A theoretical proposal for the relationship between context and disease

Studies of ‘context’ are increasingly widespread. These studies often become entrenched in methodological debates rather than being conceptually satisfying. We suggest that part of the problem lies in an inappropriate use of ‘classic’ methods used by epidemiologists to study context and that it may be useful to study, instead, the relationship between agency (the ability for people to deploy a range of causal powers), practices (the activities that make and transform the world we live in) and social structure (the rules and resources in society). We utilise two examples from the current literature to illustrate these problems; the study of lifestyles and social inequalities in disease outcomes. We develop the notion of collective lifestyles as a tentative solution, inspired by Pierre Bourdieu’s theory of social action, Anthony Giddens’ structuration theory and Amartya Sen’s capability theory. Collective lifestyles are defined as an expression of a shared way of relating and acting in a given environment. It is proposed that context is created by relationships between people.