psychology, sociology, environmental science and epidemiology, as well as biology and medicine, may all make contributions. Each of these has its own disciplinary paradigms, arenas of debate, agreed canons and particular epistemological positions. Some of the contributions of these disciplines are highly political in tone and intent.


The panel used both a social-ecological framework and a life-course perspective in determining what factors to consider in search of an explanation for the U.S. health disadvantage. Many theories or constructs could be pursued, but the panel identified five domains of particular interest that set the agenda for the next five chapters (see Figure 3-2).

We begin with health systems and individual behaviors, both of which can have important proximate influences on health, and are addressed in Chapters 4 and 5, respectively. The social-ecological model emphasizes that interactions with health systems, individual behaviors, and disease processes themselves are shaped by social factors and the environment. Chapters 6 and 7, respectively, examine their potential contributory role in the U.S. health disadvantage. Finally, Chapter 8 addresses how all these factors might be influenced at the macro level by the societal context of life in America, ranging from life-style to policies, governance, and social values.


FIGURE 3-2 Panel’s analytic framework for Part II.

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