Historical and theoretical roots of the big events framework

This article traces the evolution of the Big Events framework since it began as an attempt to understand why sociopolitical transitions in the Former Soviet Union, South Africa, and Indonesia were followed by HIV outbreaks. Big Events frameworks have evolved over time, but all versions try to concretize how macrosocial changes lead to social, personal and environmental changes that shape risk environments and drug use or other behavioral patterns in ways that may lead to epidemics. Important stages in the evolution of the Big Events framework included understanding that the sequelae of Big Events were contingent rather than deterministic, and the development of new survey measures to understand pathways through which Big Events affect social and epidemiologic outcomes. On a broader level, the Big Events framework is a useful crystallization and application of more abstract sociological, social epidemiologic and Marxist frameworks about upstream/downstream relationships and how major social changes are related to epidemics. As such, they raise issues of how to conduct research on dialectical interaction processes. On another level, this article traces the Big Events "style of thought" as Mannheim (Mannheim, 1971) termed it, within the historical context of changes in public health and social science theory, particularly during and after the 1960s.