Download Overview of Social Epidemiology

Some Issues to Consider
in thinking about
Causes and Explanations
Issues in Causal Analysis
• Limitations of traditional, single-causal models in dealing
with non-communicable disease which have many,
interconnected causes
• There are many conceptions of causation itself
• Statistics refers to probability and chance, but what do
these actually mean? How do we deal with uncertainty?
• Levels of explanation: the How vs. the Why?
• Are we using the right mathematical basis?
– Complexity & chaos theory; non-linear relations; fuzzy logic, etc.
Epistemology
• The theory of knowledge: what is
knowledge and how is it acquired?
• How do we know that we know what we
think we know? Etc.
• Bases of knowledge:
– Metaphysics
– Positivism
– Post-positivism
Metaphysics
• Deals with knowledge that cannot be
reached through studying material reality
– Nature of the mind & ideas
– Unverifiable
• But science alone cannot explain reality
– Scientific ideas are continually replaced by
newer ones
– “Truths” are not final
– Human interpretation is variable
Positivism
• Rejects metaphysics
– Focuses on observable & measurable
– Thoughts are irrelevant because
unmeasurable
• Mechanical
– Cause & effect
– Seeks to predict & control the world
Post-positivism
• Rejects positivism
• Knowledge is not based on solid
foundations; it is conjectural
– We may assert ideas but these can be
modified in light of further investigations
– We cannot take a fully objective point of view
– Context is important
– The closest we can come to proof is to try but
fail to reject a hypothesis.
Nomothetic & Idiographic
• There is a spectrum of sciences from hard to
soft; different approaches to causation in each
• Especially: generalising vs. particularising
traditions:
– What is the purpose of science: to derive general
laws, or to explain individual cases? (Nomothetic
vs. idiographic sciences)
– The approach to causal thinking is different in
each, and medicine is in both camps
Categories of explanation
• Scientific explanations (theory is central)
• Narrative (describes what happened)
• Historical (explains specific events)
• Teleological (the purpose or reason)
• Everyday (usually the “why” questions)
• Magical, religious (are these really
explanations?)
Two traditions
Aristotelian
• To make facts
teleologically
understandable
• Applied to actions &
intentional agency
• “Why?” questions
• Used in human & social
sciences
Galilean
• To explain & predict
• Commonly applied to
events
• Causal mechanisms
• Generally “how?”
questions
• Used in natural
sciences
Both seem relevant to medicine…
Holism, reductionism &
complexity theory
• Basic question of whether a complex whole (e.g.,
your mind) can be understood in terms of
functioning of its parts
• “Holism” argues that the whole cannot be
understood by analyzing parts; “why?” & “how?” are
distinct
• “Reductionism” says that laws governing the whole
can be deduced from laws governing the parts, plus
laws concerning relations between the parts
Sources of explanations for social
epidemiology
• Social sciences – sociology
• Behavioral science
• Psychology, personality, etc.
• Combined psychological + biological (e.g.,
psycho-neuro-immunology)
• What about history?