Epidemiology

The Basis of our Strength

History
Along with Leonard Syme and John Cassel, Mervyn Susser is aptly described as one of the three fathers of the field of social epidemiology in the United States. M. Susser established the Department of Epidemiology at Columbia and chaired it for 12 years. He brought sociology into medicine and shaped that influence with the deeply analytical frame expressed in his book Causal Thinking in the Health Sciences. This strong analytic frame remains dominant in social epidemiology at Columbia, especially as it has been developed and pushed forward by the methodological work of Sharon Schwartz.

Synergy with Psychiatric Epidemiology
Concerned with the possible role of adversity and stress in the onset and course of psychiatric disorders, Psychiatric Epidemiology developed an exceptionally strong orientation to the conceptualization and measurement of adversity. . Particular strengths are the measurement of stressful life events (Dohrenwend), a lifecourse developmental approach (Cohen), the use of natural experiments to refine inference (E Susser), and the conceptualization and measurement of stigma (Link). While these domains are clearly important for psychiatric disorders they are also important for other illnesses, thereby allowing the transfer these state of the art approaches to a broader social epidemiology.

Fundamental Social Causes Theory
Developed by Bruce Link and Jo Phelan, this theory seeks to explain why connections between socioeconomic status and disease express themselves in different places and at different times and in situations characterized by different risk factors and different diseases. As such it provides a lens for examining the social shaping of morbidity and mortality and provides theoretically derived predictions that can be used to evaluate the theory’s validity. Since the predictions are relevant to a wide range of disease outcomes, the theory connects social epidemiology to a broad range of disease-centered foci within the discipline. One example here is an emerging collaboration between Drs. Link and Phelan from social epidemiology and Drs. Neugut and Terry from cancer epidemiology in applying the theory to SES differences in survival from cancer.

Robert Wood Johnson Health and Society Scholars
Directed by Drs. Bruce Link and Peter Bearman of Columbia University’s Departmet of Sociology this program has invigorated themes central to social epidemiology at Columbia. The program links social epidemiology on the Columbia uptown campus to the social sciences on the Columbia downtown campus, thereby bringing the best of social science to epidemiology. One exceptional example of this influence is evident in the work of Andrew Rundle who has integrated epidemiologists, sociologists, geographers, and urban planners in the study of social and built environment on physical activity and obesity in New York. Additionally, the program has attracted talent from the top social epidemiology programs in the country.

Center for Social Inequality and Health
This Center, jointly sponsored by Epidemiology and Social Medical Sciences, seeks to bring scholars from the social sciences and epidemiology together to develop strong research focused on the role of social inequalities in health. The Center brings the capacity to study macro-level trends (1968-2006) in mortality from specific causes in every county in the United States as well as the capacity to conduct micro-level social psychological experiments on the role of social status. The Center is also especially interested in developing young scholars and has already contributed to numerous great successes in this area.

Three Selected Areas of Distinction

Health Disparities
Drs. Link (PI), Susser (Co-PI), Bresnahan, Rundle, and others in the Department led a successful application for a health disparities grant from NICHD, based on the Child Health and Development Study cohort in California with which Ezra Susser and others in the Department have previously worked. The project links Ezra Susser's interests in neurodevelopment to Bruce Link's interests in disparities by studying the mutual influence of SES, cognitive development, and emerging health across multiple points in the lifecourse as these are influenced by discrimination. The application was scored at the 5.7 percentile, passed Council, and is scheduled for award in July, 2008.

Stigma
While, the concepts and theories associated with the study of stigma have not been central to social epidemiology in most departments, the Department of Epidemiology at Columbia has emphasized this area elevated it to greater prominence. The HIV/AIDS epidemic is, of course, a major reason that the importance of stigma has become recognized in recent years. At the same time, stigma is critical for many other illnesses: it represents a barrier to good medical care, a threat to well-being, and a source of significant stress.

Drs. Link and Phelan are leaders in this area and are authors of a major theoretical statement entitled "Conceptualizing Stigma" published in the Annual Review of Sociology. The area is strongly supported with two R01 grants (Phelan PI, Link Co-Investigator); an R21 grant (Link - PI), and a K-Award (Lawrence Yang - PI, Link Mentor). Dr. Yang's K-Award work is broadening this area to include a more comprehensive assessment of the ways in which cultural factors shape the onset and course of disease and how interventions might be tailored to cultural factors so as to maximize their benefit.

Methods
Social epidemiology requires a careful transportation and elaboration of the powerful insights about causal inference that have been developed over the past few years in the parent discipline. Sharon Schwartz is the leader of a group of faculty and students who seek to achieve precisely this goal. She does this by integrating the very similar, but somewhat distictive approaches to counterfactual thinking that have developed in epidemiology on the one hand and the social sciences on the other.

The integration delivers a powerful hybrid that pushes each tradition further and provides a framework that is valuable in testing theories about upstream social determinants of health. The framework has been effective in illuminating issues such as testing for mediation (clearly critical to social epidemiology), building the capacity to think about causal inference - not only at the operational level but at the construct level as well - and many others.

To test the validity of the concepts and principles that have been put forward, Dr. Schwartz and colleagues have developed simulation techniques that help ensure that their approach produces more than just a mouth full of words. The approach spins off Dr. Schwartz's award-winning teaching and is thereby supported by departmental funds. It is an investment we make in our commitment to clarity, depth, and rigor.