Elsevier

Social Science & Medicine

Volume 39, Issue 7, October 1994, Pages 887-903
Social Science & Medicine

Epidemiology and the web of causation: Has anyone seen the spider?

https://doi.org/10.1016/0277-9536(94)90202-XGet rights and content

Abstract

‘Multiple causation’ is the canon of contemporary epidemiology, and its metaphor and model is the ‘web of causation.’ First articulated in a 1960 U.S. epidemiology textbook, the ‘web’ remains a widely accepted but poorly elaborated model, reflecting in part the contemporary stress on epidemiologic methods over epidemiologic theories of disease causation. This essay discusses the origins, features, and problems of the ‘web’, including its hidden reliance upon the framework of biomedical individualism to guide the choice of factors incorporated in the ‘web.’ Posing the question of the whereabouts of the putative ‘spider,’ the author examines several contemporary approaches to epidemiologic theory, including those which stress biological evolution and adaptation and those which emphasize the social production of disease. To better integrate biologic and social understandings of current and changing population patterns of health and disease, the essay proposes an ecosocial framework for developing epidemiologic theory. Features of this alternative approach are discussed, a preliminary image is offered, and debate is encouraged.

References (158)

  • M. Susser

    What is a cause and how do we know it? A grammer for a pragmatic epidemiology

    Am. J. Epidemiol.

    (1991)
  • J. Ziman

    Reliable Knowledge: an Exploration of the Grounds for Belief in Science

    (1978)
  • J. Wisdom

    Challengeability in Modern Science

    (1987)
  • J.M. Cassel

    Potentialities and limitations of epidemiology

  • M. Terris

    The epidemiological tradition

    Pub. Hlth Rep.

    (1979)
  • R.A. Stallones

    To advance epidemiology

    Ann. Rev. publ. Hlth

    (1980)
  • G. Rose

    The Strategy of Preventive Medicine

    (1992)
  • N. Krieger

    Race, Class, and Health: Studies of Breast Cancer and Hypertension

  • M. Susser

    Epidemiology today: ‘a thought-tormented world’

    Int. J. Epidemiol.

    (1989)
  • M. Terris

    The Society for Epidemiologic Research (SER) and the future of epidemiology

    Am. J. Epidemiol.

    (1992)
  • A.M. Lilienfeld et al.

    Epidemiology and the public health movement: a historical perspective

    J. publ. Hlth Policy

    (1982)
  • L.H. Kuller

    Epidemiology is the study of ‘epidemics’ and their prevention

    Am. J. Epidemiol.

    (1991)
  • L. Fleck

    Genesis and Development of a Scientific Fact

    (1935)
  • T.S. Kuhn

    The Structure of Scientific Revolutions

    (1962)
  • E. Mayr

    The Growth of Biological Thought: Diversity, Evolution, and Inheritance

    (1982)
  • G. Holton

    The Thematic Origins of Scientific Thoughts: From Kepler to Einstein

    (1988)
  • J.N. Morris

    Uses of Epidemiology

    (1957)
  • I. Taylor et al.

    Principles of Epidemiology

    (1957)
  • J.E. Gordon

    Epidemiology—old and new

    J. Michigan St. Med. Society

    (1950)
  • G. Rosen

    What is social medicine?—a genetic analysis of the concept (1947)

  • J. Cornfield

    A method of estimating comparative rates from clinical data: applications to cancer of the lung, breast, and cervix

    J. natn. Cancer Inst.

    (1951)
  • A. Sayre

    Rosalind Franklin and DNA.

    (1975)
  • C.O. Nordling

    A new theory on the cancer-inducing mechanism

    Br. J. Cancer

    (1953)
  • R.G. Skeet

    The impact of the computer on the cancer registry

    Gann Monograph on Cancer Res.

    (1987)
  • M.J. Anderson

    The American Census: a Social History

    (1988)
  • H. Zinn

    A People's History of the United States

    (1980)
  • P. Blumberg

    Inequality in an Age of Decline

    (1980)
  • D. Bell

    The Social Sciences Since the Second World War

    (1982)
  • T. Branch

    Parting the Waters: America in the King Years, 1954–1963

    (1988)
  • E. Fee et al.

    Understanding AIDS: historial interpretations and the limitations of biomedical individualism

    Am. J. publ. Hlth

    (1993)
  • A. Watts

    Tao: The Watercourse Way

    (1975)
  • J.D. Bernal
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