==Needs to be edited for reading. A summary of this is [[Eco-social theory|here]]== Speaker 1:  It is building upon a huge body of work and trying to synthesize, summarize multiple sort of developments in multiple fields, all of them related to health inequities and inequalities. Yeah, so I think this paper, not only this paper, but the author Nancy Krieger has, by sort of advocating the eco-social approach, eco-social theory, has helped advance a more comprehensive understanding of why some inequalities are pervasive and why some inequalities are pervasive in particular population groups, in particular regions and particular time periods. So it's a very lucid sort of overview of that. Speaker 1:  The first two quotations, so I don't have a PowerPoint presentation, I was hoping that this could be an interaction and I hope I will finish before 12.30 so that we can have a bit more discussion perhaps. So the paper for those of you who have not already read it, begins with two very nice quotations, of which the second one I would like to read out. It says, "Once we recognize the state of the art is a social product, we are freer to look critically at the agenda of our science, its conceptual framework and accepted methodologies and to make conscious research choices." So I think at the very heart of this paper is the submission that the product of science itself is a social one, it's socially constructed, given that human beings who have very diverse experiences, social, cultural, political beliefs, etc. are the ones who are also scientists. Even if they are engaging in a very objective enterprise, they bring in their own sort of thinking, their beliefs, their cultural systems into their science. So in some sense, some of you may recollect how I keep mentioning in many instances how we need to distinguish between the science and the scientist. Whereas the science seeks to seek validity outside social constructs, the scientist is always a product of the society into which he is born into and the time into which he is born into. So I think that underlying premise is what is there. So the article sort of begins with introducing social epidemiology. So social epidemiology for those who are already not familiar with this term is, you could say a branch or a wing or something. Speaker 1:  Within epidemiology, the group that tries to understand why there are various different disease patterns across social groups, which is something that has been from the very beginnings of epidemiology, the consistent finding across studies. So it first begins by showing how this is a product of both society and biology. And that's something, even today, I think many epidemiological frameworks do not sufficiently acknowledge the society and biology together produce these patterns. I thought I will discuss a few salient features of the paper as we go along. So to begin with, she talks of how the origins, at least in modern American literature, where these social epidemiology begins. So it begins, in fact, in order to reinforce that science is a product of society, she gives a very powerful example of how scientific questions can reproduce the prejudice of the day. For example, early questions in American public health and epidemiology community were related to explaining why black people have worse health outcomes. And the obvious immediate choice of research questions were to do with one, either bad genes or bad behaviors. So for a long time and for a very long time, which I'm not talking about five years or 10 years, I'm talking about decades, if not centuries, was spent on epidemiological research that tried to explain this pattern of black people having worse health, either because they are indulging in unhealthy behaviors, or they have some genetic defect or a problem, which is the reason underlying this disease pattern. So this is again a beautiful illustration of the original quotation of how the scientist and the way he understands society can very pervasively enter into very good quality research. So you can do a very good quality research scanning for genes in a particular cause or in particular communities on why their health is poor because it is embedded in their genes, which of course, over the last several decades, thanks to social consciousness raising has been largely discredited as unscientific, unethical and immoral kind of an approach. But we must remember that these are, there are very many research papers with very good research methodologies, sound science, which try to advance this hypothesis and build a body of knowledge around bad genes explaining social epidemiological patterns. Then in the first page, she goes on to tracing the history. Unfortunately for us, it's entirely American epidemiology history that is traced. She begins with which when was the first time social and medicine came together and she traces that to Alfred Young cover in American Sociological Review in 1950. But we know that this has been around for a very long time. Rudolph Warkow, for example, when he investigated type first epidemics in I think Southern or Eastern Europe was already saying that the way to overcome type of epidemics is investment in schools, colleges, education, empowerment, etc. And yeah, so it's been it's been around before even if it has not had the name social epidemiology. Speaker 1:  Then after that piece, I think which is not very relevant for us the history of social epidemiology in the US, I'll drop that. So she then identifies three theoretical trends in social epidemiology. And I think this is very important for us for all of us who are working on health inequalities, public health in general. So the first theme is the so called psychosocial theory. The second one is the social production of disease and the political economy of health. And the third one is her own or at least the one that she has championed, which is called eco social theory. But there are a few others which are somewhat related to this. And one very interesting remark she makes in on the stage 669 under the paragraph current theoretical trends in social epidemiology. She says all these three seek to elucidate principles