Meanwhile Some Social Epidemiology

http://www.coursera.org is a website offering hundreds of free short online courses from many reputable universities around the world.  It’s well worth taking a look at what they have to offer if you’re at all interested in undertaking any type of informal but structured study.  There is an enormous range of subjects, and the website is ever-expanding, most recently reporting an enrolment of 4 million students, and new courses being offered constantly.

This year I enjoyed and completed a nine-week HIV course.  Enjoyed but didn’t complete an eight-week Introduction to Psychology course.  About to complete a seven-week Social Epidemiology course.  And in a few weeks’ time I will begin an eleven-week Virology course through Columbia University in New York.

The courses are all free, with online webinars presented by lecturers / professors from the university delivering the course, online readings, references to interesting online videos on the relevant subject, etc.  Some of the courses now have an optional “Signature Track” which costs a small amount of money and allows the student to have their course participation acknowledged should they apply to the university for a more formal course.  All you really need is an interest in the subject, the time to listen to lectures, do the required readings and online quizzes, possibly write a few short essays and possibly mark some of your peers’ work, all as a part of the course requirements (not every course has every one of these components).

After studying Epidemiology as part of my Masters degree years ago, and working in the area of disease Epidemiology for ten years or more, I decided to take the Social Epidemiology class offered via Coursera, by University of Minnesota.  It was an introductory level course,  but nevertheless I learned a lot, around the sub-discipline of “Social Epi”.

Epidemiology as a subject looks at health and disease at the population level, related to patterns and causes of illness.  Much of my paid work relates to infectious diseases, identifying who is sick with a particular disease and responding to this from a public health perspective (as opposed to an individual-level clinical perspective).  For example identifying contacts of someone with a specific infectious disease and providing education, preventive treatment etc, to stop the disease from spreading.  It’s an interesting subject with a lot of variation and interaction with people from all walks of life.  The study of Epidemiology has a lot to do with mathematics and research, so as a subject that I have come to know and love, it has drawn me into dealing with two study areas which would have to be my least favourite.  But because they’re connected to a subject I enjoy, I can (reluctantly) tolerate thinking about mathematics and research methodologies.

Social Epidemiology, as I have learned, is more specifically about “the social determinants of health” – which is in brief, how social factors or social systems influence the health of a population. The lecturer compared the health of Robinson Crusoe – who was marooned on a deserted island – with the health of those of us who live in a society, surrounded by other people who influence us in all kinds of ways.  For example cigarette companies who market their product to us; our peers smoking or not when we are teenagers influencing our decision to smoke; the political systems and laws which affect cigarette marketing and sales; and the social norms in our society around cigarette smoking.  For example once upon a time in Australia, smokers assumed the right to smoke wherever they wanted; but today the social norm in Australia is that smokers have designated places to smoke and they must abide by these rules.  Smoking rates in the western world have plummeted in the past two decades, influenced by changes in all of these factors.

Some of the more interesting examples discussed in this course included:

The use of diamond rings as symbols of marital engagement
In 1938 De Beers, a conglomerate of companies who dominate the diamond industry, implemented a strategy whereby they restricted the supply of diamonds (which are not a particularly rare commodity), and began marketing diamonds as a rite of passage connected to becoming engaged.  They were so successful, that they changed our social norm, such that it became expected and normal for the gift of a diamond ring to be a part of the engaged-to-be-married status of a couple.

You can read more about this interesting piece of social history at these links:

http://au.businessinsider.com/why-diamonds-are-a-sham-2013-3

Foot binding in Chinese society
For over a thousand years Chinese girls underwent the tradition of having their feet tightly bound, so that as their feet grew they were deformed into a painful and contorted shape which caused women to be housebound with limited mobility.  But their small feet were considered to be sexually attractive to men.  Women with tiny feet were considered good marriage material, while women with normal (considered to be large) feet, were guaranteed to never marry in Chinese society.  It became associated with class, with the smallest feet being the higher social classes, whilst the only place where bound feet may not be found was in the lower social classes where women’s labour was needed in the fields or workshops.  But even in the lower social classes, families would undergo great financial hardship in order to bind the feet of their daughters to ensure they could marry.  Within a single generation, through some fairly simple measures, this practice was halted simply by a shift in the “social norm”.  The parents of girls said they would not bind their daughters’ feet, and the parents of boys said they would prohibit their sons from marrying someone with bound feet.  By the early 1900s foot binding had moved from being 50% to 80% prevalent across China, to having all but disappeared from society completely.

More on foot binding can  be found at:
http://articles.latimes.com/2012/apr/16/world/la-fg-china-bound-feet-20120416

Click to access Mackie.pdf

The bottom article directly above compares the eradication of Chinese foot binding as a “social norm”, with the persistence of Female Genital Mutilation as a “social norm” across a large tract of northern Africa.

A less extreme example of Social Epidemiology than these, is the influence that neighbourhood environments in the developed world can have on population health.  Wealthier neighbourhoods with good planning and design tend to be much healthier than poorer neighbourhoods with lower value housing, fewer parks and cycle tracks, fewer affordable shops and more unhealthy takeaway establishments, etc.  Studies go so far as to say that living in a distressed neighbourhood (with high rates of poverty)  can adversely affect people’s well being and behaviour due to reasons such as limited exposure to peers and role models who support pro-social behaviours such as school and work; increased exposure to pollution or crime; limited exposure to neighbours who are willing and able to cooperate and work together to improve community life; limited exposure to high quality public institutions, from schools, housing and police, to community-run organisations.

So Social Epidemiology is about influencing populations in order to alter the status of their health, either by altering physical aspects of the environment, or cultural practises, various social systems (school systems, organisational and governmental systems, economic forces, etc).  With social media such a popular cultural practise now, this is considered one possible way to alter people’s attitudes, behaviours, beliefs and/or choices.

We hear a lot about the negative forces at play with social media such as Facebook, but I believe that there are also a lot of potential positive forces involved with such media.  For example, teenagers and young people love Facebook.  In remote Australia, for marginalised teenagers with limited educational attainment and limited literacy, the use of Facebook could well change the face of the literacy levels of some of our most impoverished teenagers, who suddenly have a reason to want to read and write.  They are talking to each other via keyboards on their phones and computers, being exposed to ideas and news which may otherwise be far removed from their world perspective.

http://www.coursera.org offer university level educational courses to anyone with access to the internet, from anywhere in the world.  While most of the courses available to date seem to be in English, there are some courses in Spanish and other languages.  The students I have studied with so far have come from all corners of the globe, and many people in developing countries have been enrolled with me in courses offered by reputable universities located in the developed world, which would not be accessible without this website.  This could well change the face of education in poorer parts of the world.

I think these are potentially exciting times and Social Epidemiologists could have a ball exploring the issue.


2 thoughts on “Meanwhile Some Social Epidemiology

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