Beyond traditional paradigms in disparities research

Recently several researchers have hypothesized pathways that attempt to explain how the sociobehavioral environment is related to health and health disparities (Acheson, 1998; Adler & Ostrove, 1999; Baum, Garofalo, & Yali, 1999; Birch, 1999; Capitman, Bhalotra, Calderon-Rosado, & Gibbons, 2003; Fuhrer et al., 2002; Macintyre, 1997; Macintyre, Ellaway, & Cummins, 2002; Williams, 1999). Historically these conceptual frameworks have formed a solid foundation upon which science has been built. Upon review of these frameworks, it is possible to make at least three general observations. The first is the lack of depth to which they integrate our present understanding of the biology of disease, particularly at the cellular and molecular levels. With the exception of those pathways based on stress (neuroimmunological) mechanisms, the published frameworks in the behavioral sciences and epidemiological literature largely lack clearly stated, causal biologic connections to observed health outcomes (Acheson; Adler & Ostrove; Evans & Stoddart, 1990; LaLonde, 1981; Macintyre; Williams). On the other hand, the biologically oriented formulations poorly account for socioenvironmental and behavioral effect modifiers that may affect the pathogenesis of disease and the development of health disparities (Burger & Gimelfarb, 1999; Meyer & Breitner, 1998; Phillips & Belknap, 2002; Sharma, 1998).