Welcome back everybody, week 4. Now we're on the downhill.

This week we're going to talk about the topic of theory, more specifically Social Epi Theory. In this lecture, this week, we have 4 modules. It'll be on the shorter side this time, we've been doing a lot of work. So these will be quicker and shorter. And hopefully fun. So I'm looking forward to walking that, walking through that with you. The four modules for this week are, social theory background. We're going to talk about that now. And then we're going to get into the, what's called the social ecological model. And it goes by several names. And I'll try to explain that. When we get that module. Then we're going to talk about what I call Coleman's theory. Which is by a late scholar named James or Jim Coleman. And then finally, I'm going to have a section or module on something called game theory. I want to introduce you to some ideas that I think are important for social epidemiologist to understand. In all of these modules, they're just going to be little tidbits. There's volumes written about this stuff. so my goal for this lecture is to help you understand some of the landscape of social epi-theory, if you will, to get you started, and so, that's the goal. This week, we're going to try something different in terms of assignment. A little experiment in this new on-line format. Instead of giving you a reading assignment and offering a quiz, which we've been doing as you know, I'm going to ask you to search the web, Google if you want, for evidence, for parts of different theories that you think. Would fit into a social epidemiologic theory framework. Now the hope is that through the modules of this week, I give you some guidance on stuff that I think should be involved or not involved. But this is an experiment, and what we want to do is to then have you, all the students, post on our discussion boards, on the Coursera discussion boards

elements or ideas for social epi theory, and then we'll discuss them interactively. And I'll try to play a role as well. But that student interaction is so critical to the success of a course such as this. I thought this was an optimal time to try this and if it fails we'll just back off, but let's try it together. And I'll give you more directions as we go on in the next modules. So, this first module we're going to call theory background and I hope to give you some. Insights, some sense of what does it mean when someone like me says we're going to talk about theory. So let's try to do that. Well what is theory? Simply put, theory, in this case social epi-theory, is like a road map. It's literally like a map that one might use to drive from point A to point B. It gives us guidance. It says, here are the road stops, here are the landmarks, here's where the road is. Here's where not to go, perhaps. Technically, theory tells us where to look. What does that mean? Well, for social epi it means, what kind of things should we be looking at? As you know, socioeconomic status, race, one's place in the world, international location, other aspects of the social system. Social epi theory will guide us as to where to look for what variables, what measures will be moving or interacting or causing one another. Theory also helps us have a framework for understanding. It helps us under-, say, well this is part of our understanding or this is now. It's akin to saying, well if we had a map of the world. That was the size of the world, it would be perfectly accurate but it would not be very helpful because you couldn't fold it up and put it in your pocket or in your glove box of your car. So to have something that's simplified, that's smaller, that isn't necessarily perfectly accurate but helps us, if you'd follow the metaphor. Get from point A to point B, that's what theory does. And we want to explore what kinds of

variables, constructs, measures will guide us into a deeper understanding of how the social system affects health. Theory also helps us illuminate and if, if we're lucky, if we work hard, mitigate an important problem called confirmation bias. Well what's that? Well confirmation bias is the biggest problem for science. And that is having a conclusion, and then looking for data to confirm your conclusion. That's confirmation bias. And so the problem with that is. We might say this kind of thing causes that disease. And then we look for evidence that confirms that. It may be true. But what that does is exclude other explanations for that very same cause. And in science, we want to entertain all explanations until we can rule them out vis-a-vis the scientific method. So theory helps us get there. This is why theory is the integral part of the scientific process or scientific method. We cannot just look to the world for data. We always come to the world of data with something in mind. And that something in mind whether it's formal or informal is theory. And so we want to be more clear, we want to be more concise about what theory is so we're clear on what we're doing when we look to the world of data. And then of course use that data to analyze it and maybe make predictions about what we can expect in terms of health outcomes. But there's some cautions. We want to be clear in our work. In our reading of whether we're trying to develop theory for its own sake. Is our goal to develop a sophisticated theory and test it and see if that's how the world works? Or are we aiming to develop theory to help us better understand mother nature or the empirical world? In our case, society and how it impacts health. So it's perfectly reasonable, perfectly reasonable to say that we have theories that we want to test about the world. And see if they're true or not. But in public health, of which