capable of explaining social inequalities in health and all represent what I would term theories of disease distribution. But cannot be reduced to make more into theories of disease causation. Speaker 1:  So I would I would suggest taking to spend some time unpacking this line. These theories, am I still audible? Speaker 1:  It says my internet. Hello. Yeah, Prashanthi, your voice was breaking a little bit. So, but we could hear you. So am I audible now? Yes. Speaker 1:  Okay, okay. So this is very interesting because I think and this also speaks to the critique that she offers to the first two of these theories. What does mean so the idea that our epidemiology as a discipline or even science as a discipline will explain patterns. Yeah, so we see some patterns we see that certain phenomena are accumulating in certain populations of geographies and epidemiology seeks to explain those patterns. So this is what she says is is something we should be aware of because sometimes we confuse explanation of patterns with mechanism oriented causation of disease. Yeah. So why the question is not about why there are these patterns. The question according to her which a good social epidemiology theory needs to offer is why are there these patterns? Why are these patterns pervasively occurring only in these communities as opposed to eloquently explaining the distribution of those patterns itself and we'll come back to this. So the so let's spend maybe five minutes each I have 15 minutes. So I thought I'll spend five minutes each on these three theories the psychosocial theory social production of disease and ecosystem theory and then we can wrap it up. So the psychosocial theory she presents a very nice history of where this comes comes from and for those who are unfortunately or unfortunately are doctors we all remember agent host in my book called park and park preventive and social medicine. I don't know which other disciplines have it but park and park book of social preventive social medicine starts with that thing disease host and environment yeah the triad in why disease occurs and it's very nice because she starts where the thinking comes from. So if you see not disease host and environment sorry agent host and environment. Speaker 1:  So when you say agent in most biomedical epidemiology we are talking of typically the pathogen yeah so and she says here to expand the ecological framework from simply agent to host agent environment so to begin with I think biomedicine started with the idea that diseases is caused by a pathogen and that's where it begins the quest for the agent and then from the quest for the agent epidemiology emerges and says okay it's not only the agent here still we are talking of agent as a pathogen an external pathogen we they epidemiology progresses to say no it's not only the agent it's the agent and the host and the environment yeah and here she says agency for example remains located in the agent typically an exogenous entity that acts upon a designated host terminology alone renders it inhospitable to conceive that the host had also has agency yeah so this is extremely important in understanding that the the lot of the causation occurs at the interfaces of these boxes which we put all our ideas into we say okay agent factors post factors environment factors and we often apply our frameworks in that way we identify what belongs in what box and that strips the output the scientific output of the interaction which is inherently where we are able to understand the agency operating yeah and environment in that agent-host environment framework is a very catch-all term for a variety of things and typically for the natural environment so for example I remember doing an exercise on why malaria occurs and we said environmental factors and we were always looking for stagnant water we were looking for the tire which holds water unhygienic we said okay some people have unclean homes and hence diseases occur there so it and she later gives a very nice description of how we are constantly trying to describe who falls off the cliff and what are his or her characteristics as opposed to understanding who is pushing them off the cliff yeah so which is what you know social epidemiology or to say so why is it that some people are falling off the cliff and others are you know quite fine so we never ask for example why some homes tend to be unclean why is stagnant water tends to occur only in certain locations in Bangalore if I take an example why is stagnant water a problem only in a tandoori road slums and not in koramangala for example yeah so that invisible and powerful forces which distribute and let the stagnant water be in some places and do not let it be in other places in fact is guiding this interaction between the agent-host and environment which she says is the larger critique she offers I'm really jumping her chips here okay so coming back in in in in this section on psychosocial theory she also has a beautiful piece on the evolution of of of the work on social on on this on how in epidemiology thinking at least in America and the west how the social environment in terms of the social institutions the norms the internal household gender dynamics for example how they find a place they start in the 40s and 50s attributable to this article by John Castle titled the contribution of the social environment to host resistance and this is very interesting because the John Castle tries to talk about okay everyone maybe epidemiology will tell us that a certain exposure is associated with a certain adverse outcome yeah now the question is it doesn't happen for everybody it's not that for example I might be exposed to TB germs but I might not develop symptoms of tuberculosis that someone else might develop and that has to do also with my vulnerability yeah not only my physical vulnerability but my social vulnerability which could translate into physical vulnerabilities which in turn make me respond to an exposure with an infection so this interplay between exposure susceptibility and resistance these three related but very important interacting components is very beautifully explained and