On social determination and social overdetermination: The epilogue to a heated debate?

In a recent publication in Cadernos de Saúde Pública (2021), Maria Cecília Minayo critically examines the concept of social determination in Collective Health. The author suggests a disconnect between epidemiology and the social sciences, arguing that the term carries a deterministic bias that is insufficient to account for the complexity of the health-disease process. Through a theoretical review and discourse analysis, this study challenges these claims. It argues that contemporary epidemiology already incorporates biological, socioeconomic, and political determinants at its core. Grounded in multilevel causality, it demonstrates how the field investigates interactions between biological and social experiences at the level of the ‘causes of causes’. The text highlights intersectionality as an approach that examines how gender, race, and class are mutually constituted and interconnected. These dimensions do not operate in isolation or as merely additive factors, but rather intertwine to produce simultaneous systems of privilege and oppression, offering a more compelling explanation for health disparities than traditional demographic interpretations. It concludes that intersectional analysis and multilevel causality provide further evidence of social (over)determination.

KEYWORDS
Social determinants of health; Intersectional framework; Socioeconomic factors.