An Interview with Julie Cwikel

Julie Cwikel is associate professor in the department of social work at Ben Gurion University of the Negev, is Israel. She is also the founder and director of Israel’s only academic center on women’s health—The Center for Women’s Health Studies and Promotion Ben Gurion University of the Negev. In Social Epidemiology: Strategies for Public Health Activism, Cwikel shows readers how the exciting and growing field of social epidemiology is both practical and activist, drawing on cutting-edge empirical findings to conduct policymaking research and promote health at both the personal and population levels. Here is an interview with Julie Cwikel about the book:nnQ: There are many different approaches to social epidemiology in the public health literature. What is unique about the model proposed in this book?nnJulie Cwikel: Theorists in social epidemiology have been concerned, for the most part, with studying the social determinants of health, such as poverty, gender, social stratification, social capital, and demographic features such as age, education, immigrant status, etc. While this yields much useful information, this book emphasizes that social factors can be both the determinants of health and the very conditions that we wish to study. For example, obesity, substance abuse, depression, or domestic violence can be predictors of health status as well as foci for research and public health activism. This book gives equal importance to the psychosocial, biological, and medical determinants of health and diseases states. Once we have empirical evidence about these issues, then social epidemiologists are called on to use their knowledge to maintain and promote health and well-being among individuals, groups, communities, and nations. This book moves from empirical research to evidence-based practice based on tools from both the social sciences and epidemiology. The analysis in the book is based on the SOCEPID model, which is a heuristic for looking at the different aspects of a health or social problem with a social epidemiological lens.nnQ: How are the challenges that public health activists face in the world today essentially different from those of last century?nnJC: In many ways, societies react to health threats in the same ways they have for centuries, often with stigma and fear rather than using scientific evidence. Understanding these historical trends gives us new tools to manage the new epidemics of this century, whether we are talking about SARS, HIV, or the growing incidence of obesity and the increasing rate of diabetes associated with this. The differences in our responses today lie with the dizzying pace of globalization and travel in the world which, on the one hand, allows access to information through the Internet as we never had before while at the same time bringing cultural and societal change at a very rapid pace. Thus, infectious diseases travel further and faster while, at the same time, scientists can use the Internet to solve problems even though they are not physically present in the same place. This was very apparent in the swift isolation of the SARS virus, which was isolated in a matter of weeks compared with the many years of research that it took to identify HIV. These trends are all presented in this book.nnQ: You have included the history of social epidemiology in this book. Why do you feel that it is important to review these developments?nnJC: I feel that it is vital to learn about the social developments that led to modern social epidemiological theory because they grew out of manifestations in public health in general, outcomes of World War II, social policies such as apartheid, and ethical breaches in research and treatment through the use or misuse of tools such as radiation. Earlier activists were the forerunners of concepts such as the Healthy Cities Movement, occupational health protections, civil and workers rights. While today we speak of the right to health or the need for access to health services, these issues have been on the public agenda for a long time. When we understand both these trends and the language used then, we can more effectively see the inter-relatedness of social and health issues.nnQ: Many practitioners find it difficult to move from conducting research into applying the research in the field toward health promotion. In what way does this book offer new tools and guidelines for making this transition more effective?nnJC: The book is innovative in the connection between the tools and language used in the social sciences and those used in epidemiology. Thus, for example, the book integrates research design in both paradigms and shows how it is possible to use qualitative and quantitative methods in many combinations over three research types: descriptive, analytic, and program evaluation. It takes well-known tools in epidemiology, such as screening tests, and asks how they can be applied to social issues and problems. The book goes beyond this: it suggests ways in which theories of social epidemiology can be integrated into policy, practices, and interventions at both the individual and community levels using, for example, participatory action research. However, what is unusual about this book is that it presents the SOCEPID model, which suggests how to incorporate cultural aspects; observations form the field and the social issues, together with empirical, epidemiological research, in order to plan research programs and political change. Today’s social epidemiologists need to know how to work effectively with concerned laypeople, community organizations, and health care professionals to form coalitions that are effective in public health activism.nnQ: This book is designed as a textbook. For what type of students do you feel it is appropriate?nnJC: This book is suitable for both undergraduate and graduate students and for the informed layperson as well. The book assumes that those who are interested in social epidemiology may be from any of the helping professions and from any type of social or medical research background. Thus, this book is as relevant to professors of medicine and public health as it is to a community health worker who wants to learn more about injury control or HIV. The last section of the book takes the tools presented in the first two sections and applies them to the analysis of chronic illnesses such as cancer, heart disease, diabetes and obesity, injury control and violence prevention, sexually transmitted diseases (including HIV), environmental and occupational hazards, and the health issues of special populations such as immigrants, migrants, and persons living in war zones. A special effort was made to use many international examples so that readers from outside the United States will feel that the book is relevant and represents them too. This also demonstrates how ideas and methods are transferable to other contexts as social epidemiologists increasingly work in communities all over the world.