Social determinants of disease.

The primary purpose for identifying psychosocial risk factors is to prevent disease and disease complications. For 30 years, we have been doing research in this field and have been successful in identifying such risk factors as Type A behavior, social isolation, stressful life events, and various psychological patterns. However, our success in using this information to help prevent disease has been much more limited. One reason for this limited success is that we have focused virtually all of our attention on the study of individuals and almost no attention on the social environment within which people live. There are two major limitations of such a one-to-one approach: it is difficult for people to change their behavior and their life situation and even if some people do change, others enter the "at risk" population because no action has been taken to change those forces in society that stimulated the problem in the first place. In discussing the social determinants of disease, it is important that we develop a new approach that permits us to study not only individuals but also the social environment. An example of this approach is provided by researchers who were successful in preventing infectious diseases. The work of these researchers focused not on clinical entities or on individuals but on the environment. This resulted in a disease classification system that included concepts such as air-borne, food-borne, water-borne, and vector-borne diseases. We have no such system for the study of non-infectious diseases. Considerable data already are available to help us to think about such a new classification system.(ABSTRACT TRUNCATED AT 250 WORDS)