Social & Spatial Epidemiology Unit

“The population strategy of prevention operates through the medical services at the level of the proximal causes of illness, but has to operate on a much wider base in order to confront those far more potent underlying influences, ‘the causes of causes’.”

– Geoffrey Rose, The Strategy of Preventive Medicine.

It is clear that social conditions affect health, and social epidemiology aims to understand the mechanisms through which social conditions exert their effects and to identify factors amenable to interventions to improve population health. However, since social conditions are often not easily manipulated, health promotion strategies typically focus on the more proximal causes of disease and ill health, in lieu of the more daunting social causes. This tendency to substitute the near causes rather than the root causes was the impetus for Geoffrey Rose to highlight the need for epidemiology re-focus prevention efforts on ‘the causes of causes.’

Geoffrey Rose, in his influential book “The Strategy of Preventive Medicine” explained that disease could either affect a minority of the population with a rare exposure (e.g. exposure to high doses of ionizing radiation among persons treated for leukemia) or an entire population through a ubiquitous exposure (e.g. exposure to alcohol). In each case, Rose argued that a different prevention approach was necessary—a individualized approach that targets the exposure in the former and a broader, population-based approach in the latter. To operationalize this two-pronged approach to prevent a given disease, epidemiology must first identify the rarity or ubiquity of an exposure within the population of interest.

In a new study led by Columbia University researchers, Rose’s approach to disease prevention was applied to investigate sociodemographic and drug use characteristics of U.S. populations who report nonmedical use of prescription opioids (NMUPO) in the presence or absence of major depression. Continue reading →

The 2015 SER Annual Conference is June 16-19 in Denver Colorado.  Several Cluster faculty and students will be attending and you can see the following talks from faculty:

Wednesday

Keyes – Modeling the effects of alcohol taxation on rates of violence and homicide in New York City: an agent-based modeling approach

El-Sayed – Do body mass norms among demographic groups influence perceptions of overweight? A study of adults in the United States

Thursday

Keyes – The mathematical limits of genetic prediction for complex chronic disease

Keyes – Teaching epidemiology by building on foundational concepts

Friday

El-Sayed – Toward a Systems Epidemiology: The uses and misuses of systems models in population health

and several posters including:

El-Sayed – Ineffective insurance in 42 low- and middle-income countries.

El-Sayed – Does health insurance mitigate inequities in non-communicable disease treatment? Evidence from 48 low- and middle-income countries.

Suglia – Adverse Child Experiences and Socioeconomic status in a nationally representative sample of young adults.

The Rio das Pedras Community

Dr. Gina Lovasi and her team are working to adapt standard methods for social epidemiologic research for use in resource constrained settings.  Her work in an informal community in Rio de Janeiro, Brazil does not have the benefit of readily available spatially aligned administrative data, remote sensing and visualization tools, WiFi assisted GPS technology, or even digitized street maps; tools commonly used in research studies in the U.S.  She and her team had to develop data collection and field tools on the fly.

Dr. Lovasi’s research site, Rio das Pedras, is home to approximately 63,500 residents and is the third largest informal community in Rio de Janeiro, Brazil. A tightly woven community, Rio das Pedras has continually attracted new residents while developing a growing local economy. Despite the collective successes, some services and infrastructure that many developed areas take for granted are missing in Rio das Pedras.  Aggravated by seasonal flooding, hectic vehicle traffic, continuous construction, soil instability, and improvised waste disposal facilities, the limited access to municipal services and transportation likely predispose residents to injury and poor health. However, there is limited data that can accurately characterize the health of residents of Rio das Pedras, and fewer data that can point out areas of improvement. As a result, there is little evidence to guide infrastructure investment or other initiatives to protect the health of residents. To fill this gap, Dr. Lovasi and her team are undertaking a Community Needs Assessment (Community Health Diagnosis) for the Rio das Pedras area.

Systematic Social Observation (SSO), also known as Neighborhood Auditing, is a standard approach to collecting data on the social and built environment characteristics of a community.  However, this method requires that the field team be able to identify and record their location, a challenge in Rio das Pedras which does not have a formal and stable street naming and building numbering system.  Dr. Lovasi’s team also needed a way to collect and organize data and photos in the field to support their understanding and documentation of the community’s resources and dis-amenities. Continue reading →

Welcome to the Social Epidemiology Cluster’s new blog and website.  The Cluster is one of the six thematic units within the Mailman School of Public Health‘s Department of Epidemiology.

Social epidemiology cluster faculty members seek to understand the ways in which social, political, cultural, and economic circumstances influence our chances for a healthy life. We combine theory from the social sciences with rigorous epidemiological methods so that we can illuminate the connections between social factors and health and use what we find to improve health. Within this broad frame we have a special interest in the connections between social inequalities and health inequalities.

The blog will highlight the importance of research and interventions focused on social determinants of health for promoting population health and reducing disparities in health outcomes.  The blog will include commentary on research news and policy debates and initiatives, and will disseminate research findings from work being performed at Columbia University.  We plan to publish companion info-graphics and visualizations that will serve as companion pieces to the research papers published in the academic press.