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The Web of Causation

The Web of Causation. Well ,” said Mrs. Zukerman, “it seems to me you’re a little off. It seems to me we have no ordinary spider.”. The Web = Multiple Causation. Population patterns of health and disease can be explained through a complex web of numerous interconnected risk factors

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The Web of Causation

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  1. The Web of Causation Well,” said Mrs. Zukerman, “it seems to me you’re a little off. It seems to me we have no ordinary spider.”

  2. The Web = Multiple Causation • Population patterns of health and disease can be explained through a complex web of numerous interconnected risk factors • How do we identify and predict which strands to break or add to the causal web? • How do we without understanding the origins of these interconnected strands? What is the connection between time, place, person? Krieger, N. (1994). Epidemiology and the web of causation: Has anyone seen the spider? Social Science Medicine, 39(7), 887-903

  3. Lung Cancer Web of Causation • - Krieger states this not a theory but merely a depiction of interrelationships b/w biologic & social variables • It focuses on proximal variables and “cause of case” rather than “cause of incidence”. That is, we need to look at “characteristics of populations and not individuals” • - The goal is to address these variables with medical or educational interventions

  4. Evolution, Adaptation and the Man-made environment(McKeown’s“On the Origins of Human Disease”) • ‘Stone Age’ (hunter/gatherer) – conditions humans have lived under, and are biologically best adapted to. • Agrarian Society brought about vast changes in human disease • Industrialized Society led to a decline in infectious diseases and a rise in chronic/non-communicable diseases (e.g., obesity, lung cancer) Understanding human disease means looking at - • Prenatal disease (determined at fertilization or thru pregnancy) • Diseases of poverty (deficiencies &hazards in natural environment) • Diseases of affluence (maladaptive changes ala industrialization) Krieger, N. (1994). Epidemiology and the web of causation: Has anyone seen the spider? Social Science Medicine, 39(7), 887-903

  5. Social &Political Determinants of Health • Health stems from social organization of society • Society organizes in such a way as to create a Status Quo • Compare health status of social groups to the status quo • Look at economic and social inequalities and their differential impact (benefit or harm to health) • Identify/understand patterns of health and disease as a consequence of social relationships between groups as expressed in the context of everyday living • Improving Health requires changing patterns of political, economic, and ideological health determinants Krieger, N. (1994). Epidemiology and the web of causation: Has anyone seen the spider? Social Science Medicine, 39(7), 887-903

  6. Eco-Social Model • A complex systems view of social-biological interrelations rather than a false dichotomy of social and biological factors • The Model sees: • The biologic sets the basis for existence and social life (nature) • Social life sets the path along which the biological may flourish or wilt (nurture) • Individuals in the context of their everyday lives as shaped by their intertwined histories • Identify the link between social divisions and disease • People are but one of the species that populates our planet • The health of all organisms is interconnected • The importance of considering multiple levels when seeking to understand patterns at any given level Krieger, N. (1994). Epidemiology and the web of causation: Has anyone seen the spider? Social Science Medicine, 39(7), 887-903

  7. Eco-Social Model continued • The inherent important of profiles • within and across societies • at a given time and over time • at a given location and across locales • Notion of levels (individual, group and population) and systematically addressing the following at each level : • Social structure • Ecologic milieu • Genetic variability • Remind you of anything? If so, what and how? • Determining whether theses variables are acting exclusively or conjointly and how so at each level Krieger, N. (1994). Epidemiology and the web of causation: Has anyone seen the spider? Social Science Medicine, 39(7), 887-903

  8. A different approach to Public Health? • Spinning of Ping Pong Balls in a Lottery Machine • Stop trying to to predict which piece or pieces of motivation may tip the individual to change or not • Rather, ensure that the balls are kept spinning at various intervals, with varying air follow velocities to maximize the chance that they adhere to the receptor. • The order and combination of balls are unknown and vary • The process defies accurate predictions but to what extent is that important? Is this an acceptable course? Resnicow, K. and Page , S. E.. (2008). Embracing Chaos Theory: Change for Public Health. American Journal of Public Health, 98(8), 1382-89.

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