyright. twined with the scaVolding of society that Gender, sexism, and sex diVerent core social groups daily reinforce or Gender refers to a social construct regarding