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Integrating Law and Social Epidemiology
TL;DR: Social epidemiology and health-oriented legal scholarship are complementary in their focus and their research needs and empirical evidence has been limited.
Abstract: Social epidemiology has made a powerful case that health is determined not just by individual-level factors such as our genetic make-up, access to medical services, or lifestyle choices, but also by social conditions, including the economy, law, and culture. Indeed, at the level of populations, evidence suggests that these "structural" factors are the predominant influences on health. Legal scholars in public health, including those in the health and human rights movement, have contended that human rights, laws and legal practices are powerfully linked to health. Social epidemiology and health-oriented legal scholarship are complementary in their focus and their research needs. Legal scholarship has identified plausible ways in which legal and human rights factors could be influencing health, but empirical evidence has been limited. Epidemiology has marshaled considerable evidence that social structures are broadly related to the level and distribution of health in a society, but bolstering claims of causation and intervening both require the elucidation of the mechanisms through which social structures actually influence health. Finding these mechanisms requires the integration of all the sciences that can offer explanations of the phenomena at issue, from the physiology of stress to the sociology of social status. Law, we suggest here, is an important mechanism to pursue. In this article, we present an heuristic framework for including law as a social factor in epidemiological research, and conversely for understanding how law can have health consequences worthy of consideration by lawyers. The framework posits law operating simultaneously in two broadly defined roles: Laws and legal practices contribute to the development, and influence the stability, of social conditions that have been associated with population health outcomes (i.e., law contributes to the creation and perpetuation of fundamental social determinants of health), and law operates as a pathway along which broader social determinants of health have an effect (i.e., law is one of the social systems through which more fundamental social characteristics work to create health effects). Consideration of existing data in epidemiology and the social science of law supports the plausibility and usefulness of this framework.
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TL;DR: Social factors are indeed critical to understanding nonuniform infectious disease patterns that emerge as a result of the dependent nature of disease transmission or the idea that an outcome in one person is dependent upon outcomes and exposures in others.
Abstract: Social epidemiology is defined as the study of the distribution of health outcomes and their social determinants (1). It builds on the classic epidemiologic triangle of host, agent, and environment to focus explicitly on the role of social determinants in infectious disease transmission and progression. These determinants are the “features of and pathways by which societal conditions affect health” (2, p. 697). Early studies of human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) focused on individual characteristics and behaviors in determining HIV risk, an approach that Fee and Krieger (3) refer to as “biomedical individualism.” Biomedical individualism is the basis of risk factor epidemiology; by contrast, the social epidemiology perspective emphasizes social conditions as fundamental causes of disease (4) (table 1). Social epidemiologists examine how persons become exposed to risk or protective factors and under what social conditions individual risk factors are related to disease. Social factors are thus the focus of analysis and are not simply adjusted for as potentially confounding factors or used as proxies for unavailable individual-level data. Social factors are indeed critical to understanding nonuniform infectious disease patterns that emerge as a result of the dependent nature of disease transmission or the idea that an outcome in one person is dependent upon outcomes and exposures in others (5, 6).
399 citations
Cites background from "Integrating Law and Social Epidemio..."
...(122) argue that laws can affect health in two ways: 1) they may be a pathway through which social determinants affect health (a direct effect), and 2) they may contribute to social conditions associated with health outcomes (an indirect effect)....
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Posted Content•
TL;DR: It is argued that more research is needed at four levels--laws; management of law enforcement agencies; knowledge, attitudes, beliefs, and practices of frontline officers; and attitudes and experiences of IDUs--and that such research can be the basis of interventions within law enforcement to enhance IDU health.
Abstract: Ecological models of the determinants of health and the consequent importance of structural interventions have been widely accepted. Operationalizing these models in research and practice has been challenging. Examining the role of criminal law enforcement in the "risk environment" of injection drug users (IDUs) provides an opportunity to apply structural thinking to the health problems associated with drug use. This paper reviews international evidence that laws and law enforcement practices influence IDU risk. It argues that more research is needed at four levels - laws; management of law enforcement agencies; knowledge, attitudes, beliefs and practices of front-line officers; and attitudes and experiences of IDUs - and that such research can be the basis of interventions within law enforcement to enhance IDU health.