she comes back to these three exposure susceptibility and resistance not vulnerability vulnerability has a much stronger social component you can even locate vulnerability entirely in the biomedical space and put it as susceptibility and even then this would make sense yeah so I would encourage you to read that and then she goes on to other work for example later on economists and others have popularized the idea of social capital and social cohesion as being important factors that could prevent the adverse accumulation of exposures and susceptibilities and that also is actually linked to what this guy castle begins to talk about so for example the fact that chronic stress triggers certain neuroendocrine responses within us which makes us even more because of the constant release of adrenaline and all various complex biomedical pathways chronic stress could biomedically is linked to variety of disease outcomes and this you will find publications even in nature and science which talks about these biomedical ways in which poverty and violence etc can are linked to poor health so but I think the critic here is yeah actually what I said earlier Aaron Antonovski I am on page 670 in the first column the paragraph before social production which she says Aaron Antonovski's penultimate lament that the study of why some people swim well and others drown when tossed into a river displaces study of who is tossing them into the current and what else might be in the water yeah so this is very powerful so that's the main critique she offers to the psychosocial theory coming to the next one on social production of disease and political economy of health I think this whole body of work on social production of disease actually somehow is a very powerful critique of the psychosocial theory because the psychosocial theories are completely located and embedded within the micro the household and the cap the social networks and things like that whereas here the talk is of the upstream factors what I spoke about earlier on why stagnant water is left to remain in some locations and is cleaned up in time in other locations has to do with public policy it has to do with who is in charge and and who the people in charge care about and things like that yeah so this also talks a bit to the political economy of illness and one of the leading proponents here among many others is Vincente Navarro I would for those who are not already familiar with some of his work I would point you to many one of his famous papers had to do with a very yeah a paper on why some what kind of politics lead to better health yeah so what kind of by politics I mean what kind of political arrangements at the government level lead to better health yeah so this is very interesting because I think I read out one question in the second column here arising in part as critique of proliferating blame the victim lifestyle theories which emphasize individuals responsibility to choose so-called healthy lifestyles and to cope better with stress so this is very interesting and it has direct implications on how and why we take up alcohol into a back of control work for example so even for I'll give you an instance you see for example conservation forest conservation groups often blaming the people who are hunting wildlife and if you see the Karnataka forest department on Twitter for example they consistently put up photographs of some of someone who is looking very clearly with extremely poor often poorly dressed they are wearing torn clothes and they are caught as and say okay we caught a hunter in so-and-so wildlife division hunting is illegal yeah so it's a classic example of trying to choose the weakest problem in conservation because the bigger ones are you know maybe in terms of mining interest be it in terms of access to tourist resorts or highways etc are taking a much heavier tone but you end up finding the weakest a bit similar when if smoking anti-tobacco and alcohol policies are framed as if the problem lies in the individual user as if we have to now focus on extremely good IEC strategy so that we explain to him that alcohol is bad oh you know don't you know smoking kills so this whole theory second theory on social production of disease tries to understand the upstream drivers of why some people take up alcohol or tobacco or anything like that and I think the good summary of that is is in for example it I think it comes up later for example as to invite in some black neighborhoods access to certain kinds of foods makes them much more predisposed to hypertension many of these things are made invisible nearly because of the way we frame our questions because we frame our questions in the way that there is something about the individual which is making him or her vulnerable to disease and we forget the macro-obscuring factors that in fact created these vulnerabilities in the first place so and so I think the second theory is a very powerful argument for in and for the importance of varying a theoretical lens when before we frame a question not as not theory as a way to answer a question which we often do but in fact to where that lens and ask and frame the question in that way so the second portion on social production of disease has fairly strong leanings in Marxist theories on on on why material accumulation of capital and resources in certain population groups in fact is the underlying driver of why some people consistently remain poor consistently remain deprived and hence manifest vulnerabilities so okay I'm already beyond time so I go to the final theory on eco-social theory which is basically she names three the eco-social theory that she introduced in 90s the eco epidemiology proposed by someone else and the social ecological systems perspective there's this very nice explanation of meta thoughts that she borrow from ecology and for lack of time I don't fully go into them but there are five core ecological perspectives that she very nicely eloquently explains how they make their journey to the social maybe just one example I would give here these are scale level of organization dynamic states mathematical modeling and understanding unique