Psychosocial epidemiology, social structure, and ideology

Psychosocial epidemiology (that is, pertaining to the influence of social factors on a person’s behaviour, and to the interrelation of behavioural and social factors1) is a controversial field within epidemiology.2,3 Here, we restrict our critique to epidemiological studies of psychosocial constructs and we acknowledge the relevance of neuroscience and neuroendocrinology to understand the proximal pathways by means of which psychosocial exposures affect the health of organisms.4 Our goal is not to attack the work that has been done on psychosocial factors, but argue for the need to further integrate psychosocial factors with social structure. Important research has also been conducted on the psychosocial pathways that might mediate the effect of social structure on individual physical and mental health. This research includes studies of job control5,6,7,8,9,10 (despite negative findings in the Framingham study11), effort reward imbalance,12 social isolation/social support,13–15 and early psychosocial exposures.16 In addition, the Whitehall study has already provided evidence suggesting that control explains an important part of the health gradient among workers using both self reports and independent assessments.12,17–21 These studies lay the ground for future research that might integrate social …