Do a speech on Social environment and it's impact on individual's life.
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INTRODUCTION
This discussion of the role of the social environment and health comes at a crucial time in the history of epidemiology. A July 1995 column in Science, written by a science journalist, questioned the relevance of the field, criticizing basic methods and the emphasis on release of statistically significant results over biologically plausible results (108). Meanwhile epidemiologists were calling for paradigm shifts, new theoretical frameworks, and alternative conceptual models (56, 58, 92, 93, 104, 105, 107). This public debate typically begins and ends with the definition and mission of epidemiology, which includes the discovery of “agent, host, and environmental factors which affect health in order to provide the scientific basis for the prevention of ds we revise our definition of epidemiology to “the study of the distribution and societal determinants of the health of disease prevention and health promotion programs and for the discovery of disease etiology.
In this chapter, we elaborate on the importance of research on the social environment, discuss the epidemiologic literature, and argue for the relevance of previous research done on the social environment by others.
Significance of Research into the Social Environment
The social environment includes the groups to which we belong, the neighborhoods in which we live, the organization of our workplaces, and the policies we create to order our lives. The physical and social environments do not exist independently of each other; any environment is the result of the continuing interaction between natural and man-made components, social processes, and the relationships between individuals and groups (106). Despite the increasing attention to the environment, there has been an imbalance in the epidemiologic research conducted to date; research on the physical environment is well established, whereas research on the social environment has lagged.
There are two ways to think about prevention. An individual focus directs attention to the fact that people need to change their behavior to lower their disease risk. Thus, we develop smoking cessation, weight loss, and stress reduction programs. In these programs, the onus is on individuals to change their way of life. For this programmatic approach to have widespread impact, individuals must be interested in the programs, and they must have the time and financial resources to enable participation (see Table 1).
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TABLE 1
Contrasting approaches to disease prevention
The second way to think about prevention is from the environmental perspective. From this perspective, programs could be designed at several different levels, including place-based or structural levels. A place-based approach, for example, would include such activities as regulating billboard advertising of cigarettes and alcoholic beverages, developing zoning laws to include public recreation areas near residential areas, creating bike lanes, and establishing community policing programs. Structural approaches to prevention would include legislating speed limits, price-support policies for food, alcohol, or tobacco, and cigarette taxes.
In the end, of course, individual behavioral change is the goal, but the point of attack shifts from within the individual to the environment in which people live. The development of prevention programs that focus on places or structural dimensions can influence the lives of more people and for longer periods of time than individually based interventions.
The social environment is also significant for epidemiologists because of the possibility of better understanding of disease etiology. Haan and colleagues (32), using data from the Alameda County Study, conducted one of the early epidemiologic studies on the environment. They examined the 9-year risk of mortality for residents of the “poverty area” in Oakland, CA, compared with that for residents in the rest of Oakland. Adjusting separately for age, sex, race, baseline physical health status, income, access to medical care, unemployment status, education, health practices, social isolation, and depression did not affect the increased risk associated with residence in a poverty area. From this and other studies, we know that residence affects health not only through an individual's socioeconomic status, e even though the population changed.