phenomena in relation to general processes which is very nice for example she says in the case of populations for example no two forests are identical but they share features and processes in common relevant to understanding that Genesis longevity and degradation are declined so while while these metaphors are very nice and they map on very nicely from natural phenomena like forests into human populations I think a very important critique is to remember is that in natural processes there is no agency so many of these ecological constructs are often sure not you know individual or collective agency so and that is an important critique for ecological system approaches that do not embrace the social but otherwise I think it's very nice so as a solution what she says is that you need to have at least four multilevel sort of conceptual arrangements which help us advance our understanding of why these patterns occur not what these patterns are which the other two theories tell us very nicely but why they occur one is a very powerful construct which I have found useful in our own work is that of embodiment which means that a concept referring to how we literally incorporate biologically the material and social world in which we live from conception to death a lot of body of work has shown for example that if just pure psychology work if you keep physically insulting and abusing children verbally for example this has a bearing on what kind of way what kind of an adult they would grow up into for example and this is not so contested so if you make that insulting a collective action if entire populations or groups are collectively insulted in public spaces or discriminated against in public spaces this has a way of man of getting embodied into their biology into the way they behave and the way they react to public services and to society in general and that at the heart is embodiment and there is a lot of biomedical work that confirms many pathways through which embodiment occurs the second is the pathways to embodiment why does this embodiment occur they occur because there are societal arrangements for example caste would be one arrangement which is ossified into the way we deal with other people they make these various other societal arrangement gender is for example another one third one is the cumulative interplay between exposure susceptibility and resistance I already spoke about this and fourth one is accountability agency element ties together the upstream and downstream factors which are sort of to give two examples which I will not elaborate for lack of time one of them is on pregnancy and risk of cancer how social classical social epidemiology or biomedical theories view pregnancy as a possible risk factor for cancer and how you can move away from the risk factor logic to a more logical embodiment for example if you adopt a reproductive rights approach if you and you realize who is able to claim these rights and which kind of people are not able to claim these rights because of adverse societal arrangements you realize then why pregnancy related risk factors will accumulate unfairly in some groups and not in others the second example is a very beautiful one on why black communities tend to have higher risk of hypertension and she says moving beyond eclectic purely psychological or purely economic sets of factors the four eco social constructs can systematically be used to propose six discrete yet entangled multi-level pathways linking expressions of racial discrimination and their biological embodiment across the life course it's very beautiful actually in these just six factors she explains a multitude of factors upstream and downstream and how they're entangled into the lives of particular black communities who develop higher hypertension so it helps us understand how these patterns come about when we think of our causation in this manner I think I'll end by saying saying yeah I think her conclusion is quite good theory matters and I think that's really a message without a thorough thorough understanding and application of theory into our research our research becomes yeah I mean we may be able to do a very good paper but it may not really transform either science or three minutes overtime am I still audible okay maybe yeah so I'm a team mentioned that I mean we're doing this exclusively on zoom so I really don't know how moderation I haven't thought through so well on moderation but maybe we can have a few remarks comments etc I'm not an expert on these but I can sort of contribute to the discussion I'm aware that there are a few others also who can speak on these matters so I open if anyone wants to make a remark or comment please use the raise hand feature and I can just invite you to start anyone if it was not if it was too quick and not very well elaborated on some points I'm happy to sort of explain further okay there's a deafening silence and I don't know how to read that okay yeah so maybe Mina and then Vybha yeah Mina go ahead yeah thanks Prashant it's a very nice paper I really enjoyed reading this I just had one query like I also heard about this intersectionality where they're also you want try to understand how the different combination of factors influence people's lives and health outcomes so I just want to know what is your observations with regards the conceptually how you see the differences and the similarities between the eco-social perspective and the intersectionality framework so you see any similarities or any differences conceptually sure sure I will I will give my remarks and I think Werner I'm sure may also be able to contribute to that so the way I see is intersectionality is a very transformative way of thinking thinking outside of very large single categories clearly and it helps us understand the diversity of experiences much better than talking of you know SC and ST and OBC and male and female kind of categories and you know as for example some the paper in social science and medicine from Gita Sen talks of many intersectional categories across these and how different their experiences are so it's very transformative way of thinking in health inequities