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Vol. 20. Num. 1. 2011. Pages 109-118

Contextual Influences on the Individual Life Course: Building a Research Framework for Social Epidemiology

[Influencias Contextuales en el Ciclo Vital Individual: Construyendo un Marco de Investigación para la Epidemiología Social ]

Merlo, Juan

Abstract

Individual health is not only individual responsibility, but also depends on the social contexts that condition the individual across the life course. However, while it is of high public health relevance to identify these contextual influences, they still remain poorly understood, and the research performed so far has suffered from severe limitations. This paper presents a research agenda for social epidemiology that underlines a number of novel concepts, ideas, and unanswered questions deserving future investigation. The paper presents a conceptual framework intended to organize the investigation of geographical, socioeconomic, and cultural disparities in health. This framework identifies five main areas of research: (1) identifying the relevant contexts that influence individual health by measuring general contextual effects, (2) measuring contextual characteristics, the specific effects of these characteristics on individual health and their underlying cross-level mechanisms, (3) investigating general and specific contextual effects from a longitudinal, a life-course perspective and across generations, (4) developing quasi-experimental methods (e.g., family-based designs) for the analysis of causal effects in contextual analyses, and (5) using the achieved scientific knowledge for planning and evaluating interventions. The proposed framework emphasizes that future research in social epidemiology should question the current means-centric reductionism that is mostly concerned with the identification of (contextual) risk factors, and it stresses the need to deliberately investigate determinants of variance. In fact, social epidemiology is not only interested in increasing the (mean) health of the population, but also in understanding and decreasing inappropriate health inequalities (variance).

Resumen

La salud individual no depende sólo de la responsabilidad individual, sino también depende de los contextos sociales que condicionan al individuo a lo largo de su ciclo vital. Sin embargo, aunque la identificación de esas influencias contextuales es de una gran relevancia para la salud pública, su comprensión es todavía pobre y la investigación realizada hasta ahora presenta importantes limitaciones. Este trabajo presenta una agenda de investigación para la epidemiología social donde se subrayan un conjunto de nuevos conceptos, ideas y cuestiones pendientes para la investigación futura. El marco conceptual que se presenta trata de organizar la investigación de las desigualdades geográficas, socioeconómicas y culturales en salud. Este marco identifica cinco áreas principales de investigación: (1) identificar los contextos relevantes que influyen en la salud individual a través de la medida de los efectos contextuales generales, (2) medida de las características contextuales, los efectos específicos de esas características en la salud individual y los mecanismos inter-nivel subyacentes, (3) investigar los efectos contextuales generales y específicos longitudinalmente desde una perspectiva del ciclo vital y entre generaciones, (4) desarrollar métodos cuasi-experimentales (por ejemplo, diseños basados en familias) para investigar los efectos contextuales en análisis contextuales, y (5) utilizar el conocimiento científico obtenido para planificar y evaluar intervenciones. El marco conceptual propuesto enfatiza que la investigación futura en epidemiología social debería cuestionar el reduccionismo que suponen los acercamientos centrados en las medias, preocupados fundamentalmente en la identificación de factores (contextuales) de riesgo, y subraya la necesidad de investigar deliberadamente los determinantes de la varianza. La epidemiología social, de hecho, no sólo está interesada en incrementar la salud (la media), sino también en comprender y reducir las desigualdades en salud (la varianza).

Keywords

contextual effects
health inequalities
life course
multilevel analyses
public health
social epidemiology

Palabras clave

análisis de multinivel
ciclo vital
desigualdades en salud
efectos contextuales
epidemiología social
salud pública
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