Ross, Lauren N. and Kendler, Kenneth (2023) Proximal and Distal Causes in Medicine. [Preprint]
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Abstract
The proximal-distal model of disease causation is often used to capture how social causes influence health outcomes. This model serves as a conceptual framework for many analyses of social determinants of health-—it does so by locating social factors as distal causes, which are upstream of proximal biology. In an influential paper, Krieger criticizes this model for being inaccurate and confused, and suggests that we “abandon the deeply confused language of the terms proximal and distal” (Krieger 2008). While we agree with many of Krieger’s criticisms, we examine different weaknesses of this model and argue that it has important strengths. We examine three causal scenarios to show how social and biological causes interrelate in various ways, which are only partly captured by this model. In particular, we show how social factors can play three types of causal roles: they can be distal causes, parallel causes, and proximal causes. We argue that-instead of eliminating “proximal” and “distal” causal terminology—accurate use of these terms is not only possible, but instrumental in capturing how social causes influence health and disease.
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| Item Type: | Preprint | |||||||||
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| Keywords: | causation ; explanation ; philosophy of medicine ; proximal causation ; distal causation | |||||||||
| Subjects: | General Issues > Causation Specific Sciences > Medicine > Epidemiology General Issues > Explanation Specific Sciences > Medicine > Health and Disease Specific Sciences > Medicine > Psychiatry |
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| Depositing User: | Lauren N. Ross | |||||||||
| Date Deposited: | 13 Dec 2023 03:38 | |||||||||
| Last Modified: | 13 Dec 2023 03:38 | |||||||||
| Item ID: | 22849 | |||||||||
| Subjects: | General Issues > Causation Specific Sciences > Medicine > Epidemiology General Issues > Explanation Specific Sciences > Medicine > Health and Disease Specific Sciences > Medicine > Psychiatry |
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| Date: | 2023 | |||||||||
| URI: | https://philsci-archive.pitt.edu/id/eprint/22849 |
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