but I think if I map that onto the eco-social approach I think intersectionality theory unless you bring in the upstream factors and the multi-level arrangement outside of those intersections then it will still remain a bit like social epidemiology so for example if you are doing an intersectional analysis of say gender and caste and health in a particular neighborhood if you limit yourself to the intersectional framework only there is a risk that you might not embrace the historical and the upstream factors the public policy drivers which could result in those intersectional disadvantages that you are seeing so it really it's not so much about the framework as it is about the one who applies it and this is true with every framework you can apply a very classical agent host environment framework in a very intersectional way also yeah so it is about the scientist and not so much entirely about the science is what I would say. Wernher would you like to also come in on this if you wish I am. Speaker 1:  Or anyone else after that? Yes yes yes I will. Am I understandable? Yes understandable we don't know yet but you are audible. We will know soon whether you will be understanding. Nice afternoon all of you. It's of course two things which come from different corners there was a Krieger's eco-social theory and the social ecological systems all come out of epidemiological schools intersectionality does not yes it comes out of a feminist activist female law people out of the US originally but there is definitely a very constructive and in the term you used it transformative overlap but you have to see these times in these things in time perspective whereas this whole evolution of social epidemiology is about 200 years old starting in central Europe with with Richok and others 200 years ago and not in the US in the mid-20th century the intersectionality approach is only from the from the late 1980s and it only crossed roads in the 21st century I would say with with the epidemiologists. Now this article this very interesting article a nice introduction to Nancy Krieger's work and to to eco-social theory we have to put it in its historical place also this is this is written around 2000 privileged in 2001 so she gives for example as an alternative to her approach the social ecological systems but she cites a Mac Michael from Johns Hopkins now if you followed up this a bit you will see that there's plenty of much more in-depth work on social ecological systems done over the last 20 years not so much in Johns Hopkins but in Canadian environments yes and that today in fact social ecological systems is much more predominant predominant in social epidemiology than the eco-social theory of Nancy Krieger however attractive her concept of embodiment is it it wasn't really swallowed by by many people another thing and this is where this intersectionality thing overlaps also this is that you have similar tensions if you read again this Krieger's plea plea for new epidemiology you see that she still sticks enormously to a quantitative positivist approach mathematical modeling those kind of things similarly in in multi-sectional in multi-sectionality you see people like like our friend Gita Sen who also are used for quantitative approach to it on the other hand you have people also in social epidemiology for example I know Almeida Fio already in the early 90s wrote a book for the Pan American Health Organization called epidemiology without numbers who argue for a more qualitative qualitative approach to get more understanding of a problem of causes instead of instead of correlations similar things you have an intersectionality and if you if you would google intersectionality and you would limit your search to the last two years you see an enormous production of new articles that that piggyback intersectionality on top of a rather qualitative understanding social ecological systems perspective so so there is a match definitely but it are two different frameworks from two different sciences but in a way they they they they have the same goal and they are quite they are quite supportive one for the other I would say yes thank you thank you for that Werner and I must say a couple of colleagues so IPHPC whoever that is says can't hear by the way someone please message them to check their audio settings by the way a couple of yeah Prashant can I inter-win yeah go ahead yeah so just to answer Mina's question this is Sukanya so this is the Mina's question on intersectionality and how it relates to this paper so I would like to point out like you have no as Werner Sousa talked about no the recent I mean in comparison to social epidemiology how intersectionality has just started in late 1980s with no crunchers and Collins work which basically looked at no within gender how you have race dynamics and class dynamics and how it is affecting health so the parallels between what Krieger is speaking in this paper and in the due course you can see Sen's work basically how they have adapted the direction and not this model on basically you have the Krieger speaks of the exposure susceptibility and the disease patterns so why it is happening and same is same has adapted from Dalgian invited models which know which also speaks of this exposure vulnerability and how the know that there are four processes basically social stratification then you have the exposures the vulnerability and the economic and the social consequences and how the health consequences are also coming into picture so that's the kind of parallel that you can draw between this paper and the within intersectionality how different kinds of work have been done yeah so you can refer to Sen's work basically the report that she has in 2007 yeah yeah thank you Sukanya I was just saying that some of us are doing also an intersectional quantitative intersectional group analysis of malnutrition and I hope you can have a seminar on that after we submit that paper and we can come back to this again I had before Pragati Vybab and then Pragati go ahead Vybab and then Pragati yeah thanks Prasanth I just wanted to share that thanks a lot I mean a lot many things I had heard