Invited commentary: social mechanisms, race, and social epidemiology.

In the leading article in this issue of the Journal, Kaufman and Cooper (1) attempt to elucidate why social epidemiology has allegedly failed to provide explanations for the associations between social factors and disease. Their main argument is that the assumptions of counterfactual models routinely used in observational studies are not adequate for testing social factors. The authors illustrate their argument with the concept of race, on the grounds that using race in counterfactual models requires the assumption that a Black person could be thought of as being White—which the authors argue is not conceivable. In this commentary, I argue that the main reason why social epidemiology has not provided better explanations is lack of social theory development, due mainly to the reluctance of epidemiologists to think about social mechanisms (e.g., racial exploitation). I support this point of view with an analysis of the role of counterfactual models in social science, an illustration of the fundamental similarities between epidemiology and other socionatural sciences, and the failure of contemporary epidemiology to generate hypotheses about social mechanisms. In particular, I point to the notion of racial social systems, the concept of Whiteness, and its measurement implications to highlight the lack of attention to social mechanisms in social epidemiology. However, I do not examine the concept of race understood as a collective response to the experience of racial ideology, oppression, and exploitation.