Skip to main content
PMC home page
Emerging Infectious Diseases logoLink to Emerging Infectious Diseases
. 1996 Oct-Dec;2(4):259–269.

Social inequalities and emerging infectious diseases.

P Farmer 1
PMCID: PMC2639930  PMID: 8969243

Abstract

Although many who study emerging infections subscribe to social-production-of-disease theories, few have examined the contribution of social inequalities to disease emergence. Yet such inequalities have powerfully sculpted not only the distribution of infectious diseases, but also the course of disease in those affected. Outbreaks of Ebola, AIDS, and tuberculosis suggest that models of disease emergence need to be dynamic, systemic, and critical. Such models--which strive to incorporate change and complexity, and are global yet alive to local variation--are critical of facile claims of causality, particularly those that scant the pathogenic roles of social inequalities. Critical perspectives on emerging infections ask how large-scale social forces influence unequally positioned individuals in increasingly interconnected populations; a critical epistemology of emerging infectious diseases asks what features of disease emergence are obscured by dominant analytic frameworks. Research questions stemming from such a reexamination of disease emergence would demand close collaboration between basic scientists, clinicians, and the social scientists and epidemiologists who adopt such perspectives.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Berkelman R. L., Hughes J. M. The conquest of infectious diseases: who are we kidding? Ann Intern Med. 1993 Sep 1;119(5):426–428. doi: 10.7326/0003-4819-119-5-199309010-00014. [DOI] [PubMed] [Google Scholar]
  2. Bloom B. R., Murray C. J. Tuberculosis: commentary on a reemergent killer. Science. 1992 Aug 21;257(5073):1055–1064. doi: 10.1126/science.257.5073.1055. [DOI] [PubMed] [Google Scholar]
  3. Centers for Disease Control and Prevention (CDC) Diphtheria outbreak--Russian Federation, 1990-1993. MMWR Morb Mortal Wkly Rep. 1993 Nov 5;42(43):840-1, 847. [PubMed] [Google Scholar]
  4. Chaisson R. E., Keruly J. C., Moore R. D. Race, sex, drug use, and progression of human immunodeficiency virus disease. N Engl J Med. 1995 Sep 21;333(12):751–756. doi: 10.1056/NEJM199509213331202. [DOI] [PubMed] [Google Scholar]
  5. Eckardt I. Challenging complexity. Conceptual issues in an approach to new disease. Ann N Y Acad Sci. 1994 Dec 15;740:408–417. doi: 10.1111/j.1749-6632.1994.tb19901.x. [DOI] [PubMed] [Google Scholar]
  6. Epstein P. R. Commentary: pestilence and poverty--historical transitions and the great pandemics. Am J Prev Med. 1992 Jul-Aug;8(4):263–265. [PubMed] [Google Scholar]
  7. Field M. G. The health crisis in the former Soviet Union: a report from the 'post-war' zone. Soc Sci Med. 1995 Dec;41(11):1469–1478. doi: 10.1016/0277-9536(95)00060-k. [DOI] [PubMed] [Google Scholar]
  8. Fife D., Mode C. AIDS incidence and income. J Acquir Immune Defic Syndr. 1992;5(11):1105–1110. [PubMed] [Google Scholar]
  9. Frenk J., Chacón F. Bases conceptuales de la nueva salud internacional. Salud Publica Mex. 1991 Jul-Aug;33(4):307–313. [PubMed] [Google Scholar]
  10. Iseman M. D. Tailoring a time-bomb. Inadvertent genetic engineering. Am Rev Respir Dis. 1985 Oct;132(4):735–736. doi: 10.1164/arrd.1985.132.4.735. [DOI] [PubMed] [Google Scholar]
  11. Johnson K. M., Lange J. V., Webb P. A., Murphy F. A. Isolation and partial characterisation of a new virus causing acute haemorrhagic fever in Zaire. Lancet. 1977 Mar 12;1(8011):569–571. doi: 10.1016/s0140-6736(77)92000-1. [DOI] [PubMed] [Google Scholar]
  12. Krieger N., Rowley D. L., Herman A. A., Avery B., Phillips M. T. Racism, sexism, and social class: implications for studies of health, disease, and well-being. Am J Prev Med. 1993 Nov-Dec;9(6 Suppl):82–122. [PubMed] [Google Scholar]
