The Role of Sociology and Social Networks in Integrating the Health Sciences

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The Role of Sociology and Social Networks in
Integrating the Health Sciences
Bernice A. Pescosolido Indiana University Present
ation in the Networks and Complex Systems Talk
Series, Indiana University, November 28,
2005 Support is acknowledged from NIMH grant
K0242655, Indiana Consortium for Mental Health
Services Research (ICMHSR), and Indiana
University (COAS OVP)
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• The long-standing debate about the importance of
  nature versus nurture, considered as independent
  influences, is overly simplistic and
  scientifically obsolete.
• -- Neurons to Neighborhoods (20006)
• It is time to reconceptualize nature and nurture
  in a way that emphasizes their inseparability and
  complementarity, not their distinctiveness it is
  not nature versus nurture, it is rather nature
  through nurture.
• -- Neurons to Neighborhoods (200041)
• In the past 25 years, the study of human health
  has included a distinguished, but neglected
  intellectual tradition put forth by numerous
  investigators, who saw the need for broad
  integrative frameworks that capture complex
  pathways to illness and disease.
• -- New Horizons in Health (200121)

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Series of Reports

• New Horizons in Health An Integrative Approach,
  2001
• Toward Higher Levels of Analysis Progress
  Promise in Research on Social and Cultural
  Dimensions of Health, 2001
• Bridging Disciplines in the Brain, Behavioral and
  Clinical Sciences, 2000
• From Neurons to Neighborhoods The Science of
  Early Childhood Development, 2000
• Through the Kaleidoscope Viewing the
  Contributions of the Behavioral and Social
  Sciences to Health, 2002
• Breaking Ground, Breaking Through The Strategic
  Plan for Mood Disorders Research of the NIMH,
  2002
• Translating Behavioral Science into Action, 2000

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Basic Problem

• Limits of biomedical approaches in predicting who
  gets sick, who seeks treatment, and who recovers

Call

• Understanding contexts
• Integrating health sciences

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Dilemma

• How to synthesize
• How to select among panorama of influences

Possible Solution

• Contexts as social structures
• Social structures as association or
  interaction
• Social networks

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Claim

• This convergence makes way for social networks
  place in integrated health research

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Three Baseline Conditions for a Response

• All levels relevant to health and health care
  must be considered, separated out and linked in
  an overarching theoretical frame by a similar
  mechanism, even when research targets only one
  level
• Room must be made to tailor such frameworks to
  particular populations, whether socially (ethnic
  or age groups) or medically (disease types)
  defined
• Find a way to work within big science to
  address problems from social construction to
  social causation that contribute to our
  understanding of basic social processes as well
  as medical phenomena

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Current Climate

• driving the disciplines toward each other
• bringing the behavioral and social sciences more
  strongly and visibly into the full panorama of
  health research
• groundswell of support
• foster communication among scientists who have
  been too long isolated behind disciplinary walls

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Looking Up From the Microscope and the Clinic

• The success of pure biomedical science that has
  led to the call to look up from the microscope to
  the environment.
• Epigenetic modification
• 50 genetics and 50 environment
• 90 of diseases do not follow simple genetic
  rules of inheritance
• Effectiveness not efficiency

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The Current Landscape of Integration
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The Environment

• The Black Box of BMS
• Luck, Chance

IOM (Committee on Assessing Interaction Among
Social, Behavioral, and Genetic Factors and
Health)

• How should social environments be conceptualized
  and measured?
• Which aspects of the social environment should be
  included and at what levels of analysis?
• How do we consider present influences and those
  that have accumulated over the life course?

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E. O. Wilson

• Consilience, 1998

De Waal

• Continued disarray of the social sciences, 1996

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Requirements for Integrating Models and Frameworks

• consider and articulate the full set of
  contextual levels that have a documented role in
  past empirical research
• offer an underlying mechanism or engine of
  action that connects levels, is dynamic, and
  allows for a way to narrow down focal research
  questions
• employ a metaphor and analytic language familiar
  to both social and natural science that can
  facilitate synergy
• understand the need for and use the full range of
  methodological tools proven useful in the social
  and natural science

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Bronfenbrenner Nested Contexts
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The Key Social Networks as Theoretical Foundation

• Puts human face on issues of access, barriers,
  intervention, by conceptualizing these as actions
  of individuals.
• Relationships are fundamental mediators of
  human adaptations.
• Networks are the active ingredients of
  environmental influences. Offers the underlying
  engine of action.
• Neurons to Neighborhoods

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NEM-Phase I Cause Consequence of
Illness/Disease Reconsidered (SOS)

• The Role of Others
• The Role of Cultural Toolboxes
• The Role of Time
• The Role of Options
• Embeddedness Social Networks
• Habit/Knowledge Content
• Dynamics
• Patterns Pathways
• Turning Points, Trajectories

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The NEM Phase I
(Pescosolido, Advances in Medical Sociology, 1991)
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The NEM Phase I
Support Choice, Coercion Muddling
Through 46 25
33 (Social Science Medicine, 1998) Patterns
of Care Social Influence (Medical Care, 1998)
Limits Role of Treatment/Organizations
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Network-Episode Model Phase II

• The Dynamics of Treatment, Organizational and
  Policy Change
• Networks
• Outside Networks
• Inside Networks

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The NEM Phase II
(Pescosolido Boyer, A Handbook for the Study of
Mental Health, 1999)
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The NEM Phase II

• Support
• Power of Organizational Context
• (Wright, Psychiatric Services, 1997)

• Limits
• Role of Disease Course
• Role of Individual
• Role of Community

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The Network-Episode Model Phase III

• The Elaboration of Contexts
• Focus on Multi-disciplinary Integration and
  Synergies
• People as the Agents of Change
• Networks as Mechanism that Connect Different
  Levels and Processes

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What Should An Integrated Health Science Model
Look Like?
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Barabási Complex Network Model
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The Network-Episode Model Phase III (Rejected)
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The NEM III Under Construction
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Nagging Questions

• Need we all embrace the Network-Episode Model or
  even the network metaphor?
• Does this mean that everyone must be engaged in
  multi-level, multi-disciplinary endeavors?
• How are integrated, multi-level studies likely to
  be accomplished?

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Multi-disciplinary versus Interdisciplinary

• All too often it is insisted that there is only
  one kind of data, one methodology that should be
  employed, when everything we know about the major
  issues in the development of the social sciences
  should warn us against such imperialism.
• Jane Lewis, 2003
• The Political Quarterly

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Big Science
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The Crossroads

• Shackled by tribal loyalty
• Snarled by disunity and a failure of vision ?
• OR
• Have we traveled different pathways to a similar
  vision?

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Conclusion

• Biophobia (Freese et al 2003)
• Methodenstreit (Swedberg 1989)
• Imperialist intrusion (Collins, 1986)
• OR
• Mutual credibility (Modell, 2002) ?