The scope and challenges of epidemiology I

Idea 1: The uses of epidemiology are many, but shift over time, and are subject to recurrent challenges from inside and outside the field.

The following articles provide a variety of historical perspectives and opinion statements on this idea:

Davey-Smith, G. (2001). “The uses of Uses of Epidemiology.” International Journal of Epidemiology 30: 1146-1155.

(See Davey-Smith’s conversation with Jerry Morris, the author of the Uses of Epidemiology, http://bit.ly/g9DDHz)

Brandt, A. M. and M. Gardner (2000). “Antagonism and accommodation: interpreting the relationship between public health and medicine in the United States during the 20th century.” American Journal of Public Health 90: 707-715 — the title conveys the point: physicians have often opposed an increasing role of public health.  Epidemiology might be needed for quantitative assessment of new interventions and  evaluating patient safety and healthcare quality, but its role beyond evaluation and assessment, especially in regards to social, cultural, and economic factors of diseases, is contested.

Caldwell, J. C. (2001). “Population health in transition.” Bulletin of the World Health Organization 79(2): 159-160.

Pearce, N. (1996). “Traditional epidemiology, modern epidemiology, and public health.” American Journal of Public Health 86: 678-683 — Pearce argues that modern epidemiologists have little concern for the socioeconomic factors that may affect health.  He contrasts “bottom-up” and “top-down” approaches. The latter begins at the population level in order to determine the primary factors that effect health, and it uses a structural model of causation. The bottom-up approach, e.g., molecular epidemiology, begins on the individual level and aims to proceed upward toward the population level.

Schwartz, S., E. Susser, et al. (1999). “A Future for Epidemiology?” Annual Review of Public Health 20: 15-35.

(This post continues a series laying out a sequence of basic ideas in thinking like epidemiologists, especially epidemiologists who pay attention to possible social influences on the development and unequal distribution of diseases and behaviors in populations [see first post in series].)

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