Prevention/Intervention

Berkman, "Social Epidemiology: Social Determinants of Health in the United States: Are We Losing Ground?" (on Zotero for your reference)

This article, framed from the public health perspective, focuses on a) life course paradigms as they relate to interventions (if you don't know what a "life course paradigm" is, don't worry, I'll explain below/in class) and b) influences on and determinants of population health.

The impetus for this work was the realization that, despite observational studies which show, for example that heart attack patients "with low levels of social support and weak networks and high levels of depression were at substantial risk" of more heart attacks and death, the results of intervention programs showed either no effect or even slight harm (32). This led Berkman to examining life course paradigms more closely.

The three paradigms are:
1) Latency: based on "critical or sensitive periods in which early childhood or even prenatal exposures shape subsequent outcomes that may or may not be evident for years" (33). This model is supported by experiments with rats--some handled and some not handled in early life. The rats in the two groups remained similar in behavior and development until midlife/older age, when "the nonhandled rats developed significant cognitive impairment and simultaneously had higher levels of corticosterone"(34) (corticosterone is one of those "stress hormones" diet supplement commercials are always pestering us about).
2. Cumulative exposure: based on the idea that, in the absence of critical periods, life experiences simply have a cumulative effect, so repeated exposure to something would cause significant shaping of behavior or development (33). This model is supported by empirical evidence from studies that link prolonged periods of economic disadvantage to increased risk of disease, for example heart disease (35). It's important to note that the cumulative exposure paradigm "argues that changes in adulthood to modify risk or prevent the onset of risk will partially offset the risks set by trajectories in early childhood (35).
3. Social trajectory: contends "that early life exposures do not directly affect adult health. They
influence adult social conditions, which, in turn, affect adult health. In this case, intervention in
adulthood can completely offset harm incurred in childhood" (36). An example of this paradigm at work (haha, punny) is related to occupational hazards. Early life experiences, such as education and class, put people on the track to more or less hazardous jobs, which results in more or less exposure to contaminants, risk of death, stress, etc. These risks can be undone with an adult intervention to change the workplace (36).

The common thread in all of these paradigms is that they seek to identify critical, sensitive, or etiological periods during which intervention would be most effective.

The prevention paradox: illustrated by Rose, it demonstrates that "a large number of people with a relatively modest risk may produce more cases of disease than would a small number of people
at high risk" and therefore prevention should focus on the whole population and not just those perceived to be at highest risk. However, Berkman acknowledges the impracticability of such strategies most of the time (shown through statistics, which I can talk about if you really want me to haha).