THE FAILURE OF ACADEMIC EPIDEMIOLOGY - WITNESS FOR THE PROSECUTION

Academic epidemiology has failed to develop the scientific methods and the knowledge base to support the fundamental public health mission o f preventing disease and promoting health through organized community efforts. As a basic science of public health, epidemiology should atte mpt to understand health and disease from a community and ecologic per spective as a consequence of how society is organized and behaves, wha t impact social and economic forces have on disease incidence rates, a nd what community actions will be effective in altering incidence rate s. However, as taught in most textbooks and as widely practiced by aca demicians, epidemiology has become a biomedical discipline focused on the distribution and determinants of disease in groups of individuals who happen to have some common characteristics, exposures, or diseases . The ecology of human health has not been addressed, and the societal context in which disease occurs has been either disregarded or delibe rately abstracted from consideration. By essentially assuming that ris k factors for disease in individuals can be summed to understand the c auses of disease in populations, academic epidemiology has limited its elf to a narrow biomedical perspective, thereby committing the biomedi cal fallacy of inferring that disease in populations can be understood by studying risk factors for disease in individuals. Epidemiology sho uld be redefined as a study of the distribution and societal determina nts of the health status of populations. This definition provides a st ronger link to the primary mission of public health and places an appr opriate emphasis on the social, economic, environmental, and cultural determinants of population health. Epidemiology must cross the boundar ies of other population sciences and add to its scope a macro-epidemio logy, a study of causes from a truly population perspective, consideri ng health and disease within the context of the total human environmen t.