but hadn't really understood well but you very nicely explained them and it also tempts me to read more about social epidemiology I found the social production of disease very interesting concept and I have a doubt I don't know whether it is really a valid doubt but I was wondering when causation comes into picture one has to measure a lot many things factors or variables whatever we call and then work on them I was wondering how it can happen with for the concept of social production of disease how one can go about it I think and that's what I think when theories take the ground it's not not not so so what you're talking about if I understand well is about relationship between variables okay and how epidemiological statistical analysis can help us understand and we must remember this distinction that these are relationship between variables that we are establishing yes we are going from relationship between variables saying this is what is causing this now many of these theories will contest that jump yeah okay for example if you take an intersectional sort of an approach at a conceptual theoretical level not in operational level then you would not even do surveys the way we would do then bunch any groups which which do not have anything to do with each other and we create variables at their aggregate level and then say okay look SC has this much rise and ST has this much rise and we in fact further try to complexify that by having models which predict on why SC and SC there is a difference but many many people in using these theories would submit that what we are talking what we end up with the results are only at the level of those variables and do not have probably causal explanations why certain people lead certain lives so this is one way of answering your question okay I don't think I mean we can have a discussion about this at many levels but but but but in if you would take a social production theory kind of theoretical kind of approach you would first start with some kind of a conceptual framework okay takes quite some upstream factors the macro so as well as micro factors create some kind of a conceptual framework and to the extent possible be comprehensive in capturing variables at all those levels and perhaps describe the interplay between those variables still your result would be at the level of describing the interaction between variables that's that's how I got it thanks a lot anyone I think one has also shared some link if anyone has any other comment on this we can also invite if not I invite Pragatia and then we will yeah hi thanks Prashant sorry I'm so sorry to interrupt Pragatia sorry one final comment I want to make is that some of these distinctions we are talking about are in relation to to the philosophy of science itself is to what are we measuring when we say we are measuring something how are we measuring it so that may also be something to think think through for each of us yeah Pragatia go ahead thanks yeah thanks Prashant no I I join Vaibhav in thanking for taking up this article it's very interesting in fact as I was listening in I was just thinking that the political economy lens and trying to bring it back to our work in tobacco control and so little is done in that domain compared to although tobacco is considered tobacco control is considered to be one of the better studied models explaining you know how a product with agency is over the years has been framed reframed and controlled or attempted to be controlled and if you look at the political economy aspect there is so little and with the deep work that's why it's like they're entering uncharted territories you know they are finding their own paths in so many ways so just wanted to put that out there as a comment yeah yeah thanks Pragatia and I think we should attempt more more journal clubs in in areas that we might that might make us uncomfortable we might not be fully experts in them I found so I merely picked this up because it's it's something that we are trying to figure out in theta as to what is the overall framework that we might end up with which which sort of explains is something that even with Wohler and Bruno at ITM I'm working on so I think if you are dealing with something struggling with something in the project journal club is a great place to because when you are challenged to explain it to an audience you really ensure that you you know it well and that that helps I think yeah next Vivek and then Nithi yeah hi Prasanth firstly a really great conversation at least the mode of presentation I quite liked it apologies for not going through the article pretty thoroughly as you did but I think the conversation gained a lot of perspective I just wanted some clarity in the initial sort of thoughts that you had as you were starting with your presentation was about the science and the scientist part if you could sort of bring that sort of give a bit of clarity on that because my further question would sort of either answer this clarity or sort of then I would be able to ask you properly so I just needed some clarity on the science slash scientist part that you were sort of bringing back and forth you know you mentioned about focusing on the scientist and some distinctions here and there so just wanted to conceptually understand what you were what was the reasoning behind that yeah yeah so this makes for a maybe another journal club on its own I can think of a lot of ways to go at this maybe one example is to just look at very famous scientists for example if you see and it's happening a lot these days with a sort of huge social awakening no you have people going back into people who are considered like idols beat Richard Dawkins in modern times or even Charles Darwin if you look at Darwin's original book I don't know how many of you have read original species it's a very racist piece of work but in his time and age and this has been said a lot on social media as well people say okay don't judge a person later in time you know judge him by how the society was during his time and if you just take Charles Darwin as an example now the theory of evolution has took the test of time and it has