epidemiology and social epidemiologies part. We typically want theories that help guide us to do things. And the things we want to do are to improve population health. So the theories we'll talk about in this week, in this module. Are theories that I hope help us actually improve population health. Now, the traditional epidemiologic theory, we've talked about before. And it's a rather simplistic view of the world, where we have an agent. Which is something like a virus or a bacteria. We have an environment, in which the agent and the host of the agent exists, and this could be a farm, it could be a city, it could be a petri dish. And then we have the host, and that's the person who is affected by the agent or the disease and time is always moving. As we said in our earlier lectures, this is a traditional theory of epidemiology. But notice that it does not incorporate the critical aspects of how social systems affect health. So this traditional epidemiology model which is well-known is not sufficient, it's not that it's wrong, it's just not sufficient for social epidemiology. Well, begs the question. What is social epidemiologic theory? It's important for me to tell you that I don't think there is one. Currently, after 20 years of focused work it's still a bit of a mish-mash. We're borrowing parts of theories from other disciplines. That might be fine, but we're yet to have a cohesive story or theory of how social systems affect health. Lots of scholars write in the professional journals, we need more theory. And I totally agree. The trouble is not much theory is forthcoming. Not much is helping us improve our questions, improve where we look for data. In fact, in epidemiology there is little talk of theory per se. Most epidemiologists are very empirical. They tend to count stuff up and analyse data without much thought to what it is we're counting, why it is we're counting, and what does this all mean in a larger logical framework.

Social Epi theory borrows from lots of places. And we borrow from statistics, we try to understand how one variable might be correlated with another. We borrow from economics. And as I said in our first lecture, I tend to borrow heavily from economics. That's due to my own training and, probably, biases. We certainly borrow from biology, and physiology, and medicine. We have to understand, ultimately, how society gets into the body. We borrow, of course, from sociology, social norms, social systems, and psychology. How do people think? What do things mean to people? And of course, anthropology. What are the cultural aspects? So these are the important components of social epi theory. And as you read, or work, or think about this stuff parts of this mish-mash become to be put together. There's been some progress, and one of the more important papers I wish to point out to you. And you can read this on your own if you wish. And this is by a scholar named Nancy Krieger. And this is a paper in the International Journal of EPI and of course it's called Theories for Social Epidemiology. And in this paper, Krieger does several important things and we'll talk more about that in later modules. I want to emphasize that in this context and even in my regular classroom, there's no time, there's not a place to discuss all the components of various theories that are very interesting. I just want to point out a few to you, for you if you want to to go out on your own, and think about them, read about them and maybe see if they can incorporate themselves into social epi theory for you. And that's the theory of memes. The theory of agent-based models, something called systems theory, social network theory, and cultural theory. In my view, all of these are valid and interesting parts of a social epi theory. I just don't have the time, in this format, to go through them all. It's extensive and so I'm going to try to narrow in on the stuff I think you need

to know the most. But a word of caution there are some theories that I read about and see that some people seem to link to social epi theory and I want to argue to you or suggest to you that these are not really. Social epi theories. The traditional ones are the theories of individual behavior. And there are several. And I just list a few on this slide. The theory of reasoned action, the health belief model. Social cognitive theory, and others. These are very important and valid theories, but they are theories about why an individual behaves. Recall, we are interested in theories of how the system, the social system, if you want, society works, and how society produces health. Also, ecological theories, which we'll explain more in later slides, ecological theories in and of themselves are not social epi theory. A theory of pure biology is not a social epi theory. And finally, theories where genes and genetics are determining outcome, are not social epi theory. So be cautious, be aware of these things that are and are not part of the social epi framework, at least as I view it. Finally, one last word of caution. There is something called the Murphy's Law of Research. And that is, with enough research, enough impirical or going-to-data research work, we will confirm our theories. This is a danger in all science, and I think it's really important to emphasize as we're talking about theory today, for social epidemiology, that you be cautious and remember that if you look hard enough, you'll find data to confirm your theory, or you'll find data that says your theory's wrong, but not believe that data. So this is a great tension in science. I don't have an answer for you, but I want to make you aware of it. So on we'll go now with Theories for Social Epidemiology. [SOUND]