An intersectional approach in social epidemiology: Understanding health heterogeneity

Sammanfattning: Critical debates within the science of (social) epidemiology concern the relative lackof social theory in epidemiological research and the low discriminatory accuracy (DA)of much epidemiological knowledge on factors and markers of risk for disease.Against this background, this thesis integrates intersectionality theory intoepidemiological study. The purposes are to improve the understanding ofheterogeneities in population groups and thus increase DA, and to incorporate atheoretical framework that directs attention toward power dynamics driving theproduction of health disparities as well as toward their measurement. Anintersectionality perspective is incorporated into empirical study of risk for ischemicheart disease in Sweden, and of influenza vaccination uptake in the US. A categoricalintersectionality perspective is operationalized through assessment of difference inaverage risk between intersectional strata. The measurement of the DA of the socialand racial/ethnic categorizations used is aligned to an anti-categorical intersectionality perspective, as this DA is found to be low due to heterogeneities within and/or overlaps between groups.Despite the integration of intersectionality theory, the DA of the social andracial/ethnic categories under study remains low. Such measurements of low DApoint to a current limitation in knowledge about causation mechanisms andindividual heterogeneity in (social) epidemiology. This project has therefore beenpartially driven by an interest in other possible ontological ways of understandinghealth, risk and prevention of disease, found in complementary or alternative forms ofmedicine (CAM). The thesis includes a pilot study measuring the use of, andattitudes towards, CAM and conventional medicine in Skåne, the southernmostprovince of Sweden.