House James S
University of Michigan, USA.
J Health Soc Behav. 2002 Jun;43(2):125-42.
The development of social epidemiology and medical sociology over the last half of the 20th century, in which Leo Reeder played a central role, transformed scientific and popular understanding of the nature and causes of physical health and illness. Viewed in the early 1950s as shaped almost entirely by biological processes and medical care, physical health and illness are now understood to be as much or more a function of social, psychological, and behavioral factors. Utilizing a stress and adaptation conceptual framework, social epidemiology has identified a broad range of psychosocial risk factors for health, most notably: (1) social relationships and support; (2) acute or event-based stress; (3) chronic stress in work and life; and (4) psychological dispositions such as anger/hostility, lack of self-efficacy/control, and negative affect/hopelessness/pessimism, with new risk factors continuing to be identified. However, proliferation of risk factors must be balanced by conceptual integration and causal understanding of the relationships among them, their causes, and consequences. One source of such integration and understanding has been the rediscovery of large and persistent socioeconomic and racial-ethnic disparities in health. Socioeconomic position and race/ethnicity shape individuals' exposure to and experience of virtually all known psychosocial, and well as many environmental and biomedical, risk factors, and these risk factors help to explain the size and persistence of social disparities in health. Improving the socioeconomic position of a broad range of disadvantaged socioeconomic and racial-ethnic strata constitutes a major avenue for reducing exposure to and experience of deleterious risk factors for health, and hence for improving the health of these groups and the overall population. This in turn requires better understanding of the macrosocial forces that influence the socioeconomic position of individuals.
在20世纪后半叶社会流行病学和医学社会学的发展过程中，利奥·里德发挥了核心作用，这一发展改变了科学界和大众对身体健康与疾病的本质及成因的理解。在20世纪50年代初，人们认为身体健康与疾病几乎完全由生物过程和医疗护理决定，而如今人们认识到，它们同样甚至更多地是社会、心理和行为因素的作用结果。社会流行病学运用压力与适应的概念框架，已确定了一系列广泛的健康心理社会风险因素，其中最显著的有：（1）社会关系与支持；（2）急性或基于事件的压力；（3）工作和生活中的慢性压力；（4）诸如愤怒/敌意、缺乏自我效能感/控制力以及消极情绪/绝望/悲观等心理倾向，并且新的风险因素还在不断被发现。然而，风险因素的激增必须通过对它们之间的关系、成因及后果进行概念整合和因果理解来加以平衡。这种整合与理解的一个来源是对健康方面长期存在的巨大社会经济和种族/民族差异的重新发现。社会经济地位和种族/民族影响着个体对几乎所有已知心理社会风险因素以及许多环境和生物医学风险因素的接触和体验，而这些风险因素有助于解释健康方面社会差异的规模和持续性。提高广泛处于社会经济劣势的阶层以及种族/民族群体的社会经济地位，是减少接触有害健康风险因素并改善这些群体以及总体人口健康状况的主要途径。而这反过来又需要更好地理解影响个体社会经济地位的宏观社会力量。
