Producing Change to Understand the Social Determinants of Health: The Promise of Experiments for Social Epidemiology
Producing Change to Understand the Social Determinants of Health: The Promise of Experiments for Social Epidemiology
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产生变革以了解健康的社会决定因素：社会流行病学实验的前景
DOI：
10.1093/aje/kwac142
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发表时间：
2023
影响因子：
5
通讯作者：
Berkman L
中科院分区：
文献类型：
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作者：
Berkman L
在这篇评论中，邀请了100周年的杂志，我们讨论了随机实验的增加，沿着自然实验，模仿随机试验使用观察数据，作为设计在社会流行病学家的工具箱。这些方法改变了我们定义和询问社会暴露问题的方式。它们迫使我们提出问题，即明确的干预措施如何改变可能导致健康变化的社会暴露。因此，实验具有独特的公共卫生和政策意义。我们认为，他们是一个强有力的方法，以促进我们的理解如何明确的变化，社会暴露影响健康，以及如何可信的社会政策改革可能有助于解决健康不平等。我们专注于两个研究设计。第一种是“纯”随机对照试验（RCT），研究者定义并随机分配干预措施。第二个是自然实验，它利用了这样一个事实，即真实的世界中的政策或干预措施往往涉及随机分配的元素，模仿RCT。为了给读者提供我们的底线：虽然承认它们的局限性，但我们仍然对RCT和自然实验在推进社会流行病学方面的前景感到非常兴奋。
In this commentary, invited for the 100th anniversary of theJournal, we discuss the addition of randomized experiments, along with natural experiments that emulate randomized trials using observational data, as designs in the social epidemiologist’s toolbox. These approaches transform the way we define and ask questions about social exposures. They compel us to ask questions about how well-defined interventions change a social exposure that might lead to changes in health. As such, experiments are of unique public health and policy significance. We argue that they are a powerful approach to advance our understanding of how well-defined changes in social exposures impact health, and how credible social policy reforms may be instrumental to address health inequalities. We focus on two research designs. The first is a “pure” randomized controlled trial (RCT) in which the investigator defines and randomly assigns the intervention. The second is a natural experiment, which exploits the fact that policies or interventions in the real world often involve an element of random assignment, emulating an RCT. To give the reader our bottom line: While acknowledging their limits, we continue to be very excited about the promise of RCTs and natural experiments to advance social epidemiology.