Looking back on "causal thinking in the health sciences"

It has now been over a quarter of a century since the publication of Mervyn Susser's Causal Thinking in the Health Sciences (1973, Oxford University P ress), the first book-length treatment of causal reasoning and inference in our field. Major contributions of this work were its holistic focus on the origins of health outcomes in the context of ecologic systems and its invi goration of the literature on causal criteria in epidemiology. Although a r ecent resurgence of interest in social context has revivified many points m ade by Susser, a formal basis for causal analysis consistent with this ecol ogic perspective has failed to emerge in public health research. Susser's d iscussion of causal criteria, on the other hand, helped spur a vigorous dia logue that has persisted unabated to the present day. Although the basic ou tline of the criteria has evolved little, their applications, interrelation s, and relative contributions to causal judgments have been the subject of continued and sometimes contentious debate.