An intersectional approach in social epidemiology: Understanding health heterogeneity

Critical debates within the science of (social) epidemiology concern the relative lack
of social theory in epidemiological research and the low discriminatory accuracy (DA)
of much epidemiological knowledge on factors and markers of risk for disease.
Against this background, this thesis integrates intersectionality theory into
epidemiological study. The purposes are to improve the understanding of
heterogeneities in population groups and thus increase DA, and to incorporate a
theoretical framework that directs attention toward power dynamics driving the
production of health disparities as well as toward their measurement. An
intersectionality perspective is incorporated into empirical study of risk for ischemic
heart disease in Sweden, and of influenza vaccination uptake in the US. A categorical
intersectionality perspective is operationalized through assessment of difference in
average risk between intersectional strata. The measurement of the DA of the social
and racial/ethnic categorizations used is aligned to an anti-categorical intersectionality perspective, as this DA is found to be low due to heterogeneities within and/or overlaps between groups.

Despite the integration of intersectionality theory, the DA of the social and
racial/ethnic categories under study remains low. Such measurements of low DA
point to a current limitation in knowledge about causation mechanisms and
individual heterogeneity in (social) epidemiology. This project has therefore been
partially driven by an interest in other possible ontological ways of understanding
health, risk and prevention of disease, found in complementary or alternative forms of
medicine (CAM). The thesis includes a pilot study measuring the use of, and
attitudes towards, CAM and conventional medicine in Skåne, the southernmost
province of Sweden.