An epidemic, by definition, is the significant increase in the occurrence of disease and is not driven entirely by a microorganism.31 For an epidemic to occur, a definite number of individuals need to be in specific kinds of contact, within certain distances, over discrete time periods. Further, the likelihood that any given individual may become infected and develop disease will also be driven by each individual’s own prior health conditions. These are themselves driven by history and context, and can include manifestations of corporeal rifts induced by alienated, often forced, labor under capitalism.
Therefore, while specific organisms may “cause” disease (in the dialectical sense of an asymmetry in the balance of reciprocal forces), the causes and processes of an epidemic are much more complicated phenomena that arise in specific social and historical contexts. It is reductive and one-sided to represent an organism as the cause of an epidemic. Rather, epidemics arise in the context of specific processes and relationships of a social metabolism in distinct times and places, which are themselves fundamental causes and dialectically related processes.32
Some frameworks of public health theory provide a broader focus that includes consideration of factors beyond a host organism and a “pathogen,” or beyond these two and sometimes a mediating vector, to include “environment.” Some of these frameworks add further clarity to the concept of what constitutes relevant components of environment (referred to as “social determinants of health” models).33 Most such models (1) limit consideration to the current environment, which is considered static and ahistoric, and often treat socially constructed processes (for example, race, ethnicity, or poverty) as “unmodifiable risk factors,” ignoring their social construction and historical trajectories; (2) under-consider the manifold interactions constituting the specifics of the social metabolism, such as human relationships with land, terraqueous environments, and nonhuman animals; and (3) ignore the capitalist social metabolism, with its alienated production and high-velocity circulation driven by exchange value and accumulation.34