EDITORIAL
It does take two to tango! On the need for theory in research
on the social determinants of health
Matthias Richter
Published online: 22 May 2010
Ó Swiss School of Public Health 2010
Research on social determinants of health has witnessed
vivid changes and improvements over the last years. These
developments concern, for example, new possibilities of
data analysis (such as dynamic or multi level modelling),
the generation of new data (cohort or cross-national stud-
ies) and even an increase in the political awareness of the
issue in some countries. The report of WHO’s Commission
on Social Determinants of Health is a new milestone in
documenting many of these improvements (CSDH 2008).
Yet, one needs to state a strong imbalance in research on
social inequalities in health. Almost all of these develop-
ments refer to data-driven empirical research. The further
development of theory, however, is lacking way behind
other advancements in the field (Lahelma 2006). In our
research we sometimes even refer to the same theoretical
approaches that have first been proposed over 30 years ago,
for example in the Black report. Of course, even in this
field there have been improvements and progression, for
example in linking psychobiological processes and aggre-
gate deprivation to social inequalities in health (Marmot
and Wilkinson 2006). However, many of these approaches
are still largely driven by empirical data. Without any
doubt, social epidemiology as well as public health in
general are disciplines that strongly focus on empirical
research. However, this cannot mean that the gap between
empirical and theoretical work continues to increase. While
it is not possible to look at the reasons of this development
in detail here (due to necessary length-restrictions of an
editorial), it is very obvious that the status quo in research
on social determinants of health needs a change to a
stronger accentuation of explanatory approaches. The full
potential of a theory-driven analysis is hardly utilised
(Potvin 2009).
Let me illustrate this with two recent examples: First,
life course approaches on social inequalities in health have
attracted a lot of attention within public health research.
The proposed theoretical concepts and models largely
originate from epidemiology (Blane et al. 2007). This
perspective was truly helpful to contribute to a better
understanding of biological, behavioural and social influ-
ences—from gestation to death—for health as well as
health inequalities. However, all these approaches within
the mainstream of life course research strongly focus on a
medical risk factor concept. A theoretical foundation of the
different life course models—in the sense of a developed
formal theory—which goes beyond rather static assump-
tions is still lacking. This is especially striking because
right here a connection with theories of life span psy-
chology and sociological life course research seems to be
apparent (Settersten 2009). This is also true for a sociali-
sation theory perspective, which tries to combine
approaches from these two disciplines. Singh-Manoux and
Marmot (2005) used similar arguments when first trying to
use approaches from socialisation theory for the explana-
tion of health inequalities. Unfortunately, this perspective
has seldom been considered in life course epidemiology.
This Editorial belongs to the series ‘‘Social determinants of health’’.
Matthias Richter is Assistant Professor for Medical Sociology and
Social Epidemiology at the Institute of Social and Preventive
Medicine, University of Bern. His research interests lie in the field of
explaining and reducing socioeconomic differences in health as well
as international child and adolescent health research. He also has
particular interests in human development across the life course and
the role of socialisation for social inequalities in health.
M. Richter (&)
Division of Social and Behavioural Health Research,
Institute of Social and Preventive Medicine, University of Bern,
Niesenweg 6, 3012 Bern, Switzerland
e-mail: mrichter@ispm.unibe.ch
Int J Public Health (2010) 55:457–458
DOI 10.1007/s00038-010-0148-1
So far, the strength of public health (i.e. its interdisciplin-
ary exchange) as well as the potential of combining
different theoretical approaches has not been utilised in life
course research.
A second example provides the recent discussion on the
effects of welfare state regimes on health and health
inequality. Several studies have been able to show that
even though social democratic welfare states have the best
overall population health, they do not have the lowest level
of health inequalities (Lahelma and Lundberg 2009). Here
again the questions of a theoretical foundation as well as
possible collaborations between different disciplines
emerge to contribute to a better understanding of these
irritating findings. It’s already been troubling to explain
how education and income find their way into the human
body. But figuring out how the welfare state gets under our
skin is an even stronger theoretical challenge.
These are only two examples and surely other areas in
the field could be indentified also showing large theoretical
deficits. The question, however is, how both theoretical and
empirical research learn to dance together more easily. The
task of the next years will be to catch up conceptionally
with the vast number of empirical findings and to underpin
them theoretically. A minimal requirement is to continue
combining single approaches to develop broader theoreti-
cal models which can be tested empirically; a more
comprehensive requirement is the effective integration of
the issue of social determinants of health into the overall
framework of social science. (Social) epidemiology is
required to make a stronger reference to social science
theories while the theoretical assumptions and epidemio-
logical findings on disease aetiology should be established
and adapted within the sociological research. Furthermore,
it would be desirable for senior researchers to encourage
their young colleagues not only to publish quantitative
papers but also to participate in further development of
theories. Maybe provocative theoretical contributions of
younger researches are needed—just as much as brave
editors are, to publish these new thoughts—in order to put
theory on the agenda again. Maybe it is about time to
remind ourselves that there ‘‘is nothing so useful as a good
theory’’ (Lewin 1935).
References
Blane D, Netuveli G, Stone J (2007) The development of life course
epidemiology. Rev Epidemiol Sante Publique 55:31–38
Commission on Social Determinants of Health (CSDH) (2008)
Closing the gap in a generation: health equity through action on
the social determinants of health. Final report of the Commission
on Social Determinants of Health. World Health Organization,
Geneva
Lahelma E (2006) Health inequalities—the need for explanation and
intervention. Eur J Public Health 16:339
Lahelma E, Lundberg O (2009) Health inequalities in European
welfare states. Eur J Public Health 19:445–446
Lewin K (1935) A dynamic theory of personality. McGraw-Hill, New
York
Marmot MG, Wilkinson RG (eds) (2006) Social determinants of
health, 2nd edn. Oxford University Press, Oxford
Potvin L (2009) Yes! More research is needed; but not just any
research. Int J Public Health 54:127–128
Settersten RA (2009) It takes two to tango: the (un)easy dance
between life-course sociology and life-span psychology. Adv
Life Course Res 14:74–81
Singh-Manoux A, Marmot M (2005) The role of socialisation in
explaining social inequalities in health. Soc Sci Med 60:2129–
2133
458 M. Richter