in fact branched out into you have evolutionary psychology you'll have evolutionary genetics evolutionary biology you have various sub specializations and evolution has made its thinking into various streams but inherently if you look at the first body of work that proposed it that racism is very evident in the way that Darwin looks at differences and says why there are differences and what is the species etc of course the science has progressed and it has removed that racism so even if a Nobel laureate talks today about genetics showing one race having problem genes the community you know response immediately and we have had such examples of luminaries in Nobel laureates talking you know really racist shit so I think we must acknowledge that on one hand science is an incremental body of knowledge to which scientists have added and they come in with their own inherent frameworks whatever it may be some of them may be problematic frameworks like all these isms some of them may be really empathetic and humanist frameworks but all of them leave their mark in the empirical work in for example at a very operational level in my multivariate analysis which variables I will choose to measure and hence those will enter the test of significance and my model is also based on my framework of what is important to measure you know so if I am doing a very thorough scientific inquiry on health inequalities in chamraj nagar my own framework on whether caste matters will matter enormously as to how well and rigorously I will measure caste I am just making an example here you can replace caste with anything else and that's the point I was trying to make and this has to do with maybe reflexivity and dialogue wider social awakening in the scientific community and society etc I don't know if this answers your point yes very much because I was wondering so when you were talking about it it sort of took me back to this Netflix series that I was watching on so it's called Douglas and Nanette by Hannah Gatsby so she's a Nausalian comedian and it's two series of hers that she had I mean it's about her comedian also her personal life where she talks about her own struggles related to intersectionality, masculinity, patriarchy and in one of her series she talks about this of so many people who've told her you know you must separate the art from the artist and that sort of it took me back there because when you were speaking about science and the scientist I was wondering is it really easy to split the science and the scientist because I mean science is not just like a body of work it is also embedded in the institutions in the culture that we are part of and just as you were giving the Darwin example I was wondering then how would that have a bearing on these three types of you know the author had talked about one is the psychosocial one is the eco social so I was wondering how would that have a bearing on all of on those three I was just trying to sort of understand from that lens. I lost your last piece sorry but I am with you I think my internet is poor I am with you when you say this is not an easy enterprise I just sort of threw it out there saying that we must remember this distinction I don't think I meant to say that science and scientists are separate and I don't mean to say that these ought to be looked we must be aware of that distinction when we examine pieces of scientific work that's what I meant I agree that it's not possible to completely just separate them out I meant that we must keep that in mind that's how but I lost the last bit of what you said though. I was wondering let's say I mean we look at this possibility I mean not a possibility but we look at the assumption that if one could separate the science with the scientist then how would that have a bearing on the three types of assumptions or theories that the author had prescribed one was the psychosocial and the eco social would it be a different world of imagination altogether or I don't know I am just like thinking out loud because yeah. Speaker 1:  I think it would be impossible actually I mean if I read at least what Krieger says it may be impossible it may be even fallacious to conceptualize it I would say I invite one or anyone else to comment on this if you want but I feel it might be fallacious to even conceptualize a scientific enterprise as being sure of scientists because it is a social construct in that sense and by social construct we don't have a demean it I think that's really unfortunately what needs what often tends to happen sort of for me a bit uncomfortable purely postmodernist sort of framing of okay everything is you know social it's not to say that everything is a social construct so nothing means anything that's not what I wish to say I wish to say that we must accord this product of science a certain value and I think we already do that but we must afford that value while being critical and aware of how it has come about. If you see the Lancet I will just come to Chupanya I mean if you see the Lancet article on HCQ it's very interesting right now on medical print circle very interesting discussions are going on this big data that Lancet published on HCQ's arms you can see how the enterprise of science is so flawed even at the very top very very what we are caught such high status and we know say Lancet published it and we have known this we don't have to be shocked that today the Lancet published something that is questionable New England Journal of Medicine is soon probably going to retract another HCQ study so we must keep this in our minds but not entirely dismantle the knowledge body that we have been here. So Kanya and then Warna. I think Vivek has asked a very interesting question but yeah I mean how do you see the scientist and know vis-a-vis how he looks at the science but at the same time Krieger actually comes from positivist you know kind of approach for which I mean she has not. Kriya we can't hear you. We can't hear you anymore Sukanya. Speaker 1:  Maybe we bring in Warna and someone just leave a chat message for Sukanya she can come in after Warna. Warna you wanted to say something? Okay then yes pretty