  13. Krieger N., Zierler S. What explains the public's health?--A call for epidemiologic theory. Epidemiology. 1996 Jan;7(1):107–109. doi: 10.1097/00001648-199601000-00020. [DOI] [PubMed] [Google Scholar]
  14. Lurie P., Hintzen P., Lowe R. A. Socioeconomic obstacles to HIV prevention and treatment in developing countries: the roles of the International Monetary Fund and the World Bank. AIDS. 1995 Jun;9(6):539–546. doi: 10.1097/00002030-199506000-00002. [DOI] [PubMed] [Google Scholar]
  15. Mac Kenzie W. R., Hoxie N. J., Proctor M. E., Gradus M. S., Blair K. A., Peterson D. E., Kazmierczak J. J., Addiss D. G., Fox K. R., Rose J. B. A massive outbreak in Milwaukee of cryptosporidium infection transmitted through the public water supply. N Engl J Med. 1994 Jul 21;331(3):161–167. doi: 10.1056/NEJM199407213310304. [DOI] [PubMed] [Google Scholar]
  16. McCarthy S. A., McPhearson R. M., Guarino A. M., Gaines J. L. Toxigenic Vibrio cholerae O1 and cargo ships entering Gulf of Mexico. Lancet. 1992 Mar 7;339(8793):624–625. doi: 10.1016/0140-6736(92)90918-s. [DOI] [PubMed] [Google Scholar]
  17. McCord C., Freeman H. P. Excess mortality in Harlem. N Engl J Med. 1990 Jan 18;322(3):173–177. doi: 10.1056/NEJM199001183220306. [DOI] [PubMed] [Google Scholar]
  18. McKenna M. T., McCray E., Onorato I. The epidemiology of tuberculosis among foreign-born persons in the United States, 1986 to 1993. N Engl J Med. 1995 Apr 20;332(16):1071–1076. doi: 10.1056/NEJM199504203321606. [DOI] [PubMed] [Google Scholar]
  19. McMichael A. J. The health of persons, populations, and planets: epidemiology comes full circle. Epidemiology. 1995 Nov;6(6):633–636. [PubMed] [Google Scholar]
  20. Morse S. S. Factors in the emergence of infectious diseases. Emerg Infect Dis. 1995 Jan-Mar;1(1):7–15. doi: 10.3201/eid0101.950102. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Murray C. J. Social, economic and operational research on tuberculosis: recent studies and some priority questions. Bull Int Union Tuberc Lung Dis. 1991 Dec;66(4):149–156. [PubMed] [Google Scholar]
  22. Navarro V. Race or class versus race and class: mortality differentials in the United States. Lancet. 1990 Nov 17;336(8725):1238–1240. doi: 10.1016/0140-6736(90)92846-a. [DOI] [PubMed] [Google Scholar]
  23. Patz J. A., Epstein P. R., Burke T. A., Balbus J. M. Global climate change and emerging infectious diseases. JAMA. 1996 Jan 17;275(3):217–223. [PubMed] [Google Scholar]
  24. Sampson J. H., Neaton J. On being poor with HIV. Lancet. 1994 Oct 22;344(8930):1100–1101. doi: 10.1016/s0140-6736(94)90623-8. [DOI] [PubMed] [Google Scholar]
  25. Satcher D. Emerging infections: getting ahead of the curve. Emerg Infect Dis. 1995 Jan-Mar;1(1):1–6. doi: 10.3201/eid0101.950101. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Small P. M., Moss A. Molecular epidemiology and the new tuberculosis. Infect Agents Dis. 1993 Jun;2(3):132–138. [PubMed] [Google Scholar]
  27. Spence D. P., Hotchkiss J., Williams C. S., Davies P. D. Tuberculosis and poverty. BMJ. 1993 Sep 25;307(6907):759–761. doi: 10.1136/bmj.307.6907.759. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Wallace R., Fullilove M., Fullilove R., Gould P., Wallace D. Will AIDS be contained within U.S. minority urban populations? Soc Sci Med. 1994 Oct;39(8):1051–1062. doi: 10.1016/0277-9536(94)90376-x. [DOI] [PubMed] [Google Scholar]
  29. Warner D. C. Health issues at the US-Mexican border. JAMA. 1991 Jan 9;265(2):242–247. [PubMed] [Google Scholar]
  30. Wilson M. E. Travel and the emergence of infectious diseases. Emerg Infect Dis. 1995 Apr-Jun;1(2):39–46. doi: 10.3201/eid0102.950201. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Emerging Infectious Diseases are provided here courtesy of Centers for Disease Control and Prevention

RESOURCES