PHA-Exch> Proximal, Distal, and the Politics of Causation: What's Level Got to Do With It?

[Claudio Schuftan]

From: Ruggiero, Mrs. Ana Lucia (WDC) <ruglucia at paho.org>
cros posted from: EQUIDAD at listserv.paho.org



*Proximal, Distal, and the Politics of Causation: What's Level Got to Do
With It? *

* *

Krieger Nancy*
*Am J Public Health – February 2008; 98:221-230. DOI: 10.2105/AJPH.2007.111278

*American Journal of Public Health  - February 2008, Vol 98, No. 2 *

*
*URL: http://www.ajph.org/


Abstract:
http://www.ajph.org/cgi/content/abstract/98/2/221?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&author1=krieger&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&sortspec=relevance&resourcetype=HWCIT



"….Causal thinking in public health, and especially in the growing
literature on social determinants of health, routinely employs the
terminology of proximal (or downstream) and distal (or upstream). I argue
that the use of these terms is problematic and adversely affects public
health research, practice, and causal accountability. At issue are
distortions created by conflating measures of space, time, level, and causal
strength.



To make this case, I draw on an ecosocial perspective to show how public
health got caught in the middle of the problematic proximal–distal
divide—surprisingly embraced by both biomedical and social determinist
frameworks—and propose replacing the terms proximal and distal with explicit
language about levels, pathways, and power…."





For reprints requests:
Nancy Krieger, PhD Professor, Department of Society, Human Development, and
Health

Harvard School of Public Health

677 Huntington Avenue, Kresge 717 Boston, MA 02115 (USA)
email: vnkrieger at hsph.harvard.edu

web:     http://www.hsph.harvard.edu/faculty/NancyKrieger.html
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