Abstract
The relative lack of attention to philosophy and theory in research on social inequalities in health and its consequences for explanation and methodology has been described in the social epidemiologic literature. Nevertheless, the field of social epidemiology, dominated as it is by the trappings of positivism, is arguably still in need of further development of epistemological frameworks that can adequately incorporate richer explanations of the phenomena we study. Some have advocated for the adoption of a critical realist perspective for the study of social inequalities in health in order to overcome some of the difficulties described above. This chapter uses critical realism as a means to identify some of the epistemological and methodological difficulties inherent in attempts to explain health inequalities (especially the connection between social and biological mechanisms) and offer an “affirmative” approach to health inequalities research based on the insights of critical realist philosophy. In both the physical and social sciences, concerns about epistemology and philosophy are routinely left unexamined. This chapter argues that a more explicit engagement with such questions is an important next step in social epidemiology and health inequalities research. The chapter begins with a description of the explanatory problem faced by research on social inequalities in health. This explanatory task is difficult, but it is precisely that difficulty which cannot be adequately accommodated by the unacknowledged epistemological underpinnings of social epidemiology. The chapter highlights several key features of the critical realist approach and demonstrates how these can be usefully applied to health inequalities research to solve persistent problems of explanation and methodological pluralism. Specifically, the chapter argues that the complexity of the social phenomena implicated in this research demands a more detailed consideration of what is meant by causation, “explanation” and “theory,” and of what the relationship of these concepts should be to empirical research.
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Notes
- 1.
There are, of course, some examples of works that have been at least partly successful at mounting social explanations, including the work of Kawachi and others on social capital (Kawachi et al. 1997, 2004; Kawachi 1999), Wilkinson (1996) with regards to social capital and other psychosocial factors, Hertzman and Marmot’s (1996) explanations of the health consequences of rapid economic change in central and eastern Europe, and the work of a number of authors offering sociopolitical explanations (e.g., Navarro et al. 2006; Bambra et al. 2009).
- 2.
Link and Phelan’s (1995) work on “fundamental causes” is a step in the right direction of deeper explanations, but I argue that the emphasis on social conditions and socioeconomic position is not fundamental enough, as its explanatory focus is situated primarily at the level of events (as opposed to mechanisms and structures – see Fig. 2.1) and it is not successful in distinguishing between necessary and contingent relations.
- 3.
Indeed, one of the criticisms of realism when people started writing about it in the social sciences is that many said “we’re all realists now” (Cloke et al. 1991). Essentially, it codified the way many social scientists already worked. Even if this critique of unoriginality is valid, it is certainly advantageous that social scientists practice their craft in a way that is self-consciously aware of the philosophical underpinnings, and there is still plenty of relatively superficial analysis that could benefit from the insights of realist philosophy.
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Dunn, J.R. (2012). “Explanation,” Philosophy and Theory in Health Inequalities Research: Towards a Critical Realist Approach. In: O’Campo, P., Dunn, J. (eds) Rethinking Social Epidemiology. Springer, Dordrecht. https://doi.org/10.1007/978-94-007-2138-8_2
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