Emerging Themes in Epidemiology

Social epidemiologists have drawn attention to health inequalities as avoidable and inequitable, encouraging thinking beyond proximal risk factors to the causes of the causes. However, key debates remain unresolved including the contribution of material and psychosocial pathways to health inequalities. Tools to operationalise social factors have not developed in tandem with conceptual frameworks, and research has often remained focused on the disadvantaged rather than on forces shaping population health across the distribution. Using the example of transport, we argue that closer attention to social processes (capital accumulation and motorisation) and social forms (commodity, corporation, and car) offers a way forward. Corporations tied to the car, primarily oil and vehicle manufacturers, are central to the world economy. Key drivers in establishing this hegemony are the threat of violence from motor vehicles and the creation of distance through the restructuring of place. Transport matters for epidemiology because the growth of mass car ownership is environmentally unsustainable and affects population health through a myriad of pathways. Starting from social forms and processes, rather than their embodiment as individual health outcomes and inequalities, makes visible connections between road traffic injuries, obesity, climate change, underdevelopment of oil producing countries, and the huge opportunity cost of the car economy. Methodological implications include a movement-based understanding of how place affects health and a process-orientated integration of material and psychosocial explanations that, while materially based, contests assumptions of automatic benefits from economic growth. Finally, we identify car and oil corporations as anti-health forces and suggest collaboration with them creates conflicts of interest. Introduction In this paper, we explain how thinking about social forms and social processes can develop epidemiological theory about the social determinants of health. We present the case of the car, the related social forms of the commodity and corporation, and the social processes of motorisation and capital accumulation. These concepts help to elucidate the car's role in production and consumption, and how this impacts on health. Our focus on these social forms and social processes introduces an area missing from social epidemiological work with implications for theoretical and empirical work. We discuss these implications for debates on psychosocial versus material pathways and the impact of place on health, before offering suggestions on how to progress the research agenda and identify major anti-health forces. Published: 21 February 2008 Emerging Themes in Epidemiology 2008, 5:4 doi:10.1186/1742-7622-5-4 Received: 1 August 2007 Accepted: 21 February 2008 This article is available from: http://www.ete-online.com/content/5/1/4 © 2008 Woodcock and Aldred; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Emerging Themes in Epidemiology 2008, 5:4 http://www.ete-online.com/content/5/1/4