Epidemiological Research, Individualism, and Public Health

Abstract

Liberal individualism cannot be used as the methodological and ethical basis for epidemiological research and public health policy formulation because it obscures the social production of poor health and fails to serve as a basis for social justice in health promotion efforts. A group of authors¹ has argued that modern epidemiology has been colonized by the individualistic ethics of medicine and economics. Although the influence of behavioral factors in disease production cannot be denied, emerging epidemics and other health conditions such as obesity in the USA or the recent Ebola disease in West Africa have shown that special attention needs to be given to social forces that create risk environments and weaken individual agency. When we advert to “structural factors,” we mean those socioeconomic, cultural, and political conditions that affect the life of many in different contexts, whether for good or ill. Social structures determine the availability of material and social resources to people. Illness is more likely to occur where social structures fail to provide individuals or population groups with resources necessary to reduce exposure to life-threatening conditions. Structural factors are not controllable by the individual, yet they affect the individual’s environment. Given the effects of social forces, the individual cannot be considered as the unique unit of study nor individualism as a framework for analysis and intervention. Instead, the community or the individual, considered as an entity which is nested within the social fabric, needs to be considered as the unit of study. With such an anthropological shift, structural interventions ought to be considered as the bedrock on which any intervention may be framed and implemented so as to address both proximal and distal causes of vulnerability, as well as the pathways that link them.