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Epi Wit & Wisdom Articles
American Journal of Public
Health Devotes August Issue to Epidemiology and Statistics
At Least One Theme Emerges
What is Epidemiology All About?
The August 1999 issue of the
American Journal of Public Health features 17 opinion and
science-based articles on epidemiology focused, at least in part, on
what constitutes proper work for epidemiologists.
In a lead editorial, Nancy
Krieger from the Harvard School of Public Health notes that recent
“polarizing propositions” (e.g., epidemiology is or is not the basic
science of public health, and should or should not include advocacy)
are responsible for recent controversies about the scope and mission
of public health and epidemiology. She believes these competing claims
have profound implications for epidemiology and would prefer to see
these propositions revised to state that epidemiology is one of many
basic sciences in public health, that epidemiology, like any science,
is at once objective and partisan, and that both science and advocacy
require calling into question underlying assumptions. In fact,
examining underlying assumptions is what Krieger seems most interested
in as a means of furthering socially responsible science, and
presumably socially responsible epidemiology.
In a second editorial, Jeff
Koplan, Steve Thacker, and Nicole Lezin from the CDC present the text
of the first Jon Mann lecture given at the annual conference of the
Council of State and Territorial Epidemiologists last June. In this
article, Koplan and colleagues discuss some of the outstanding past
achievements in epidemiology and state that “These achievements have
depended on the complementary contributions of different facets of
epidemiology: calculating disease trends and probabilities;
communicating findings to the public and policy makers; and designing
and implementing interventions based on the data.” In order to meet
future challenges, the authors remind us that “epidemiology’s full
value is achieved only when its contributions are placed in the
context of public health action, resulting in a healthier populace.”
In a related article seeking the
identity of epidemiology as seen in its textbooks, Raj Bhopal from the
University of Edinburgh notes that changes in recent editions
“exemplify the fundamental question...of whether epidemiology is
primarily an applied public health discipline— requiring textbooks
fully illustrating applications—or primarily a science in which
methods and theory dominate over practice and applications.” According
to Bhopal, “a lively discussion is continuing in the journals and is
likely to sharpen in the 21st century.” He notes that “Epidemiology
might benefit from a collaboration with science philosophy to assess
its directions and to help maximize the benefits of the current
debate.”
Calling the translation of
epidemiologic findings into policy “one of the most difficult issues
facing epidemiologists,” Leila Jackson, Nora Lee, and Jonathan Samet
from Johns Hopkins describe the frequency of policy recommendations in
editorials and articles from the American Journal of Epidemiology, the
Annals of Epidemiology, and Epidemiology between 1991 - 95. They found
that about a quarter of the articles sampled in AJE and in the Annals
contained such recommendations. Epidemiology, in contrast, has a
policy reserving such material for editorials and commentaries.
Quoting Milton Terris that epidemiologic findings should play a major
role in the formulation of health policy, the authors leave no doubt
about the importance epidemiology can have for public health programs.
Their description of current practices, at least in publications, is
intended to provide a basis for further examination and dialogue on
the role of epidemiologists in the policy making process.
In what appears to be a very
different view from those of the above authors, David Savitz, Charles
Poole, and William Miller from the University of North Carolina School
of Public Health argue for a reassessment of the role of epidemiology
in public health. They state that epidemiology is a science, but is
not the basic science of public health because there is more to what
public health needs than what epidemiology can provide. Furthermore,
translation of epidemiologic evidence into public health action
appears to lie outside the domain of epidemiology because it needs to
take place under a set of rules different from those which govern in
epidemiology. They state, “In principle, the talents that make an
effective scientist and the talents that make an effective advocate,
both of which are vital to public health, can coexist in the same
individual. However, flexibility in responding to new information
objectively, a requirement of science, runs counter to the consistent
ideology needed for public health activism...public health is far too
complex to be considered merely applied epidemiology.”
Published August/September 1999
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