Social epidemiology: directions for the future in academic and "shoe-leather" risk analysis.

In the past, social epidemiology has been a field of interest to only a few professionals, notably sociologists and a select few epidemiologists. Expansion of the scope of epidemiology beyond infectious diseases and a few chronic diseases has made social epidemiology vitally important in the work of a host of professionals in public health and preventive medicine. These include persons doing risk analysis, persons working in environmental and occupational health, health educators, and persons working in institutions such as labor unions and schools which mediate the effects of risk factors upon population groups. With the expansion of the field, it is becoming apparent that the interrelationships among social risk factors are complex. Some social factors are both predictors of health status and outcome factors. This complexity will require new analytic methods, some of which are outside the present repertoire of most epidemiologists and biostatisticians. This paper examines the changing scope and impact of social epidemiology and suggests directions for the future of teaching and research in the field. If these new directions, guide research and teaching in the field, public health professionals will be able to bring a host of newly acquired skills to their "shoe-leather" epidemiology. Using those skills will require broad interdisciplinary cooperation in health promotion and disease prevention.