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Epidemiology has been enormously successful in heightening public awareness of risk factors for disease. Research findings are frequently and prominently publicized in the mass media and in rapidly proliferating university-based health newsletters. Moreover, there is evidence that the message has been received and that many people have at least attempted to quit smoking, include more exercise in their daily routine, and implement a healthier diet.
With few exceptions, however, the new findings generated within the field of epidemiology have focused on risk factors that are relatively proximate "causes" of disease, such as diet, cholesterol, hypertension, electromagnetic fields, lack of exercise, and so on. Social factors, which tend to be more distal causes of disease, have received far less attention.(1) This focus on more proximate links in the causal chain may be viewed by many, not as a limitation or bias, but as the rightful progression of science from identifying correlations to understanding causal relationships (e.g., Potter 1992). In fact, some in the so-called "modern" school of epidemiology (e.g., Rothman 1986) have explicitly argued that social conditions such as socioeconomic status are mere proxies for true causes lying closer to disease in the causal chain.
This focus on proximate risk factors, potentially controllable at the individual level, resonates with the value and belief systems of Western culture that emphasize both the ability of the individual to control his or her personal fate and the importance of doing so (Becker
1993). This affinity between cultural values and the focus of contemporary epidemiology undoubtedly contributes to the level of public interest in epidemiological findings, and probably influences funding priorities as well. Thus modern epidemiology and cultural values conspire to focus attention on proximate, individually-based risk factors and away from social conditions as causes of disease.
This is not to say that the role of social factors in disease causation has been neglected in all quarters. Medical sociologists and social epidemiologists have kept alive classical epidemiology's (e.g., Susser, Watson, and Hopper 1985) concern with social conditions and have made major strides toward documenting and understanding the connections between social factors and disease. However, we believe there are conceptual pitfalls that sometimes lead medical sociologists and social epidemiologists themselves to unwittingly reinforce the emphasis on proximate, individual-level risk factors. One...