Farmer P
Harvard Medical School, Department of Social Medicine, Boston, MA 02115, USA.
Emerg Infect Dis. 1996 Oct-Dec;2(4):259-69. doi: 10.3201/eid0204.960402.
Although many who study emerging infections subscribe to social-production-of-disease theories, few have examined the contribution of social inequalities to disease emergence. Yet such inequalities have powerfully sculpted not only the distribution of infectious diseases, but also the course of disease in those affected. Outbreaks of Ebola, AIDS, and tuberculosis suggest that models of disease emergence need to be dynamic, systemic, and critical. Such models--which strive to incorporate change and complexity, and are global yet alive to local variation--are critical of facile claims of causality, particularly those that scant the pathogenic roles of social inequalities. Critical perspectives on emerging infections ask how large-scale social forces influence unequally positioned individuals in increasingly interconnected populations; a critical epistemology of emerging infectious diseases asks what features of disease emergence are obscured by dominant analytic frameworks. Research questions stemming from such a reexamination of disease emergence would demand close collaboration between basic scientists, clinicians, and the social scientists and epidemiologists who adopt such perspectives.
尽管许多研究新发传染病的人认同疾病的社会生产理论，但很少有人研究社会不平等对疾病出现的影响。然而，这种不平等不仅有力地塑造了传染病的分布，也影响了感染者的病程。埃博拉、艾滋病和结核病的爆发表明，疾病出现的模型需要是动态的、系统的和批判性的。这样的模型——力求纳入变化和复杂性，具有全球性但又关注局部差异——对因果关系的简单论断持批判态度，尤其是那些忽视社会不平等致病作用的论断。对新发传染病的批判性观点会探讨大规模社会力量如何在日益相互关联的人群中不平等地影响处于不同地位的个体；对新发传染病的批判性认识论会追问主导分析框架掩盖了疾病出现的哪些特征。对疾病出现进行这种重新审视所产生的研究问题将需要基础科学家、临床医生以及采用这些观点的社会科学家和流行病学家密切合作。
