Understanding the routinised inclusion of race, socioeconomic status and sex in epidemiology: the utility of concepts from technoscience studies

The multifactorial model of disease causation constitutes the dominant conceptual framework underwriting the epidemiology of chronic illness. Under this rubric, factors correlated with disease are analysed at the individual level; accordingly, race, social class and gender are routinely conceptualised and incorporated into epidemiological research as individualised measures of racial category, socioeconomic status and sex. This paper employs three concepts from the field of technoscience studies to elucidate how epidemiological constructions about bodily 'differences' are infused with authority and legitimacy. The multifactorial model and accompanying representations of race, class and gender can be usefully conceptualised as a black box (Latour 1987, Latour and Woolgar 1986), in which individualised inputs to epidemiological studies are routinised while the interior workings of the black box - how exactly 'differences' come to affect health - are taken for granted. Second, processes of triangulation (Star 1985, 1986) are evident, as results from multiple lines of research on an array of different diseases are used to enhance the stability of the multifactorial model and associated constructions of 'difference'. A final illuminating technoscience concept is that of the boundary object (Star and Griesemer 1989), whose dual properties of conceptual flexibility and integrity help in understanding the proliferation and institutionalisation of epidemiological methods of studying race, class and sex/gender in chronic disease.