short I just confirm or endorse what you just answered and I think if you talk about how to take into account the social production of science I think there's three things to make it easy it's not an easy thing but there's three things you should take into account the first one is time. Speaker 1:  What is dominant thought what is dominant paradigm what is dominant value today is not necessarily what it was yesterday not nor what it will be tomorrow. Your example of Darwin is a good one yes. The second is place yes environment. Speaker 1:  You talk about the lancets that's UK yes or that's that's a global that's a so-called self-declared global community in the UK yes. So place is extremely important yes. These are the things. And that third thing resumes in fact the first two is power. Speaker 1:  Is power because what is mainstream what is dominant in a certain place and in a certain time is defined by power balances and disparities at that time in that place yes and this and here I come back to intersectionality this is where adding on intersectionality approach I wouldn't call it the framework and intersectionality approach to the framework of social ecological systems is so so useful because it makes these power things visible. Speaker 1:  Thank you thank you very much. So Kanya are you now audible or are you able to speak now. I was just suggesting this work by Mary Dixon Oates et al who have looked at road based accidents and how they were questioning evidence based no kind of approach while looking at these accidents in England and I right now not finding out the exact name of that paper but it is Mary Dixon Oates et al so Vivek can Google search or maybe I can share this paper later with him. Social construction. Speaker 1:  Thank you so much. Last comment from Neeti thanks Vivek Neeti. Yeah I actually had two comments one which is closely related to Vivek's question about going back to the first thing that you discussed Prashant about asking the right or the relevant questions about what is what constitute a quote unquote good or relevant question and I think this is particularly interesting because we are having this conversation in this course that we're conducting you know the good health research practices course about and if I was wondering if there might be some way of some test almost or some way of thinking through what might be you know useful relevant slash good slash I don't know what the right adjective is research question and I mean to to some extent you did mention about having a theory using a theory based approach to even come up with those questions and again here and again relating to what both Werner's comments and Mina's questions on intersectionality and approaches in different theories including in the paper I think our very use of these terms itself need to be somewhat better defined I think the same ideas can be used as an approach can be used as a framework and then can be used as a theory at various stages and again going back to the application of these ideas I wonder if there is now you know as there is more field building if there is a little bit more requirement for defining what we mean by each of these I know that there is a lot of literature and there is still you know a lot of evolution I think and some changes in what the meaning of each of these might mean but some of the confusion for some of the earlier early stage researchers were still learning all of these things I think comes from this interchanging usages of you know the same ideas for example intersectionality which we had quite a bit of conversation about as an approach as in different scenarios using it as a framework as well as using it as you know theories to develop to investigate particular questions. So I don't think there is a shortcut so if you wish to for example see whether there is a checklist or a tool yeah which helps you sort of examine your objectives or questions to see whether they have they have sufficiently embraced these kind of concepts that we are talking about maybe it's possible to build one but again I come back to it's a bad metaphor for this the science and scientist you know the framework the same checklist and tool can be applied in a very silly way or it can be applied in a very integral way to the work for example you can take intersectionality approach and design service in a very intersectional way yeah that's one way of applying intersectionality you can take intersectionality approach and use it to perhaps make objects in your study which embrace intersectionality you can take the same approach and frame your questions itself in an intersectional way you can take the same approach and entirely frame your career and life around and you live and you in fact embody so to speak an intersectional way of living so I think this transition is something that the researcher will have to make over time and I think if I look at my own journey I also started with applying these concepts at a very operational level at my tool level and I struggled a lot with it and I think many researchers go through that struggle and I think it's fine some of it has to do with the way we are taught to do research in our schools and the way we are taught research itself as a kind of an objective enterprise where you are removed and you do something which results in objective knowledge which is uncontested so breaking those down and unlearning that and then relearning some of these is a cycle I think that's what I would say at least from my own experience does that somehow respond Nithi partly it brings up many other questions but I know we're running out of time yeah we're running out of time I'm so sorry so I really thank all of you for your patience in participating in a sort of an oral nearly between a rhetoric and an oratory perhaps and thanks a lot for your questions and engagement and see you all thank you very much. Speaker 1:  out of time I'm so sorry so I really thank all of you for your patience in participating in a sort of an oral nearly between a rhetoric and an oratory perhaps and thanks a lot for your questions and engagement and see you all thank you very much.