ABSTRACT
This chapter provides some critical reflections on epidemiology and social epidemiology, as well as the application of risk-factor social epidemiology to the social determinants of health. Whilst there have been significant recent methodological advances within the field of social epidemiology, the risk-factor approach still dominates. Using a case-study of migration, population mobility and HIV in sub-Saharan Africa, this chapter illustrates some of the political-economic limitations of this approach when analysing the structural drivers of HIV. These limitations include an inherent methodological individualism at odds with the social determinants of health, the need for complex social phenomena to be captured in a reduced form by variables that can be incorporated into statistical analyses, and the extent to which variables like ‘being mobile’ are treated in the same way as exposure, such as having unprotected sex. The consequence is an expanding literature that reports often inconclusive and contradictory results, leading to few firm conclusions on the extent to which mobility is a risk factor for HIV and for whom. The social epidemiological approach is contrasted with a political economy approach that emphasizes the need to locate the relationship between population mobility and HIV within the dynamics of contemporary capitalism, and the experiences and working conditions of mobile populations.
