Alright, welcome back. This is part three of lecture four, which is on Social Epidemiologic Theory.

Here, we're going to have a little module on what I call Jim Coleman's Theory of Society. Now, Jim Coleman is a late, a deceased sociologist, who wrote this book in 1990 called The Foundations of Social Theory, or. It was published in 1990, and it's a big book. And the joke has always been, Oh, you're still reading Coleman's Theory. It was controversial at the time, and some people like it and some people don't. I think it has some important elements for understanding how society works, and therefore, has important elements for social epidemiologic theory. Lots of components in this big book. The key idea, first and foremost, is that Coleman wants to understand how the social system works. So this is what I was getting at earlier in the last module. A good theory for social epidemiology ought to, in my opinion, help us understand how society or the social system works. We can literally ask, why is there society at all? Why not pure anarchy? The war of all against all, as the philosopher Thomas Hobbs used to lament. Why is there society? Who benefits, and why? Relatedly, why do we have social norms? What's a social norm? The social norm is to smoke cigarettes, to wear a seatbelt, to behave in this way, to not chew with your mouth open. All kinds of social norms that are big and small, where do they come from? Why do they emerge? How are they maintained, and who benefits by them? In my view, these kinds of questions are critical to understand how society works and particularly how society works to produce population health. Coleman's Theory or. Big book is focused on the rules of the game. It's not an individual person, John Doe or Jane Smith, but rather the rules and incentives in the system in which they operate.

Where are the incentives? Why would someone behave in a certain way, and not another due to the incentives. We'll talk more about this in a later module, these rules of the game. But that's the focus. Coleman also describes individual and group or corporate actors. This is an important distinction. We have persons, like you and me. Then we have groups of persons, perhaps Exxon Corporation, the federal government, a club, a sports team. These are groups. So there's individuals that make up groups, and both act. So both are actors. We have an individual actor and a group actor. And one of the great mysteries, one of the great areas of research is why do individuals in groups behave the way they do for often the benefit of the group and not necessarily a benefit of themselves. Coleman spends a great deal of time on studying the critical issues that we described before in this class. Of the macro to micro, and the micro to macro transitions. How does society get into people? How do people change? And then how does the changed people re-emerge and affect society. That's that multilevel model stuff we talked earlier. It's the group affecting the person, and the person affecting the group. Coleman describes that a lot. It's worth studying. The last thing I really like about Coleman's theory is it conforms, it's very similar to the jargon and language of modern economics, legal theory and political science. This matters not just because that's a neat thing. But it matters because if social epidemiologists want to sit at a table with policy makers. The language of modern policy is not about the ecology affecting individuals, but rather the legal, economic, and political power situations that are going on. Who benefits, who loses. And Coleman's theory is written in language that is very similar in concept, in understanding, for modern economist and lawyers and political scientist.

And I think that gives social epidemiologist using the theory an advantage. Alright some basics, now this is a big book. I'm just trying to give you a few ideas to get you started, to understand why this might be useful for social epidemiology. First, the idea is that persons act with a purpose. Everyone's trying to get something done. This does not mean that this is true everywhere and always. Of course, people act with habit and there is addictions and even whim or fiat. But the basic idea of understanding society begins with understanding that people by and large act with a purpose. In economics there's lots of strict, even mathematical, components to rationality. Well, this isn't quite rationality. This is instead acting with a purpose, trying to get something done. Second, there are actors and resources in the system. Now again, actors can be individuals or a group of individuals that we call corporate actors. Both are actors in their own way. Actors have resources, these might be money, these might be skills or abilities. These can be all kinds of things that are valuable resources. And what happens, in the theory, is that these individuals who have stuff, they have resources, have interest in their own resources and perhaps someone else's resources. And we have control or. Property ownership of some of these resources and not others. And so what happens in this theory, is there's this great exchange. You have apples. I have oranges. And we trade, a simple trade. You might have excellent skills as a carpenter. I might need a carpenter. And so we trade. you might be a big employer. I need a job. We exchange my labor for your paycheck, back and forth we go. So, the basic idea is there's this exchange going on, everywhere and always. Which leads us to the rules of the game

and the incentives for doing things. This whole theory can be viewed as a big old market transaction. It's a little more nuanced, or a little more social than what a pure economist might talk about. But, for now, we can just imagine it as a big market exchange, where all kinds of people. And groups or corporations, are exchanging things. Importantly, sometimes this exchange is fair. You get an apple, I get an orange. Other times, it's not fair. I have money, you need money, I can exploit you, exploit your labor. So fairness. Becomes something of interest, and not something to be said, to be not to be discussed. We can understand political power by the person's resources and their interests over those resources. So, those ideas of coercion and power become an important part in understanding how society works and later on we can decide whether we think that's fair or just. What does this all mean? How about some implications for health? First, we've talked about health disparities before. With Colemans framework we can ask, Who benefits from health disparities? How could there be anything but health disparities given a system? That is, if we change the system that's producing health disparities will some gain and some lose? Who have to give up what to remedy or mitigate health disparities? These questions become quite clear, and addressable, and approachable, through the lens of Coleman's social theory. We talk about norms for binge drinking and college students, or cigarette smoking, or not wearing seatbelts, or motorcycle helmets on a, on a motorcycle. Where do these norms come from, who's benefiting, and who's interests are there to maintain, or to repeal, or even turn over? There's some fascinating work done on Chinese foot binding in years past. Where did the norm for foot-binding come from? Why was it maintained for many centuries? And why was it nearly eliminated in a generation or two?

These are the kinds of things that Coleman's theory can help us address. Finally, we talk about changing the health producing system. Maybe it's the health care system, such as the current Affordable Care Act, sometimes called Obamacare. What does it mean we want to have such a big change, how does a social system react, whose going to fight for it, whose going to rebel against it and what can we predict about the outcome of this great mixing of resources, power, interest and control? These are the kind of questions that Coleman theory can help us illuminate. And I think it's a useful approach to understanding social epidemiology. It's not, of course, perfect though. First, Coleman's Theory is not complete. He wrote merely about the foundations, so more work needs to be done. Second, Coleman's emphasis on individual purpose of actions. This is by and large how things operate but there's also habit, there's also whim, there's also addiction. And so these other kinds of behaviors play a big role in health particularly. So the, utility for Coleman's purpose of action, doesn't fit perfectly well with understanding health. Finally, of course, Coleman's theory really says nothing at all about health. It's not a formal theory of social epidemiology. It's a theory of how society works. I think that's useful but much more work needs to be done to understand how it's the workings of society translate into better or worse health for individuals and populations. It should be fun to work on this into the future.