Metaphors and visual images have been used in epidemiology in conjunction with frameworks and theories proposed to explain disease causation and the processes that give rise to social patterning of disease risks and the ways in which risk behaviors arise and become maintained in social groups. The metaphor of a running stream has recently been extended by Glass and McAttee to stimulate creative thinking about the determinants of risk behaviors in populations and emerging paradigms of disease causation. The frameworks and theories that have been proposed to illustrate or explain the processes that give rise to social patterning of disease have been paralleled by the development and refinement of methods of multilevel statistical analysis and complex systems modeling in public health. The metaphors and conceptual models employed in epidemiology have moved beyond short, causal chains and reductionist world-views to include more holistic, dynamic perspectives that are more consistent with the complexity of real world situations.
