Ecosocial theory

Ecosocial Theory, first proposed by name in 1994 by Nancy Krieger of the Harvard T.H. Chan School of Public Health, is a broad and complex theory with the purpose of describing and explaining causal relationships in disease distribution. While it incorporates biological and psychosocial influences on disease occurrence, the theory is also suited to analyze the relationships between social factors and disease development in public health research. The core constructs of Ecosocial Theory are: Embodiment; Pathways to Embodiment; the cumulative interplay between exposure, resistance, and susceptibility; and agency and accountability. Further, the theory specifies that all constructs must be considered in concert, as they work together in a synergistic explanation of disease distribution. The theory assumes that distributions of disease are determined at multiple levels and that analyses must incorporate historical, political economic, temporal, and spatial analyses.

The key constructs of Ecosocial Theory are:

All of these constructs work together and must be understood en toto in order to assess the impact of multiple levels of influence on the distribution of disease in populations. Embodiment describes the literal physical incorporation of the social and biological world into an individual’s body. Embodiment is an active process (a verb-like noun), in that the relationship between bodies and the world around them is reciprocal, cyclical, and synergistic. Pathways to Embodiment describes the various ways that social, biological, and environmental forces may interact with an individual’s body in context. Pathways must be explored on various spatio-temporal scales in order to understand the complex interplays that can occur through history, inter-generationally, across the lifecourse; as well as at global, national, societal, familial, and molecular levels. Cumulative Interplay describes how patterns of disease occur within a social, ecological, and biological context. It emphasizes how individuals in different socio-economic positions have different exposures, susceptibilities, and resistance (both biological and political) to disease, based on their unique histories and experiences over the lifecourse, based on spatio-temporal factors and the interaction with groups, power structures, discrimination, and inequality. Agency and Accountability claims that the State is a responsible agent in the patterns of disease distribution in a given society. In contrast to biomedical and lifestyle theories of disease distribution, the social system that creates discrimination and inequalities are also responsible for patterns of disease. Further, Krieger expands this construct to include the accountability we as epidemiologists have in the identification and treatment of health disparities, and the obligation we have to explicitly identify our theoretical lens, as well as to become activists, not just researchers, when we observe injustice.

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