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1.7 Reconstructing the mixed mechanisms of health: the role of bio- and sociomarkers

V. Ghiara and Russo, F. (2019)

Keywords: biomarkers, Sociomarkers, Mixed mechanisms, Life-course approach

Author Frederica Russo on the article: 

Within epidemiology, medical sociology, and public health, it is widely agreed that social factors are related to health outcomes. This is a well-established result that no-one is going to question. However, much research has served to establish correlations between classes of social factors on the one hand and classes of disease on the other hand. This kind of result has been long established in the field of social epidemiology and quantitative-oriented medical sociology. In sum, there is a solid tradition establishing that health outcomes are correlated with social factors (and also that inequalities in health and in socio-economic factors are correlated).

However, why and how social factors are an active part in the aetiology of disease development is something that is gaining attention only recently in the health sciences and in the medical humanities. To understand the relevance of this claim, we need to consider that the sciences of health are somehow compartimentalized. And while we did gain a lot of understanding about the ‘why and how’ of the bio-chemistry of health and disease, a lot less is explored about the interaction between the biological and social sphere.

In this paper, Ghiara and Russo aim to contribute to addressing the question of how the social is related to health outcomes, not just in correlational terms, but in terms of their explanatory and causal import. In other words: how can we make progress in ‘quantifying’ how the ‘social gets under the skin’?

To address this question, Ghiara and Russo develop an account of sociomarkers, in analogy to biomarkers. Their view is that, just as biomarkers help trace the causal continuum from exposure to disease development at the biological level, sociomarkers ought to be introduced and studied in order to trace the social continuum from exposure to disease development.

Conceptually, their proposal is to treat sociomarkers in analogous way as biomarkers. This is justified by the idea that biological and social factors should treated on a par ontologically: they can both be causes (not just correlations) of health and disease. Methodologically, their proposal is to make better use of the large amount of data and approaches that are already available. The point is not to come up with a new measurement of social factors, but (i) to enlarge the scope of relevant factors, beyond the ones traditionally used (viz. educational level, occupational class, income), and (ii) to use sociomarkers to trace active causes, not just the proxies.

In this sense, their concept of sociomarkers is not the same as ‘social indicators’: sociomarkers are not just indicators, but are conceptualized as markers of a salient bio-social process. Sociomarkers can be used in combination with biomarkers in order to reconstruct the mixed mechanisms of health and disease, namely mechanisms in which both biological and social factors have an active causal role.

The relevance of this contribution is in its attempt to build bridges between the (biological) sciences of health and disease, the social sciences of health and disease, and ultimately with public health. It is of possible interest to the IAS community for its conceptualization of health, disease, and the social sphere; even if the paper does not use the notion explicitly, it is very much in line with complexity approaches, and highly interdisciplinary in character.

V. Ghiara and Russo, F. (2019). Reconstructing the mixed mechanisms of health: the role of bio- and sociomarkers. Longitudinal and Life Course Studies, vol 10, no 1, 7-25