Social and biological mechanisms of diseases

1. Social and biological
mechanisms of disease
Federica Russo
Universiteit van Amsterdam
Joint work with
Mike Kelly (NICE) and Rachel Kelly (Harvard)

2. Mechanisms
of Disease
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3. Overview
The background on disease mechanisms
Biological causes, the proximal-distal distinction, and
current views on social causes
Lifeworlds and mixed mechanisms
How the social enters disease aetiology, examples of
integration
When the social was proximal
Rehabilitate old, holistic views of health and disease
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4. THE BACKGROUND
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5. Biological causes of diseases
The conceptualisation of disease
The outcome of exposure to a pathogen or other noxious factor
Pathogens
Cause disease
Initiate mechanisms that lead to disease
A heir of the germ theory of disease and of the isolation of
bacterial
‘Biologisation’ of disease
Complications
Multiple pathogens at work
etc
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6. The proximal – distal distinction
Biological causes are proximal, social causes are distal
Distal causes do not exert direct influence on health
Hence, social causes are at best classificatory devices,
but not active causes in disease aetiology
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7. Social causes of disease
A number of accounts try to bring in social causes
Engel; Susser & Susser; Thisted, Cockerman; Rose; Marmot &
Wilkinson; Galea; …
They either use the social to classify diseases, or the
social is not integrated in disease mechanisms
Krieger’s web of causation comes quite close, but does
not sufficiently emphasises the explanatory import of
social factors
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8. Against the proximal – distal distinction.
For an integrated aetiology of disease.
Integration means explaining disease
with mixed mechanisms.
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9. LIFEWORLDS AND
MIXED MECHANISMS
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10. The social world. And health.
Sociology attempts to explain and predict
human behaviour
Societies manifest observable patterns of change
Humans are thinking and acting beings
Their thought and action take place within the
constraints imposed by social structures
How is behaviour linked to health?
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11. Initiates and mediates
exposure to toxins,
hazards, pathogens, etc
Drives health states of
individuals and
populations
Is the product of the
interaction between
human agency and
social structure
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12. An integrated pathogenic approach
The ‘social’ and the ‘biological’ are integrated in the
aetiology of disease
Behavioural factors are active parts of disease
mechanisms
Disease mechanisms are mixed
Social and biological factors are on a par
Social factors are not mere classificatory devices
The social and the biological together explain
disease
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13. EPIGENETICS
An example
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14. The epigenome reflects
acquired and inherited
genetic modifications
Recent studies show how
socio-environmental
pressures are linked to
epigenetic changes in the
short term
One generation distance
Pregnancy
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Epigenetic changes due to
social and environmental
pressures
Disease
Environm
ent
Behaviou
ral factors
Epigenetic
changes

15. DISEASES CAUSED BY
ALCOHOL CONSUMPTION
An example
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16. Alcohol consumption is part of
the lifeworld of individual and
of groups
It varies across friends, family,
social groups, populations,
age groups, etc
Just reducing exposure to the
‘pathogen’ does not reduce the
burden of disease
Broader interventions on
lifeworlds are needed
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Alcohol-related diseases are
not just caused by alcohol
consumption
Disease
Environm
ent
Behaviou
ral factors
Biological
factors

17. WHEN THE SOCIAL WAS PROXIMAL
Moving forward is moving back to the origins
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18. The original public health vision
Public health interventions targeted social factors
John Snow
Rudolf Carl Virchow
William Duncan
William Tennant Gairdner
…
Social inequalities, health inequalities
In the past. And today.
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19. TO SUM UP
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20. Health and disease are complex phenomena
Biological and social aspects studied in detailed
However …
Biological and social components of disease
Different roles
Proximal – distal
Classificatory – explanatory
An integrated aetiology of disease
Puts biological and social factors on a par
Points to a concept of ‘mixed mechanism’ where both are
‘active’ causes to explain disease
A further step for philosophy of science
Shed light on the (informational?) nature of the mixed
aetiology of disease
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