Jahiel René I
Department of Community Medicine, University of Connecticut Health Center, Farmington, CT 06030, USA.
J Urban Health. 2008 Jul;85(4):517-31. doi: 10.1007/s11524-008-9283-x.
Corporation-induced diseases are defined as diseases of consumers, workers, or community residents who have been exposed to disease agents contained in corporate products. To study the epidemiology and to guide expanded surveillance of these diseases, a new analytical framework is proposed. This framework is based on the agent-host-environment model and the upstream multilevel epidemiologic approach and posits an epidemiologic cascade starting with government-sanctioned corporate profit making and ending in a social cost, i.e., harm to population health. Each of the framework's levels addresses a specific level of analysis, including government, corporations, corporate conduits, the environment of the host, and the host. The explained variable at one level is also the explanatory variable at the next lower level. In this way, a causal chain can be followed along the epidemiologic cascade from the site of societal power down to the host. The framework thus describes the pathways by which corporate decisions filter down to disease production in the host and identifies opportunities for epidemiologic surveillance. Since the environment of city dwellers is strongly shaped by corporations that are far upstream and several levels away, the framework has relevance for the study of urban health. Corporations that influence the health of urban populations include developers and financial corporations that determine growth or decay of urban neighborhoods, as well as companies that use strategies based on neighborhood characteristics to sell products that harm consumer health. Epidemiological inquiry and surveillance are necessary at all levels to provide the knowledge needed for action to protect the health of the population. To achieve optimal inquiry and surveillance at the uppermost levels, epidemiologists will have to work with political scientists and other social scientists and to utilize novel sources of information.
企业引发的疾病被定义为接触过企业产品中所含致病因子的消费者、工人或社区居民所患的疾病。为了研究这些疾病的流行病学并指导对其进行扩大监测，提出了一个新的分析框架。该框架基于病原体-宿主-环境模型和上游多层次流行病学方法，假定了一个从政府批准的企业盈利开始，以社会成本（即对人群健康的损害）告终的流行病学级联反应。该框架的每个层次都涉及一个特定的分析层面，包括政府、企业、企业渠道、宿主环境和宿主。一个层次上的被解释变量也是下一个较低层次上的解释变量。通过这种方式，可以沿着流行病学级联反应从社会权力场所一直追踪到宿主的因果链。因此，该框架描述了企业决策向下渗透到宿主疾病产生的途径，并确定了流行病学监测的机会。由于城市居民的环境在很大程度上受到上游很远且相隔几个层次的企业的影响，该框架对城市健康研究具有相关性。影响城市人口健康的企业包括决定城市社区兴衰的开发商和金融企业，以及利用基于社区特征的策略销售危害消费者健康产品的公司。各级都需要进行流行病学调查和监测，以提供采取行动保护人群健康所需的知识。为了在最高层面实现最佳的调查和监测，流行病学家将不得不与政治学家和其他社会科学家合作，并利用新的信息来源。
