Published on January 2, 2008
The Role of Sociology and Social Networks in Integrating the Health Sciences: The Role of Sociology and Social Networks in Integrating the Health Sciences Bernice A. Pescosolido Indiana University Presentation in the Networks and Complex Systems Talk Series, Indiana University, November 28, 2005 Support is acknowledged from NIMH grant K0242655, Indiana Consortium for Mental Health Services Research (ICMHSR), and Indiana University (COAS & OVP) Slide2: The long-standing debate about the importance of nature versus nurture, considered as independent influences, is overly simplistic and scientifically obsolete. -- Neurons to Neighborhoods (2000:6) It is time to reconceptualize nature and nurture in a way that emphasizes their inseparability and complementarity, not their distinctiveness: it is not nature versus nurture, it is rather nature through nurture. -- Neurons to Neighborhoods (2000:41) In the past 25 years, the study of human health has included a distinguished, but neglected intellectual tradition put forth by numerous investigators, who saw the need for broad integrative frameworks that capture complex pathways to illness and disease. -- New Horizons in Health (2001:21) Series of Reports: Series of Reports New Horizons in Health: An Integrative Approach, 2001 Toward Higher Levels of Analysis: Progress & Promise in Research on Social and Cultural Dimensions of Health, 2001 Bridging Disciplines in the Brain, Behavioral and Clinical Sciences, 2000 From Neurons to Neighborhoods: The Science of Early Childhood Development, 2000 Through the Kaleidoscope: Viewing the Contributions of the Behavioral and Social Sciences to Health, 2002 Breaking Ground, Breaking Through: The Strategic Plan for Mood Disorders Research of the NIMH, 2002 Translating Behavioral Science into Action, 2000 Basic Problem: Basic Problem Limits of biomedical approaches in predicting who gets sick, who seeks treatment, and who recovers Call Understanding “contexts” Integrating health sciences Dilemma: Dilemma How to synthesize How to select among panorama of influences Possible Solution Contexts as social structures Social structures as “association” or “interaction” Social networks Claim: Claim This convergence makes way for social networks place in integrated health research Three Baseline Conditions for a Response: Three Baseline Conditions for a Response All levels relevant to health and health care must be considered, separated out and linked in an overarching theoretical frame by a similar mechanism, even when research targets only one level Room must be made to tailor such frameworks to particular populations, whether socially (ethnic or age groups) or medically (disease types) defined Find a way to work within “big science” to address problems from social construction to social causation that contribute to our understanding of basic social processes as well as medical phenomena Current Climate: Current Climate “driving the disciplines toward each other” “bringing the behavioral and social sciences more strongly and visibly into the full panorama of health research” “groundswell of support” “foster communication among scientists who have been too long isolated behind disciplinary walls” Looking Up From the Microscope and the Clinic: Looking Up From the Microscope and the Clinic The success of “pure” biomedical science that has led to the call to look up from the microscope to the “environment.” Epigenetic modification “50% genetics and 50% environment” 90% of diseases do not follow simple genetic rules of inheritance Effectiveness not efficiency The Current Landscape of Integration : The Current Landscape of Integration The “Environment”: The “Environment” The Black Box of BMS Luck, Chance IOM (Committee on Assessing Interaction Among Social, Behavioral, and Genetic Factors and Health) How should social environments be conceptualized and measured? Which aspects of the social environment should be included and at what levels of analysis? How do we consider present influences and those that have accumulated over the life course? E. O. Wilson: E. O. Wilson Consilience, 1998 De Waal Continued disarray of the social sciences, 1996 Requirements for Integrating Models and Frameworks: Requirements for Integrating Models and Frameworks consider and articulate the full set of contextual levels that have a documented role in past empirical research offer an underlying mechanism or “engine of action” that connects levels, is dynamic, and allows for a way to narrow down focal research questions employ a metaphor and analytic language familiar to both social and natural science that can facilitate synergy understand the need for and use the full range of methodological tools proven useful in the social and natural science Bronfenbrenner: Nested Contexts: Bronfenbrenner: Nested Contexts The Key: Social Networks as Theoretical Foundation: The Key: Social Networks as Theoretical Foundation Puts human face on issues of access, barriers, intervention, by conceptualizing these as actions of individuals. Relationships are “fundamental” mediators of human adaptations”. Networks are the “active ingredients of environmental influences”. Offers the underlying engine of action. Neurons to Neighborhoods NEM-Phase I: Cause & Consequence of Illness/Disease Reconsidered (SOS): NEM-Phase I: Cause & Consequence of Illness/Disease Reconsidered (SOS) The Role of Others The Role of Cultural Toolboxes The Role of Time The Role of Options Embeddedness – “Social Networks” Habit/Knowledge – “Content” Dynamics “Patterns & Pathways” “Turning Points, Trajectories” The NEM – Phase I: The NEM – Phase I (Pescosolido, Advances in Medical Sociology, 1991) Slide18: Support Choice, Coercion & “Muddling Through” 46% 25% 33% (Social Science & Medicine, 1998) Patterns of Care & Social Influence (Medical Care, 1998) Limits Role of Treatment/Organizations The NEM – Phase I Slide19: Network-Episode Model – Phase II The Dynamics of Treatment, Organizational and Policy Change Networks “Outside” Networks “Inside” Networks Slide20: (Pescosolido & Boyer, A Handbook for the Study of Mental Health, 1999) The NEM – Phase II Slide21: Support Power of Organizational Context (Wright, Psychiatric Services, 1997) Limits Role of Disease Course Role of Individual Role of Community The NEM – Phase II Slide22: The Elaboration of “Contexts” Focus on Multi-disciplinary Integration and Synergies People as the Agents of Change Networks as Mechanism that Connect Different Levels and Processes The Network-Episode Model – Phase III What Should An Integrated Health Science Model Look Like?: What Should An Integrated Health Science Model Look Like? Barabási Complex Network Model: Barabási Complex Network Model Slide25: The Network-Episode Model – Phase III (Rejected) The NEM III Under Construction: The NEM III Under Construction Nagging Questions: Nagging Questions Need we all embrace the Network-Episode Model or even the network metaphor? Does this mean that everyone must be engaged in multi-level, multi-disciplinary endeavors? How are integrated, multi-level studies likely to be accomplished? Multi-disciplinary versus Interdisciplinary: Multi-disciplinary versus Interdisciplinary “All too often it is insisted that there is only one kind of data, one methodology that should be employed, when everything we know about the major issues in the development of the social sciences should warn us against such imperialism.” Jane Lewis, 2003 The Political Quarterly “Big Science”: “Big Science” The Crossroads: The Crossroads “Shackled by tribal loyalty” “Snarled by disunity and a failure of vision” ? OR Have we traveled different pathways to a similar vision? Conclusion: Conclusion “Biophobia” (Freese et al 2003) “Methodenstreit” (Swedberg 1989) “Imperialist intrusion” (Collins, 1986) OR “Mutual credibility” (Modell, 2002) ?