“…this interest in identifying causes has, during the past quarter century , increasingly come at the expense of a more rigorous engagement with the second part of our vision for ourselves---the intent for us to intervene ---and this approach threatens to result in an imbalance in our vision that takes the field far away from relevance and into obsolescence.” So writes Sandro Galea in an October 15, 2013  commentary in the American Journal of Epidemiology entitled “An Argument for a Consequentialist Epidemiology”. His concerns are echoed by Ward Cates writing in the same issue of the AJE and revisiting a topic he first addressed at an SER meeting as far back as 1994.

Speaking at the recent SER meeting and now in the AJE, Galea is seeking to provoke epidemiologists into a rethinking of their priorities. His goal is to shift the current focus from one heavily devoted to etiologic research to one devoted more consciously to improving health outcomes. Otherwise, he fears that epidemiology, whose relevance is already being questioned, will fade in importance.

Familiar Refrain

This is not a new topic for epidemiologists since calls for researchers to become more consequential were issued years ago by Milton Terris at APHA in Atlantic City in the 1970s and William Foege  in the 1980’s even before Cates’ address at SER. Why the failure to heed these calls for paying more attention to public health?

Part of the problem is the system of incentives currently in place for academic researchers. When the funding source for research at the National Institutes of Health rewards etiologic research over more applied public health research, it is not surprising this type of research is what is submitted. Also, salaries and promotions are based on publications of this type of research. As stated by Galea, these factors are determinants of how epidemiologists behave, and he calls for changing these determinants once and for all.

Accountable Health Advocates

This topic was the subject of an article in Epidemiology last year by David Dowdy and Madhukar Pai who made a case for creating “Accountable Health Advocates”, a new subspecialty of epidemiologists which would focus more intentionally on the translation or use of epidemiologic findings to improve public health.

According to Dowdy and Pai, support for this work would come from a reallocation of resources or creation of new rewards and incentives for epidemiologists who choose this career path. At present, the authors say there are many disincentives for epidemiologists to advocate for the utilization of established evidence, including “professional fallout” from a perceived lack of objectivity and difficulty of publishing such work in scientific journals.

Epi Marketing

In an accompanying commentary, Ward Cates revisits his remarks at SER some20 years ago and concludes that although epidemiology as the science of causality is still alive and well, it can do so much more.  He agrees with Galea that “the key will be our ability to market our epidemiologic skills in a way that is seen by society as making a difference. And the advent of the Affordable Care Act provides epidemiologists with an opportunity to prove that relevance “…not only by clarifying etiologies but also by planning public health actions and evaluating interventions.  ■

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