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An Exclusive Interview With Nancy Krieger
Author of Epidemiology and the People's Health

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?

The book 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.

Unlike 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 disease distribution.

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 book?

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 people's health.


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        2011 The Epidemiology Monitor

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