Society for
Epidemiologic Research (SER) Presidential Addresses
Outgoing SER
President Calls for More “Consequential Epidemiology”
Colleagues
Urged to Ask “So What?” and “How Much?”
“The future of epidemiology in
the United States... depends on how well we adapt to the ongoing
process of health care reform.” This was one of the major themes
struck by Ward Cates, CDC epidemiologist and outgoing
president of SER, at the group’s annual meeting in Miami in mid-June.
Cates sounded an optimistic note saying that epidemiology should be on
firmer ground than other disciplines because its focus on populations
is “ideally suited for the ‘outcomes research’...which the consumer
and provider collectives will demand.”
And what will it take for
epidemiology to actualize its potential under health care reform? “The
key,” says Cates, “will be our ability to market our epidemiologic
skills in a way that is seen by society as making a difference”—best
put 12 years ago by the Carter Center’s Bill Foege in
a Frost Lecture as “consequential epidemiology.” We make our
epidemiologic work consequential according to Cates by asking two
questions—“so what?” i.e. do our inferences work to change people’s
lives, and “how much?”—i.e. what do interventions cost for the
benefits they provide? “...Given the pace and inevitability of health
care reform, now is the time to reframe our science to emphasize
consequential outcomes,” said Cates.
Published July 1994
Postscript 2000
“Consequential
Epidemiology” in the New Millennium
Six years later, the
term “Consequential Epidemiology” has a similar meaning as it did in
1994, namely, the application of epidemiologic methods to answering
the most important public health questions and indicating appropriate
interventions to improve health. The burgeoning science of “outcomes
research” and the continued demand for specialists in health economics
attest to the importance of the “so what?” and “how much?” questions.
Our understanding
the processes by which our science of epidemiology is translated into
public health practice is becoming more clear. Epidemiology, as a
science, can be differentiated from public health as a mission. The
use of scientific data to answer key questions is a necessary, but not
sufficient, step along the pathway to promote public health action.
Because of its mission, public health draws not only on epidemiology,
but on many of the other disciplines within the broad context of
“prevention sciences” (2). By making our discipline of epidemiology
more inclusive of other fields, we can better move in the direction of
becoming truly “consequential.”
References:
1. Savitz DA, Poole C,
Miller WC. Reassessing the role of epidemiology in public health.
American Journal Public Health 1999;89:1158-1161.
2. Cates W Jr. Prevention
science: the umbrella discipline. American Journal Preventive
Medicine 1995;11:211-12.
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