234 citations
Cites background from "Integrating Law and Social Epidemio..."
...As a causal factor, law contributes to the construction of ecological determinants, and also operates as a mechanism through which ecological characteristics operate to produce health outcomes (Burris, Kawachi, and Sarat 2002)....
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TL;DR: A logic model of public health law research and a typology of approaches to studying the effects of law on public health are offered, which hold great promise for supporting evidence-based policy making that will improve population health.
Abstract: Public health law has received considerable attention in recent years and is assuming the role of an essential field within public health. Public health law research has received less attention. This paper explores the boundaries and promise of public health law research, defined as the scientific study of the relation of law and legal practices to population health. The paper offers a logic model of public health law research and a typology of approaches for studying the effects of law on public health. Research on the content and prevalence of public health laws; processes of adopting and implementing laws; and the extent to which and mechanisms through which law affects health outcomes can be pursued using methods drawn from epidemiology, economics, sociology, and other disciplines. The maturation of public health law research as a field depends on overcoming several challenges, including the need to assure methodological rigor, adequate research funding, access to appropriate data sources, and uptake of research findings by policy makers. Public health law research is a young field, but holds great promise for supporting evidence-based policy making that will improve population health.
162 citations
Cites background from "Integrating Law and Social Epidemio..."
...Other commentators insist that public health law must include the role of law as a determinant and mechanism for the health effects of social and physical environments (Burris, Kawachi, and Sarat 2002; Magnusson 2007; Mariner 2009)....
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...Social epidemiology, the branch of epidemiology aimed at understanding social determinants of health (Berkman and Kawachi 2000), provides a theoretical framework into which PHLR can readily fit (Burris, Kawachi, and Sarat 2002)....
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...Published by Wiley Periodicals Inc. 169 THE MILBANK QUARTERLY A MULTIDISCIPLINARY JOURNAL OF POPULATION HEALTH AND HEALTH POLICY Law is an important discipline within public health(Gostin, Burris, and Lazzarini 1999)....
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...…survey, interview, and focus-group studies, systematic reviews, and meta-analyses are included, as is legal research to systematically and reproducibly collect, classify, and quantify laws and judicial decisions for analytic purposes (Hall and Wright 2008; Tremper, Thomas, and Wagenaar 2010)....
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Posted Content•
TL;DR: Repeated measurements and mixed-effects models were used to analyze the effects of an intensive long-term street-level police intervention on syringe exchange program use, finding declines in use fell across all categories and time periods studied.
Abstract: Law enforcement activity has been found to influence health risk behavior of injection drug users. Repeated measurements and mixed effects models were used to analyze the effects of an intensive long-term street-level police action to reduce open drug sales on syringe exchange program use. Utilization data for 9 months before and after the beginning of the intervention were analyzed. Use fell across all categories and time periods studied, with significant declines in use among total participants, male participants, and Black participants. Declines in use among Black and male participants were much more pronounced than decreases among White and female participants.
136 citations
Cites background from "Integrating Law and Social Epidemio..."
...Differences in exposure to street-level drug policing may contribute to sharp differences in the rate of injection-related HIV in Black and White people in the United States.(18)...
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TL;DR: An emerging model of public health law is described that adds scientific practices to the lawyerly functions of normative and doctrinal research, counseling, and representation that can help break down enduring cultural, disciplinary, and resource barriers that have prevented the full recognition and optimal role of law in public health.
Abstract: Public health law has roots in both law and science. For more than a century, lawyers have helped develop and implement health laws; over the past 50 years, scientific evaluation of the health effects of laws and legal practices has achieved high levels of rigor and influence. We describe an emerging model of public health law that unites these two traditions. This transdisciplinary model adds scientific practices to the lawyerly functions of normative and doctrinal research, counseling, and representation. These practices include policy surveillance and empirical public health law research on the efficacy of legal interventions and the impact of laws and legal practices on health and health system operation. A transdisciplinary model of public health law, melding its legal and scientific facets, can help break down enduring cultural, disciplinary, and resource barriers that have prevented the full recognition and optimal role of law in public health.
111 citations
References
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TL;DR: Multilevel analyses showed that a measure of collective efficacy yields a high between-neighborhood reliability and is negatively associated with variations in violence, when individual-level characteristics, measurement error, and prior violence are controlled.
