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Recent publications in the epidemiology literature have called for an evolution of theory and practice that would move the field from a focus on proximate, independent risk factors toward new paradigms of distal, interconnected determinants of disease risk. Example frameworks include "eco-epidemiological" constructions of nested systems, 1 socioeconomic foundations of health, 2 predisposing childhood exposures 3 and fundamental causes. 4 The case for moving from identification of individual risk factors to broader population and societal-level contextual determinants of risk has been well argued in the literature 4 - 8 and is an underlying motivation for much of the research in the field of social epidemiology. 4 Explicitly or implicitly, the need for such discussions has been driven by the aetiological complexity of chronic diseases. 8 9
The importance of social factors as causes of disease has been well established. 10 Indeed, questions of social causation of disease have been asked throughout the history of public health. 11 The ubiquitous association between socioeconomic status and health has been described, 4 if not wholly explained; 12 the decrease in morbidity and mortality with increasing socioeconomic position is one of the most consistent relationships in epidemiology. 13 A key difference identified by some social epidemiologists in their frameworks for understanding disease processes has been the focus on social conditions that promote or harm health, rather than on specific health outcomes. 11 14 It has been argued that such inclusiveness is required by the fact that all diseases can be considered to be products of both biological and social processes. 15 In practice, however, social epidemiology has focused historically on exploring aetiologies of non-infectious diseases. For example, in a review of social epidemiology, Renaud defines it as a "field of inquiry that regards the role of social and psychological factors in the etiology of chronic diseases", 16 while McQueen concurs that social epidemiology is "a term which has recently come into favor to describe research concerned with social factors in the etiology of chronic disease". 17
It is clear that social, political, behavioural and environmental factors shape the emergence and re-emergence of infectious diseases. 18 19 Farmer 19 has discussed the role of social inequalities in the recent emergence of infections such as Ebola, AIDS and tuberculosis. Despite proven...