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Despite well-documented evidence that structurally disadvantaged populations are disproportionately affected by infectious diseases, our understanding of the pathways that connect structural disadvantage to the burden of infectious diseases is limited. We propose a conceptual framework to facilitate more rigorous examination and testing of hypothesized mechanisms through which social and environmental factors shape the burden of infectious diseases and lead to persistent inequities. Drawing upon the principles laid out by Link and Phelan in their landmark paper on social conditions (J Health Soc Behav. 1995;(spec no.):80–94), we offer an explication of potential pathways through which structural disadvantage (e.g. racism, sexism, and economic deprivation) operates to produce infectious disease inequities. Specifically, we describe how the social environment affects an individual's risk of infectious disease by 1) increasing exposure to infectious pathogens and 2) increasing susceptibility to infection. This framework will facilitate both the systematic examination of the ways in which structural disadvantage shapes the burden of infectious disease and the design of interventions that can disrupt these pathways. [ABSTRACT FROM AUTHOR]

The authors offer a response to a commentary made by J. Zelner and colleagues on their article "Sociological Imagination and Infectious Disease." Zelner and colleagues highlight the importance of considering structural factors as fundamental causes of disease. The authors offer follow-up points that clarify the reasoning behind their perspective and highlight how failure to consider both frameworks proposed by B. G. Link and J. Phelan limits research and furthers health inequities.