The Social Side of Disease and Disease Prevention

Belinda Needham, Associate Professor and Chair of Epidemiology, University of Michigan School of Public Health

Belinda Needham

Associate Professor and Chair of Epidemiology

As a child growing up in Birmingham, Alabama, Belinda Needham’s future was affected by the global steel trade, though she couldn’t have known it at the time.

While Needham’s mother stayed home to manage the household, her father worked at US Steel, one of the biggest employers in the area in the 1970s. “Working conditions at the plant were tough,” Needham says. “But the pay was good, especially for someone without a college education.”

By the early 1980s, international competition led to financial losses for US Steel. The United Steelworkers union couldn’t reach an agreement with the steelmaker to keep the plant open, and Needham’s father was laid off. “My dad worked at a paint store during the day and as a security guard at night, and my mom got a job as a secretary,” she recalls. “But two people working three jobs couldn’t make up for the loss of income from the plant.”

Needham says that, in her youth, she didn’t understand the structural forces responsible for the hardship the family was experiencing: “I just knew things were bad. Whether my parents understood the root causes or not, they were acutely aware that their opportunities were limited by a lack of education, and they were determined that my sister and I would go to college.”

Needham fulfilled that desire, and in a sociology course at Texas A&M University began to understand that her family’s situation wasn’t unique, that powerful social forces shape our opportunities and the choices we make. “Once I understood the connection between social inequality and health inequality, I knew what I wanted to spend the rest of my life doing.”

Because human beings are a social species, we can’t understand human health without considering the role of social factors.

Needham completed a master’s degree and PhD in sociology at the University of Texas at Austin, focusing throughout on various ways in which social factors and human health intersect. While things are changing, Needham says that “many sociologists are interested in social patterning of health and illness but tend to pay less attention to the biological mechanisms that link social factors to health.”

“I wasn’t satisfied knowing that childhood poverty increases the risk of cardiovascular disease in late life. I wanted to know why and how,” she recalls. These questions led her beyond the usual scope of sociology to technical areas of study in genetics like telomeres and DNA methylation. “In looking at which changes happen in the body and the brain over a person’s lifetime that result in age-related diseases, I really needed to understand social behaviors and human biology and diseases.”

As she brought together sociology and epidemiology, Needham was drawn to the field of public health. She is associate professor of Epidemiology and co-director of the Center for Social Epidemiology and Population Health (CSEPH), and was recently appointed chair of the Department of Epidemiology at the School of Public Health.

As a social epidemiologist, Needham studies the social patterning and social determinants of aging and age-related chronic diseases, such as cardiovascular disease. “In the department we have epidemiologists from a range of backgrounds conducting research to reduce and prevent disease. This includes social epidemiologists, who study stroke, diabetes, depression, tuberculosis, and many other outcomes with a social science lens,” she says. “Because human beings are a social species, we can’t understand human health without considering the role of social factors.”

Needham uses the COVID-19 pandemic as an example: “Social factors like socioeconomic status, overcrowding, institutional racism, political partisanship, and global economic inequality are all recognized as important determinants of disease risk for individuals and populations.”

“Social factors also contribute to vaccine acceptance and other behaviors that affect disease transmission,” she says. Together, these social factors had an enormous influence on how the virus has spread and, in turn, how we’ve been able to respond to that spread.

As a researcher and teacher working across the social, behavioral, and natural sciences, Needham is tuned into the places where science must collaborate broadly to solve problems. “Scientists know what causes the COVID-19, how widespread it is, and how to reduce transmission. But that knowledge hasn’t been sufficient to end the pandemic,” she observes. “Even if we do understand how to improve a problem, our communities might not be willing, for a variety of reasons, to implement those ideas.”

One of the greatest challenges in public health leadership, Needham says, is “how we move from scientific insight to action and to things that directly improve population health and reduce or eliminate health disparities.”

We study problems that aren’t just intellectually engaging but matter for people’s health and well-being.

“We have to think about how we translate scientific evidence into things like policy recommendations and, maybe before that, how we make epidemiology understandable for people who work in policy and those in the general public,” she says.

To that end, Needham and other faculty in the Center for Social Epidemiology and Population Health developed a course on social epidemiology for the school’s online MPH degree program. “We want to incorporate into our teaching what it means to translate science into policy. I hope scientists think about this in their work, and I certainly think we should be teaching it in public health programs.”

Needham, like many of her colleagues, was drawn to public health because of the potential to do research that directly benefits people. “We study problems that aren’t just intellectually engaging but matter for people’s health and well-being.”

Making sure students understand the difference they can make is part of what Needham passes on to each student. “Every year we train over 200 students and postdoctoral fellows in the department of Epidemiology alone. These are the public health leaders of the future, and it’s our job to prepare them to communicate effectively with policy makers and the public to increase support for evidence-based approaches across our communities.”

The powerful social forces that can shape our well-being—including our job prospects and how we support ourselves and our families—can be studied, understood, and improved. Needham wants public health to be central to that effort. “At a time when the public is increasingly skeptical of science, it’s up to us as public health leaders to help people understand what we do and why it’s important."