RPAR is also informed by social epidemiology, the science devoted to understanding how the social and physical environments influence the level and distribution of health in a population. Social epidemiology has made a powerful case that health is determined not just by individual-level factors such as our genetic make-up, access to medical services, or lifestyle choices, but also by social conditions, including the economy, law, and culture. The search for ecological conditions that promote (or inhibit) health has led social epidemiologists to look outside the traditional biomedical model, toward macroeconomic factors (such as the level of economic development, poverty, unemployment, and income distribution) and features of social relationships (social cohesion, social exclusion, gender and race relations). These broad characteristics of society, in turn, determine the conditions under which people live, work, and stay healthy (or get sick). Although these social determinants of health are often characterized as “fundamental” or “superstructural,” they are hardly distant from daily life or health outcomes. Economic inequality, for example, can be seen as a characteristic of social groups at all levels of social organization, from the nation to the neighborhood, and at any level will owe a considerable proportion of its effect to the way it shapes the mundane details of individual interaction in everyday life.

Last Updated: February 2006