<span class="gmail_quote">From: <b class="gmail_sendername">Ruggiero, Mrs. Ana Lucia (WDC)</b> <<a href="mailto:ruglucia@paho.org">ruglucia@paho.org</a>><br>cros posted from: <a href="mailto:EQUIDAD@listserv.paho.org">
EQUIDAD@listserv.paho.org</a><br><br></span>
<div lang="EN-US" link="blue" vlink="purple">
<div>
<p><font face="Courier New" size="2"><span style="FONT-SIZE: 10pt"> </span></font></p>
<p style="MARGIN-LEFT: 0.5in"><b><font face="Arial" color="#993300" size="2"><span style="FONT-WEIGHT: bold; FONT-SIZE: 10pt; COLOR: #993300; FONT-FAMILY: Arial">Proximal, Distal, and the Politics of Causation: What's Level Got to Do With It? 
</span></font></b></p>
<p><b><font face="Arial" color="#333399" size="2"><span style="FONT-WEIGHT: bold; FONT-SIZE: 10pt; COLOR: #333399; FONT-FAMILY: Arial"> </span></font></b></p>
<p style="MARGIN-LEFT: 0.5in"><font face="Arial" color="#333399" size="2"><span style="FONT-SIZE: 10pt; COLOR: #333399; FONT-FAMILY: Arial">Krieger Nancy<b><span style="FONT-WEIGHT: bold"><br></span></b></span></font><font face="Arial" color="#333399" size="1">
<span style="FONT-SIZE: 9pt; COLOR: #333399; FONT-FAMILY: Arial">Am J Public Health – February 2008; 98:221-230. DOI: 10.2105/AJPH.2007.111278 <br></span></font><b><font face="Arial" color="#333399"><span style="FONT-WEIGHT: bold; COLOR: #333399; FONT-FAMILY: Arial">
American Journal of Public Health  - February 2008, Vol 98, No. 2 </span></font></b></p>
<p style="MARGIN-LEFT: 0.5in"><b><font face="Arial" color="black" size="2"><span style="FONT-WEIGHT: bold; FONT-SIZE: 10pt; COLOR: black; FONT-FAMILY: Arial"><br></span></font></b><font face="Arial" color="#333399"><span style="COLOR: #333399; FONT-FAMILY: Arial">
URL: <a onclick="return top.js.OpenExtLink(window,event,this)" href="http://www.ajph.org/" target="_blank"><font color="#333399"><span style="COLOR: #333399">http://www.ajph.org/</span></font></a> </span></font></p>
<p style="MARGIN-LEFT: 0.5in"><font face="Arial" color="#333399" size="2"><span style="FONT-SIZE: 10pt; COLOR: #333399; FONT-FAMILY: Arial"><br>Abstract:<br></span></font><font face="Arial" color="#333399" size="1"><span style="FONT-SIZE: 8pt; COLOR: #333399; FONT-FAMILY: Arial">
<a onclick="return top.js.OpenExtLink(window,event,this)" href="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" target="_blank">
<font color="#333399"><span style="COLOR: #333399">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
</span></font></a> </span></font></p>
<p style="MARGIN-LEFT: 0.5in"><font face="Arial" color="#333399" size="2"><span style="FONT-SIZE: 10pt; COLOR: #333399; FONT-FAMILY: Arial"> </span></font></p>
<p style="MARGIN-LEFT: 0.5in"><font face="Arial" color="#333399" size="2"><span style="FONT-SIZE: 10pt; COLOR: #333399; FONT-FAMILY: Arial">"….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. 
</span></font></p>
<p><font face="Arial" color="#333399" size="2"><span style="FONT-SIZE: 10pt; COLOR: #333399; FONT-FAMILY: Arial"> </span></font></p>
<p style="MARGIN-LEFT: 0.5in"><font face="Arial" color="#333399" size="2"><span style="FONT-SIZE: 10pt; COLOR: #333399; FONT-FAMILY: Arial">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…."
</span></font></p>
<p style="MARGIN-LEFT: 0.5in"><font face="Arial" color="#333399" size="2"><span style="FONT-SIZE: 10pt; COLOR: #333399; FONT-FAMILY: Arial"> </span></font></p>
<p><font face="Arial" color="black" size="2"><span style="FONT-SIZE: 10pt; COLOR: black; FONT-FAMILY: Arial"> </span></font></p>
<p style="MARGIN-LEFT: 0.5in"><font face="Arial" color="#333399" size="1"><span style="FONT-SIZE: 8pt; COLOR: #333399; FONT-FAMILY: Arial">For reprints requests:<br>Nancy Krieger, PhD Professor, Department of Society, Human Development, and Health
</span></font></p>
<p style="MARGIN-LEFT: 0.5in"><font face="Arial" color="#333399" size="1"><span style="FONT-SIZE: 8pt; COLOR: #333399; FONT-FAMILY: Arial">Harvard</span></font><font face="Arial" color="#333399" size="1"><span style="FONT-SIZE: 8pt; COLOR: #333399; FONT-FAMILY: Arial">
 School</span></font><font face="Arial" color="#333399" size="1"><span style="FONT-SIZE: 8pt; COLOR: #333399; FONT-FAMILY: Arial"> of Public Health</span></font></p>
<p style="MARGIN-LEFT: 0.5in"><font face="Arial" color="#333399" size="1"><span lang="IT" style="FONT-SIZE: 8pt; COLOR: #333399; FONT-FAMILY: Arial">677 Huntington Avenue, Kresge 717 Boston, MA 02115 (USA)<br>email: <a onclick="return top.js.OpenExtLink(window,event,this)" href="mailto:vnkrieger@hsph.harvard.edu" target="_blank">
vnkrieger@hsph.harvard.edu</a> </span></font></p>
<p style="MARGIN-LEFT: 0.5in"><font face="Arial" color="#333399" size="1"><span style="FONT-SIZE: 8pt; COLOR: #333399; FONT-FAMILY: Arial">web:     <a onclick="return top.js.OpenExtLink(window,event,this)" href="http://www.hsph.harvard.edu/faculty/NancyKrieger.html" target="_blank">
<font color="#333399"><span style="COLOR: #333399">http://www.hsph.harvard.edu/faculty/NancyKrieger.html</span></font></a> </span></font></p>
<p style="MARGIN-LEFT: 0.5in"><font face="Arial" color="#333399" size="2"><span style="FONT-SIZE: 10pt; COLOR: #333399; FONT-FAMILY: Arial"> </span></font></p>
<p style="MARGIN-LEFT: 0.5in"><font face="Times New Roman" color="#333399" size="3"><span style="FONT-SIZE: 12pt; COLOR: #333399"> </span></font></p></div><pre> </pre></div>