Comparative Perspectives conference write-up
Comparative perspectives on social inequalities in life and death: An interdisciplinary conference - write-up
The question of how social inequalities in life and death are made, unmade and remade is located at the very epicentre of scientific and policy debates alike at century’s dawn. Since 2014, the St John’s College Reading Group on Health Inequalities has been bringing together scholars from a range of disciplines to consider the wider mechanisms by which disparities in human health arise and are sustained across time and generations.
The purpose of our conference was to probe this interface through a novel analytic lens capable of shedding fresh light on the matter of health inequalities. Our threefold goal was to promote an interdisciplinary research agenda that weds insights from a variety of research streams; to offer a framework within which diverse methodological approaches can be brought together; and finally, to address the contemporary relevance and urgency of developing a unified scientific understanding of health inequalities.
By deploying emerging analytic tools in biology to better understand key phenomena pertaining to inequality as studied by social scientists, we sought to bridge the gap between social and biological sciences on the one hand. On the other hand, to fully break with disciplinary sectarianism, we also wished to bridge the gap between diverse studies of social mammals, human and non-human alike. This ambition is rooted in the belief that such an endeavour will prove both fruitful and necessary in an age of rising inequities and deepening gulfs between different strata of local and global populations.
With the rapid developments in studies of the interaction between social factors and biology in the human and animal sciences, it is timely to consider anew potential synergies and avenues for future research. Several decades ago, the MRC funded a number of animal ethological studies to help inform the understanding of human health; this potential interchange remains to be consummated. The purpose of our conference was to do precisely that and to revisit the traditional relationships between sociology and biology and between human societies and social mammals as seen through the lens of adaptation. In short, there are untapped methodological potentials in the work we sought to showcase and explore; health inequalities remain a stubborn fact of life globally and efforts to do something about them based on associational epidemiology and a focus on proximal risk factors have failed to change anything to any substantial degree, save perhaps the political rhetoric. There is a lot we can learn from social mammalian studies and we wished to showcase this, along with the insights gleaned from the interdisciplinary approach the St John’s group has sought to develop.
The morning session focused on “Mechanisms and Processes”. In her opening address, Ann Louise Kinmonth established the conference as an interdisciplinary space for the consideration of what research from social mammals might contribute to our understanding of inequalities in health in human society. In the first talk of the day, Mike Kelly examined inequalities in human health by looking to the past at some of the key public health figures in the 19th century, highlighting longstanding observations that demonstrate a social gradient in health. Moving forward in time, he cited promising developments in the field of epigenetics that could offer ways to more effectively examine the links between the biological outcomes of social influences on health. Exploring this link between the social and the biological could bring together the hitherto often competing explanations focusing on material and structural factors, and cultural and behavioural factors.
Tim Clutton-Brock drew on extensive research on, amongst others, meerkats, red deer, and baboons to demonstrate not only how the environment in which you live can impact on health, but also that social relations and hierarchies within groups actively sustain inequalities. Those who are already advantaged work to maintain and enhance that advantage, while those who are disadvantaged seek to mitigate the consequences of their disadvantage, including poorer health.
Natasha Kriznik highlighted that in both human and non-human societies, an understanding of one’s position within a hierarchy directly influences health outcomes. Individuals internalise values and expectations concerning their position and role, which can lead to psychosocial experiences of inequality. Social position is maintained through an accumulation of capitals throughout the lifecourse; some of these may be inherited from parents while others are accrued by the individual throughout their life through, for example, education, work and socialising with others. One such capital is social capital, or the social networks to which one belongs. Social networks are not simply about “who you know” as they also offer support and trust to individuals – these are resources that can be drawn on in times of hardship. For humans, this might be in times of financial difficulty. For other social mammals, this trust might be vital in mounting challenges to dominant individuals or groups. As Tim discussed in his talk, social capital is a central resource in non-human social mammal society particularly when instigating challenges on the existing social order.
Natasha’s first question to the speakers was “Are hierarchies useful?”. Mike answered that, if you were to adopt a Functionalist approach, hierarchies could be seen as a “good” thing as they create competition and encourage individuals to do their best. Tim added that hierarchies are not natural; they emerge from relations and interactions with and between others and can therefore be challenged and change over time. This discussion gave rise to the second question, “How do we tackle ‘social stability’ in human societies?” – in other words, how can we address the fact that those at the top of society tend to stay at the top? The speakers noted that disasters, such as wars, and the political and economic decisions made in light of them could be great levellers. It is also important not to divorce the idea of social mobility from social structures; individuals cannot be blamed for their position in society.
