Pathways must be explored on various spatio-temporal scales in order to understand the complex interplays that can occur through history, inter-generationally, across the lifecourse; as well as at global, national, societal, familial, and molecular levels.
Further, Krieger expands this construct to include the accountability that epidemiologists have in the identification and treatment of health disparities, and their obligation to explicitly identify one's theoretical lens, as well as to become activists, not just researchers, when faced with injustice.
As described by Doyal, SPD consists of the following key constructs: (1) The distribution of disease in a population will pattern along social, economic, and political lines in a given society.
(4) Societies valuing profit, consumption, capitalism, and wealth over the well-being of their people and environments will reflect these priorities in the unequal distribution of disease in the poor and disempowered classes.
The distribution of income, access to healthcare, education, and occupation is not equal in most societies; and often follows power dynamics that repress women, people of color, sexual minorities, and other discriminated groups.
Taking a historical perspective, we can begin to describe the high rates of obesity seen among African Americans in the so-called "stroke belt" of the Southern U.S.
The culture of food created in this setting, and transmitted over the centuries, still exists today, however the social and physical environment in which people live has changed dramatically.
Similar analyses can be examined in multiple generations of Hispanic immigrants as they acculturate to the United States, American Indians and their history of abuse and repression in this country, and people of low SEP. Ecosocial Theory could also help us examine how these social forces and pathways become embodied and incorporated into the physiological outcome of obesity over the lifecourse, for example by looking at dietary patterns during pregnancy and how this affects risk of obesity to the fetus as it ages and grows into an adult with an altered metabolism from early exposure.