The Health of Populations General Theories and Particular Realities

In the maelstrom of current public health debate over the social determinants of health, this book offers a well-balanced discussion on the roots of prevalent strains of thought on the matter. While this area of research deals in complex problems, it is often dominated by those who deploy rather categorical, partisan positions, citing from a wide range of contradictory statistical studies. Stephen Kunitz brings a measured, balanced and independent perspective to bear on the debate, taking a step back from current arguments to look at the fundamental issues through a socio-historical lens. Part I describes how ideas about the costs and benefits of industrialization, and about the causes of disease, have been used by writers from different ideological persuasions to explain the health of populations. Part II focuses on some of the ideas that have been particularly influential in contemporary debates: factors such as standard of living, community and its loss, inequality, and globalization. The fact that these have been used to support differing explanations of the determinants of population health suggests that there are no easy generalizations in a field with so many discrepant findings. Scientists often ignore anomalous findings in the interests of advancing a particular paradigm, until the anomalies outweigh the norm and a new paradigm is created. This book argues that in considering social determinants of health, no meaningful over-arching explanations may be possible. Rather, it is by immersion in the reality of particular contexts - work settings, historical periods, geopolitical regions, and governmental credos - that we may gain a better understanding of the way in which social forces shape patterns of health and disease.

Stephen J. Kunitz is Professor, Division of Social and Behavioral Medicine, Department of Community and Preventive Medicine, University of Rochester Medical Center.