The afternoon session was composed of three segments. First, Stephen Suomi offered an enlightening talk in which he outlined a set of mechanisms by which social exposures become embedded at a biological level. Through the study of behavioural and biological traits in rhesus monkeys, Stephen’s work empirically substantiates not only a pathway by which social inequalities are translated into vital inequalities, but also a pathway by which these are transmitted from one generation to the next. His research shows what social scientists have been wanting to show for a long time – namely that both material and symbolic components of one’s social habitat shape minds and bodies in ways that profoundly affect a range of complex phenotypes and disease susceptibility.
A striking example offered by Stephen is how extracellular signals, such as stress hormones (cortisol) secreted into the bloodstream in response to social adversity, can elicit changes in genome-wide transcriptional dynamics by up-regulating entire gene profiles whilst down-regulating others. However, this kind of social regulation of gene expression remains mediated by relational and interactive dynamics between social agents. Most notably, the affective ties between mother and infant in early social rearing processes are shown to play a major role for the acquisition of specific social skills and strategies that shape life course health trajectories, even under otherwise adverse environmental conditions.
In the second talk of the afternoon, Rebecca Sear demonstrated how, when seen through the evolutionary, adaptive lens of behavioural ecology, social and behavioural configurations associated with inequalities in health must be viewed as part and parcel of an environmental response repertoire. Insofar as plasticity allows for changes in a range of phenotypic traits in response to social and environmental conditions (whether benign or adverse), behavioural ecology allows us to better grasp the broader context in which such changes are triggered and reproduced across time and space.
She showed, for instance, how ecological settings can galvanise a set of adaptive responses that especially affect risk-seeking behaviour (such as smoking, drinking), reproduction (such as age at first birth), or parenting (breastfeeding or parental investment). In harsh, unpredictable environments, the social and material dynamics of family life differ from those in benign environments, in ways that shape the intergenerational transmission of advantage and disadvantage. In fact, the social gradient in health-related behaviours, such as breastfeeding, is more pronounced in harsh environments, whereas variability in adaptive behaviours decreases as the quality of one’s environment improves.
Both talks highlighted something that is both conceptual and methodological in nature, namely that the focal point of an analysis does not always have to be the individual. Both Stephen and Rebecca, in their own ways, emphasised the need to adopt a relational analytic lens which is sensitive to different kinds of causal dynamics that operate at different levels and scales of social life.
In Stephen’s case, the locus of interest was not so much the individual rhesus monkey but the interactive dynamics that tie individuals together throughout the life course, across generations. Similarly, Rebecca showed that the behavioural moralism that often accompanies public health recommendations – telling us to “choose healthy lifestyles” – tends to be blind to the ecological contexts in which our lives unfold and which have the capacity to shape our lived experiences in powerful ways.
The lead discussant for the afternoon was Elias Nosrati, who had been asked to offer some reflections on the preceding talks as seen through the analytic lens of a sociologist. Elias highlighted the importance of three concepts in Stephen’s and Rebecca’s presentations, namely mechanism, plasticity, and relationality. The concept of mechanism was most explicit in Stephen’s research on the diverse pathways (as outlined above) by which a set of social conditions materialise in the minds, bodies, and practices of rhesus monkeys. However, (the scientific understanding of) a mechanism does not need to be mechanistic nor rigid. Hence both Stephen and Rebecca spotlighted the plasticity that is operant at the confluence of social and biological reality, where plasticity designates the capacity to adapt to ecological pressures through a range of socially mediated experiences or strategies – or as the French sociologist Pierre Bourdieu would perhaps define it, the “natural capacity to acquire non-natural, arbitrary capacities”. Finally, Elias noted that both speakers had emphasised the need to adopt a relational understanding social stratification and its health consequences, according to which the study of individuals, communities, and groups should not be divorced from the bonds and interactions that tie them together.
The conference therefore proved a fruitful site for operationalising the notion of interdisciplinarity – a notion that not infrequently suffers from a hackneyed quality wrought by overexposure and vagueness. What has characterised the approach of the Reading Group, and this conference, has been to allow seemingly disparate, if not incommensurate, disciplinary perspectives to enter into dialogue with one another, not to undermine their internal logic and rigour under the rubric of “interdisciplinary synthesis” but to glean novel insights from this very tension. In many cases, we have discovered high levels of analytic and conceptual commensurability across seemingly divergent approaches to the study of health inequality which hitherto have remained underexplored and underexploited. This mode of investigation has allowed us to better understand strengths and weaknesses of extant research on health inequalities and will help us identify key sites of future enquiry.
We would like to thank Tim Clutton-Brock, Stephen Suomi, and Rebecca Sear for their wonderful lectures during the Conference.
St John’s College Conference Group: Ann-Louise Kinmonth, Mike Kelly, Natasha Kriznik, Elias Nosrati, Robbie Duschinsky and Guy Skinner.
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