On social determination and social overdetermination: The epilogue to a heated debate?

Abstract

The author Minayo questioned a term widely used in the field of Collective Health: social determination. Public Health is located at the meeting point between Social Sciences and Health. The author alleges a detachment between Epidemiology, Health and Social Sciences, which is unfounded, since modern definitions of epidemiology refer to distributions in populations of determinants of health and disease (pathophysiological, environmental, behavioral), control of health problems (biological, social, economic, political, administrative, legal). The social component is evident in the definition of epidemiology. Susser & Susser argue that the human environment comprises systems at various levels, which interact with each other. In this model of multilevel causality, epidemiology begins to investigate the ways in which biological and social experiences generate health/disease. In this new paradigm, it is up to the epidemiologist to look for causes at various levels and, in particular, the causes of causes. The intertwining of gender, race and class, ignored by the author - called intersectionality - determines the experience of health and explains health disparities more convincingly than traditional interpretations of the demographic factors of race and ethnicity. To date, few researchers have considered intersectionality as an indicator of health. The discussion concludes with discourse analysis.