American Journal of
EPIDEMIOLOGY
Volume 160
Number 1
July 1, 2004
Copyright © 2004 by The Johns Hopkins
Bloomberg School of Public Health
Sponsored by the Society for Epidemiologic Research
Published by Oxford University Press
EDITORIAL
Seeing the Forest and the Trees: New Visions in Social Epidemiology
Lisa F. Berkman
From the Department of Society, Human Development, and Health, Harvard School of Public Health, Boston, MA.
Received for publication May 28, 2004; accepted for publication May 28, 2004.
Social epidemiology, disguised in other forms and known
by other names, has been with us for decades, if not centuries. However, the upcoming issue of Epidemiologic
Reviews, the Journal’s sister publication, is devoted to a
fresh examination of this area, reflecting the enormous
advances that have been made in this field over the last
several decades. The contributors to the issue build historically on the body of work that has been produced since the
19th century focused on the health consequences of the political economy and rapid social change (1–4). They add to the
work of demographers who described the social forces that
shaped mortality, fertility, and population profiles. They
advance the work of epidemiologists and social scientists
who, early in the 20th century, helped us understand how
social and economic conditions influenced the emergence
and decline of specific diseases from pellagra and tuberculosis to heart disease (5–8).
So, what will you see that is new in this upcoming issue?
What have epidemiologists contributed to our understanding
of the ways in which society influences population health? In
the broadest sense, social epidemiologists are able to see
both the forest and the trees. At the macro level, the authors
frame the social determinants of population health. At the
level of the “trees,” they start to identify during which
periods of human development these conditions become
“embodied” to influence biology and the ways in which they
interact with other risks to shape the course of disease. They
emphasize a number of recent theoretical and methodological issues that advance epidemiology as a whole. Discussions of multilevel analysis (9), integration of group and
individual-level exposures (10), human development and
life-course approaches (11), and identification of mediating
pathways (12) dominate the volume. Increasing use of causal
modeling, counterfactuals, and a fuller use of experimental
and quasi-experimental study designs are discussed (13).
These topics are central to the entire field of epidemiology,
not just to social epidemiology. The authors address the
major health issues of our time—new infectious diseases
such as human immunodeficiency virus/acquired immunodeficiency syndrome (14), health in developing countries
(15), the growing epidemic of diabetes mellitus (16), mental
disorders (17), substance abuse (18), and human growth and
development (19). Again, the relevance for all epidemiologists is striking.
Social epidemiologists are developing new frameworks
with which to examine the etiology of disease, patterns of
population health, and modes of intervention. They are able
to integrate “upstream” social dynamics and ecologic exposures with “downstream” biologic responses and interactions
into their modeling of disease causation. The “black box”
approach typical of earlier epidemiologic investigations (20,
21) is being transformed. Social and environmental contexts
in which behaviors and risks are shaped are becoming
clearer. These approaches hold promise for all of us as we
search for ways to understand and ultimately to improve
population health. I trust that you will find the upcoming
issue of Epidemiologic Reviews on social epidemiology (to
be published along with this July 1, 2004, issue of the
Journal) helpful to you as you frame your ideas about
research and training.
Correspondence to Dr. Lisa F. Berkman, Department of Society, Human Development, and Health, Kresge 709, Harvard School of Public
Health, 677 Huntington Avenue, Boston, MA 02115 (e-mail: lberkman@hsph.harvard.edu).
1
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2 Berkman
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