Subjectivity as a key concept for epidemiological studies

Introduction:
Social Epidemiology is considered one of the main disciplines in the contemporary field of Public Health. It presents theoretical and methodological constraints including limitations in the definition of important concepts. One example is the use of the term subjectivity which is not well conceptualized and could subsequently hinder its operationalization.

 Objective:
To describe different concepts and methodologies that has been used in the field of Social Epidemiology to study the role of subjectivity in the health-disease process.

Method:
This is an exploratory and descriptive study developed through a qualitative analysis of theoretical work produced by main Social Epidemiologists. The analysis include a comparison of the work produced in Latin America by Jaime Breilh (Ecuador), Pedro Luis Castellanos (Venezuela) and Naomar de Almeida Filho (Brazil) and the theoretical work produced by Michael Marmot, John Lynch and Richard Wilkinson in the Anglo-Saxon world.

Results:
Latin American epidemiologists use concepts such as: conciousness, social representation, perception, behavior, knowledge, organization, empowerment, meaning, signification, symbolic to describe the concept of “subjectivity”. Anglo-Saxon epidemiologists use concepts such as Subjective Social Status (SSS) and psychosocial factors/variables as control, anxiety, social affiliation and social support to talk about subjectivity, focusing their analysis on the importance of absolute or relative income (as described by Lynch or Marmot & Wilkinson) for understanding subjective wellbeing. Both “lines” recognised the important role of subjectivity as a “mediator” in the pathway between social determinants and health outcomes in populations.

 Discussion:
Improving of a scientific discipline is a dialectical task in which theory (with its conceptual construction) and practice are just moments of an unique process. Subjectivity is both an important concept for Epidemiology and a key dimension in the health-disease process, but has been extremely difficult to operationalised it. Thus Epidemiological studies on its mechanism as a “mediator” has been scarcely.