EM: What type of book is Epidemiology and the People's Health?
How would you categorize or describe it briefly in comparison to
textbooks in epidemiology?
is a critical intellectual history and analysis of
epidemiological theories of disease distribution, past and
present. Its central argument is that epidemiologic theory --
itself influenced by the societal and ecologic context in which
it is conceived -- has long shaped epidemiologic practice,
knowledge, and the politics of public health.
most other epidemiology text books, which focus primarily on
epidemiologic methods, this book asks us to consider the
theoretical frameworks that motivate our research and the
methods we employ. As discussed in the first chapter of the
book, only a small fraction of contemporary epidemiologic
textbooks include any text about epidemiologic theories of
disease distribution, let alone the importance of theoretical
frameworks to scientific research; it is this gap that my book
is intended to address.
In its 8 chapters, the text accordingly
delves first into what counts as scientific theory and why this
matters, drawing in insights from work in the history and
philosophy of science. It then traces and analyzes the history
and contours of epidemiologic theories from ancient societies on
through the development of -- and debates within -- contemporary
epidemiology worldwide. Examples discussed range from critical
analysis of ancient classical texts of Greek Hippocratic humoral
theory and Chinese medicine to current oral traditions of the
Kallawaya in the Andes and the Ogori in Nigeria, on through
contrasts between contemporary dominant biomedical and lifestyle
theories of disease distribution and the different schools of
social epidemiologic theories: sociopolitical, psychosocial, and
most recently, ecosocial.
Finally, to bring home the real-life
consequences of epidemiologic theory, the last chapter offers
four contemporary case studies of how people's health has been
harmed -- or helped -- depending on the epidemiologic theory
employed. For "harm," case examples are: (1) hormone therapy,
cardiovascular disease, and breast cancer, with iatrogenic
disease resulting from biomedical disregard for social
determinants of health; (2) peptic ulcers, H. pylori,
and allergies, contrasting psychosocial and biomedical extremes;
(3) diabetes and Indigenous health, tracing theorizing from
"thrifty genes" and racialized disease to reckoning with the
transgenerational biological embodiment of social and ecological
injustice; and (4) the impact of curtailing and depoliticizing
relevant timeframes for analyzing temporal trends in health
inequities. For "help," they are: (a) improving public health
surveillance systems; (b) exposing discrimination as a
determinant fo health inequities; and (c) new national policies
and global recommendations.
Looking ahead, the book argues that the
science of epidemiology can be improved by consciously
embracing, developing, and debating epidemiologic theories of
EM: How did it happen that you
came to write this book at this point in your career? Were there
events or circumstances that triggered your writing?
This book reflects work I've
been engaged in and thinking about for many years. It presents
what I wish I had been taught when I was studying to become an
epidemiologist, regarding the theories and history of my field.
Shortly after I received my doctoral degree in epidemiology, I
started designing a course to address these gaps, which provided
a wonderfully structured way to read, systematically, through
the fascinating, at times very disturbing, and at other times
inspiring literature relevant to this task. Over the years of
teaching this course, which has evolved over time, I became
convinced that it would be useful to write a book that could not
only serve as a text for the class I teach but also be useful to
others -- whether students wanting to learn about epidemiologic
thinking, epidemiologists already engaged in public health
research and work, and others concerned about who and what
shapes patterns of population health, including health
inequities. One thing led to another and it finally just became
time to write the book -- and in 2008 I was fortunate to secure
a break from teaching my course so that I could start the
writing, a year later I had completed the first draft, and now I
am thrilled to have it in final form and published!
EM: What do you consider to
have been your primary aim in writing the book? Was there
something most important to you that you wanted to accomplish by
preparing the book?
My primary aim is to make epidemiologists
-- and others -- aware of the critical importance of being
explicit about the widely divergent epidemiologic theories of
disease distribution that underlie the research we do.
Discussing and debating these theories is essential
for sharpening our ideas and improving not only our
understanding of current and changing distributions of
population health, but also the rigor of our hypotheses, how we
test them, and how we interpret our study findings, with what
implications for the people's health.
EM: What has been the reaction
so far to your book?
My sense is that there is a
good amount of interest in the book and recognition that it
addresses an important gap in the literature. I base this
statement in part due to my editor informing me the book is
selling briskly, even despite it being before any book reviews
having been published, with the number of copies sold in the
first two months on the order of what a book of this sort
typically sells in a good year. Moreover, in addition to
supportive comments from other colleagues engaged in work that
addresses different issues discussed in the book, I have had
quite a number of individuals whom I don't know email me to say
they were very glad to learn about the book, which they have
found to be very thought provoking and informative.
EM: What would you most want
to tell a person considering the purchase or reading of your
To enjoy the challenge of thinking
critically about our field and its theories of disease
distribution -- and the difference this makes for the work we
do, here and now, to analyze, understand, and improve the
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