Kiffer G. Card, Ph.D.Blanche & Charlie Beckerman Scholar for Public Health Innovation
Theoretical framework

How health inequities shape health.

I am a social epidemiologist specializing in community-based methods and health equity. This page sets out the single framework that unifies my research: a social ecology of wellbeing that traces how natural and social environments, above and beyond individual behaviour, produce unequal health. Explore the model below.

The problem

What a social epidemiologist is trying to explain.

Across every population I study, health is patterned. People with less power, lower social position, and fewer material resources get sick earlier, suffer more, and die younger. These gaps are not random, and they are not mainly the result of personal choices. They are produced by the way societies are organized, by who holds power, by which conditions people are exposed to, and by which supports they can reach.

Social epidemiology is the science of those patterns. It asks why health is distributed the way it is, and it locates the answer in social structure rather than in individual willpower. This commitment puts the field in direct tension with a dominant way of thinking about health, one that treats wellbeing as a matter of personal responsibility and behaviour. That individualized, often neoliberal, framing is intuitive and politically convenient, but it misdiagnoses the cause and so prescribes the wrong cure. My work documents where it breaks down and offers a more accurate alternative.

The alternative is the social-ecological model below. It keeps individual behaviour in the picture, because behaviour matters, while showing that behaviour is conditioned, compelled, and reasoned within constraints set far upstream. Equity-oriented public health works on those constraints. The model is the through-line connecting my three research programs, and the lens I bring to community-based research, teaching, and policy.

Interactive model

The social ecology of wellbeing.

This is the framework that organizes my research. Select any box or any labelled process to read how I conceptualize it. The boxes are the domains where inequity lives; the labels are the processes that carry it from the structure of society into the body, and back again.

Structural Determinants -isms Politics Power & Capital Policy SociopoliticalContext Social Position Health & SocialSystems MaterialCircumstance Biological Responseand Function Sensitivity Alteration Acculturation Selection Cognition Compulsion Conditioning Reasoned Action Learning Social Construction Services & Supports Compounding Consequences Time / Life Course PsychosocialState /Disposition Behaviour Health & Harms

Tap or click any box or label. Use Tab and Enter to navigate by keyboard.

The unifying umbrella

One framework, three programs.

My three research programs look different on the surface. The framework above is what makes them one body of work: each studies a different stretch of the same pathway from environment to health inequity.

Program 1

Social connection & loneliness

Treats social environments, not personal sociability, as the modifiable determinant. Equity work means building the systems and supports that make connection reachable for everyone.

See the program
Program 2

Climate change & mental health

Locates climate distress in the natural and social environment and in who is most exposed, rather than in individual fragility. The harm is unequally distributed by social position.

See the program
Program 3

Syndemics & public-health crises

Studies how overlapping epidemics converge on the same marginalized populations through structural stigma and material disadvantage, the clearest case of inequity compounding over time.

See the program
The framework in action

Three case studies in the model.

These studies don't build the framework so much as test it against the world. Each one zooms in on a single link in the model above, showing how the pathway from social structure to health inequity actually operates. Scroll through the cases, and follow each to the published paper.

01

Is neoliberalism killing us?

Card & Hepburn (2023) · Int. Journal of Social Determinants of Health

Treating a dominant ideology as a measurable determinant of health, this study surveyed 2,632 Canadians during the COVID-19 pandemic and separated three strands of neoliberal belief. Anti-government beliefs tracked with lower social trust and life satisfaction, while belief in personal wherewithal showed a more complicated, partly protective pattern for those who hold it. An ideology that frames health as personal responsibility can quietly reinforce itself even as it erodes collective wellbeing.

In the model: the route from Sociopolitical Context to Psychosocial State through Acculturation, where ideology gets into people and shapes what they believe is possible.

Read the paper
02

What do people prefer to fund?

Card, Adshade, Hogg, Jollimore & Lachowsky (2022) · BMC Public Health

A discrete choice experiment with more than 3,000 participants and nearly 24,000 funding decisions showed how public preference reproduces inequity in what gets funded. People favoured treatment over prevention, and were markedly less likely to fund programs for marginalized or stigmatized groups, including trans people, sex workers, people who use drugs, and gay and bisexual men. Because public opinion shapes which programs survive, these preferences become a structural barrier to equity rather than a private attitude.

In the model: the Politics link that governs Health & Social Systems, and the Services & Supports that reach some populations while bypassing others.

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03

Who defends the system, and why?

Card & Hepburn (2022) · Frontiers in Public Health

Many reforms that would reduce health disparities stall because people defend the very systems that disadvantage them. Among 2,619 Canadians, system-justifying beliefs were widespread, averaging above the midpoint of the scale. Marginalization generally eroded these beliefs, yet some historically marginalized groups reported relatively high system justification, consistent with the idea that oppression itself can pressure people into legitimizing the status quo. Knowing who defends the system is essential to building consensus for equity-advancing change.

In the model: the interplay of -isms, Acculturation, and Selection, where social position and internalized belief reinforce one another.

Read the paper

Scroll, swipe, or use the arrows to move between case studies. Each links to the published paper.

The through-line

Equity and justice, by design.

Every part of this framework points to the same conclusion: health is made by the conditions people live in, and those conditions are unequally distributed by power and social position. My research, conducted with the communities most affected, is built to make that case rigorously and to give policy-makers and practitioners the evidence to act on it.

Explore the research programs Browse publications