Integrating Law and Social Epidemiology

Abstract

Social epidemiology has made a powerful case that health is determined not just by individual-level factors such as our genetic make-up, access to medical services, or lifestyle choices, but also by social conditions, including the economy, law, and culture. Indeed, at the level of populations, evidence suggests that these "structural" factors are the predominant influences on health. Legal scholars in public health, including those in the health and human rights movement, have contended that human rights, laws and legal practices are powerfully linked to health. Social epidemiology and health-oriented legal scholarship are complementary in their focus and their research needs. Legal scholarship has identified plausible ways in which legal and human rights factors could be influencing health, but empirical evidence has been limited. Epidemiology has marshaled considerable evidence that social structures are broadly related to the level and distribution of health in a society, but bolstering claims of causation and intervening both require the elucidation of the mechanisms through which social structures actually influence health. Finding these mechanisms requires the integration of all the sciences that can offer explanations of the phenomena at issue, from the physiology of stress to the sociology of social status. Law, we suggest here, is an important mechanism to pursue.

In this article, we present an heuristic framework for including law as a social factor in epidemiological research, and conversely for understanding how law can have health consequences worthy of consideration by lawyers. The framework posits law operating simultaneously in two broadly defined roles: Laws and legal practices contribute to the development, and influence the stability, of social conditions that have been associated with population health outcomes (i.e., law contributes to the creation and perpetuation of fundamental social determinants of health), and law operates as a pathway along which broader social determinants of health have an effect (i.e., law is one of the social systems through which more fundamental social characteristics work to create health effects). Consideration of existing data in epidemiology and the social science of law supports the plausibility and usefulness of this framework.

Keywords: Human Rights, Public Health Law, Social Capital, Social Determinants of Health