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Am J Public Health. 2013 Jan;103(1):22-7. doi: 10.2105/AJPH.2012.300967. Epub 2012 Nov 15.

History, biology, and health inequities: emergent embodied phenotypes and the illustrative case of the breast cancer estrogen receptor.

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Department of Society, Human Development, and Health, School of Public Health, Harvard University, Boston, MA 02115, USA.


How we think about biology--in historical, ecological, and societal context--matters for framing causes of and solutions to health inequities. Drawing on new insights from ecological evolutionary developmental biology and ecosocial theory, I question dominant gene-centric and ultimately static approaches to conceptualizing biology, using the example of the breast cancer estrogen receptor (ER). Analyzed in terms of its 4 histories--societal, individual (life course), tumor (cellular pathology), and evolutionary--the ER is revealed as a flexible characteristic of cells, tumors, individuals, and populations, with magnitudes of health inequities tellingly changing over time. This example suggests our science will likely be better served by conceptualizing disease and its biomarkers, along with changing magnitudes of health inequities, as embodied history--that is, emergent embodied phenotype, not innate biology.

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