Embodying Inequality: Epidemiologic Perspectives
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《新英格兰医药杂志》
One of the most striking things an American observes on first arriving in a developing country is that poor people are so small and rich people so large. That physical stature so perfectly mirrors social stature is hardly surprising, given that adequate nutrition is a commodity like any other. Indeed, this pattern was evident in the United States until political and economic developments drove down the price of simple carbohydrates and fat, so that calories became literally cheaper than water. Now we increasingly observe the opposite pattern in developed countries, with the poor marked by such physical manifestations of caloric excess as obesity and diabetes. Either way, the body is the physical memory of one's place in the economic order. Inscribed on us all is the detailed record of our lot in life: too little food or too much, the miles walked in good shoes or bad, and the physical and emotional insults and injuries endured. Like the rings of a tree, which are spaced according to the yearly whims of rain and sun, our bodies harbor the permanent marks of leanness or plenty and, thus, indelible physical evidence of our social arrangements.
Embodying Inequality, compiled from papers published in the International Journal of Health Services, explores this basic theme. The editor, Harvard social epidemiologist Nancy Krieger, is also the author or coauthor of 4 of the 22 chapters in the book. In addition, she provides a brief preface to each section, as well as an overall introduction that lays out the role of social epidemiology as a scientific subdiscipline and as an intellectual framework for the diverse papers that follow. Economic class is just one of the axes of social distinction that are explored in these chapters, with considerable space also given to sex role and race and with some attention to sexual orientation and physical disability. Using a wide variety of methodologic approaches from history, social science, and public health, the various authors contribute to a remarkably detailed account of how the social becomes biologic. In an era in which the biologic determination of our social arrangements is continually trotted out as the science news item of the day, this perspective is a welcome relief.
The range and quality of the material selected for inclusion are impressive and reflect favorably on the more than three decades of editorial leadership of Johns Hopkins health policy scholar Vicente Navarro at the International Journal of Health Services. The added commentary by Krieger is useful in providing a sense of the structure of this collection, revealing common themes, although she lapses at times into platitudes — such as the invocation of an "eco-social" theory, which, as one might surmise, is sort of a grand theory of everything. Nonetheless, a compelling realization gleaned from this book is that social epidemiology is, indeed, the epidemiology of just about everything, since any factor that could make us sick or healthy is meted out in accordance with our status. After all, if money couldn't buy you health, of what use would it be? And if racial privilege didn't equal more years of life, why would anyone fight to defend it? Thus, in a society of haves and have-nots, the chasm between them is inevitably one of illness and death.
Embodying Inequality lays the groundwork for an etiologic model of the production of health disparity. For those who view health as a basic human right, it is therefore also an etiologic model of injustice.
Jay S. Kaufman, Ph.D.
University of North Carolina School of Public Health
Chapel Hill, NC 27599
jay_kaufman@unc.edu
Embodying Inequality, compiled from papers published in the International Journal of Health Services, explores this basic theme. The editor, Harvard social epidemiologist Nancy Krieger, is also the author or coauthor of 4 of the 22 chapters in the book. In addition, she provides a brief preface to each section, as well as an overall introduction that lays out the role of social epidemiology as a scientific subdiscipline and as an intellectual framework for the diverse papers that follow. Economic class is just one of the axes of social distinction that are explored in these chapters, with considerable space also given to sex role and race and with some attention to sexual orientation and physical disability. Using a wide variety of methodologic approaches from history, social science, and public health, the various authors contribute to a remarkably detailed account of how the social becomes biologic. In an era in which the biologic determination of our social arrangements is continually trotted out as the science news item of the day, this perspective is a welcome relief.
The range and quality of the material selected for inclusion are impressive and reflect favorably on the more than three decades of editorial leadership of Johns Hopkins health policy scholar Vicente Navarro at the International Journal of Health Services. The added commentary by Krieger is useful in providing a sense of the structure of this collection, revealing common themes, although she lapses at times into platitudes — such as the invocation of an "eco-social" theory, which, as one might surmise, is sort of a grand theory of everything. Nonetheless, a compelling realization gleaned from this book is that social epidemiology is, indeed, the epidemiology of just about everything, since any factor that could make us sick or healthy is meted out in accordance with our status. After all, if money couldn't buy you health, of what use would it be? And if racial privilege didn't equal more years of life, why would anyone fight to defend it? Thus, in a society of haves and have-nots, the chasm between them is inevitably one of illness and death.
Embodying Inequality lays the groundwork for an etiologic model of the production of health disparity. For those who view health as a basic human right, it is therefore also an etiologic model of injustice.
Jay S. Kaufman, Ph.D.
University of North Carolina School of Public Health
Chapel Hill, NC 27599
jay_kaufman@unc.edu