Abstract: It is hypothesized that collective efficacy, defined as social cohesion among neighbors combined with their willingness to intervene on behalf of the common good, is linked to reduced violence. This hypothesis was tested on a 1995 survey of 8782 residents of 343 neighborhoods in Chicago, Illinois. Multilevel analyses showed that a measure of collective efficacy yields a high between-neighborhood reliability and is negatively associated with variations in violence, when individual-level characteristics, measurement error, and prior violence are controlled. Associations of concentrated disadvantage and residential instability with violence are largely mediated by collective efficacy.
10,498 citations
Book•
01 Jan 1995
TL;DR: In this paper, the authors define political participation as "how much? about what?" and "who participates" and "race, ethnicity, and gender" in the context of political participation.
Abstract: * *1. Introduction * Part I: The World of Participation *2. Defining Political Participation *3. Political Participation: How Much? About What? *4. Interpreting Political Activity: A Report from Activists *5. Recruiting Political Activists * Part II: Participation and Representation *6. Thinking about Participatory Representation *7. Who Participates? Economic Circumstances and Needs *8. Who Participates? Race, Ethnicity, and Gender * Part III: The Civic Voluntarism Model *9. Explaining Participation: Introductory Considerations *10. Resources for Politics: Time and Money *11. Resources for Politics: Civic Skills *12. Resources, Engagement, and Political Activity *13. Institutions and Recruitment *14. Participation and the Politics of Issue Engagement *15. From Generation to Generation: The Roots of [incomplete]
6,356 citations
Book•
01 Jan 1990TL;DR: This paper found that people obey the law if they believe it's legitimate, not because they fear punishment, which is the conclusion of Tom Tyler's classic study, "People obey law primarily because they believe in respecting legitimate authority".
Abstract: People obey the law if they believe it's legitimate, not because they fear punishment--this is the startling conclusion of Tom Tyler's classic study. Tyler suggests that lawmakers and law enforcers would do much better to make legal systems worthy of respect than to try to instill fear of punishment. He finds that people obey law primarily because they believe in respecting legitimate authority. In his fascinating new afterword, Tyler brings his book up to date by reporting on new research into the relative importance of legal legitimacy and deterrence, and reflects on changes in his own thinking since his book was first published.
3,783 citations
Book•
01 Jan 1983
TL;DR: In this paper, Blurred Genres: The Refiguration of Social Thought, Found in Translation: On the Social History of the Moral Imagination, and From the Natives Point of View: on the Nature of Anthropological Understanding.
Abstract: * Introduction Part I * Blurred Genres: The Refiguration of Social Thought * Found in Translation: On the Social History of the Moral Imagination * From the Natives Point of View: On the Nature of Anthropological Understanding Part II * Common Sense as a Cultural System * Art as a Cultural System * Centers, Kings, and Charisma: Reflections on the Symbolics of Power * The Way We Think Now: Toward an Ethnography of Modern Thought Part III * Local Knowledge: Fact and Law in Comparative Perspective
3,602 citations
TL;DR: It is argued that social factors such as socioeconomic status and social support are likely 'fundamental causes" of disease that affect multiple disease outcomes through multiple mechanisms, and consequently maintain an association with disease even when intervening mechanisms change.
Abstract: Over the last several decades, epidemiological studies have been enormously
successful in identifying risk factors for major diseases However, most of this
research has focused attention on risk factors that are relatively proximal causes of
disease such as diet, cholesterol level, exercise and the like We question the
emphasis on such individually-based risk factors and argue that greater attention
must be paid to basic social conditions if health reform is to have its maximum
effect in the time ahead There are two reasons for this claim First we argue that
individually-based risk factors must be contextualized, by examining what puts
people at risk of risks, if we are to craft effective interventions and improve the
nation's health Second, we argue that social factors such as socioeconomic status
and social support are likely 'fundamental causes" of disease that, because they
embody access to important resources, affect multiple disease outcomes throughmultiple mechanisms, and consequently maintain an association with disease even when intervening mechanisms change Without careful attention to these
possibilities, we run the risk of imposing individually-based intervention strategies
that are ineffective and of missing opportunities to adopt broad-based societal
interventions that could produce substantial health benefits for our citizens
3,483 citations