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Interview With Sandro Galea, Author Of New Book On Population Health

An “Epidemiology Of Consequence” Is Highlighted

Essays on public health topics by Boston University’s Sandro Galea have been collected into a single volume and published as a new book entitled “Healthier: Fifty Thoughts On The Foundations Of Population Health.” Galea was scheduled to give book talks in Washington DC and New York City in January. We reached Galea to ask questions about how the book came about and its relevance for epidemiologists.

Epi Monitor: Where did you get the idea to compile and write this book? Is it similar to others you know about?

Galea: This book is an adaptation of a series of essays that I started writing when I became Dean of Public Health at Boston University.  I initially set out to explore my own thinking, and to provoke our communities’ reactions around a broad range of issues that are important to public health. They evolved into an important running conversation that I was having with our school and increasingly with other colleagues around the world.   Several people urged me to consider compiling them into a book and I chose 50, or about half the notes I had written in my first two years at the school, and adapted them for a book.  What emerged was a meditation of sorts on the key issues in public health, some of them timeless (e.g., social justice) and some very much of the moment (e.g., transgender rights).

Common Thread

Epi Monitor:
Is there a common thread or theme that runs through the fifty thoughts? If so, what is it?

Galea:  If there were a common thread it would be that public health is about the social, economic, cultural, and political forces that influence the health of populations. That the aspirations of public health are inseparable from aspirations to build a more progressive society, and that public health must look well beyond its traditional functional roles to contribute to a healthier world.


Epi Monitor:  Is there a conclusion in the book about how best to promote justice and how best to act on the determinants of well-being?

Galea: The intended audience for the book was really my academic colleagues, although it has had a bit broader readership than that.  As such any conclusion about what we can do is very much with the focus on “we” as academics.  With that in mind, the book suggests, to my mind, that academics have a responsibility to tackle topics of consequence, and to speak fearlessly about what it will take to create a healthier world.   This is particularly true of public health academics because of the ineluctable link between the aspirations of public health and aspirations for a better world.  Because if academics do not speak out for this, who will?

Epi Of Consequence

Epi Monitor:
What other aspects of the book would you like epidemiologists to know about?

 Epidemiology is the foundational science of population health and without epidemiology to guide the way on what causes the health of populations public health cannot act.  An epidemiology of consequence can provide the evidence-base that can inform public health action.  Epidemiology should be at the heart of any public health thinking and action.

Epi Translation

You suggest that epidemiologists as public health scientists should be engaged in speaking out or translating the evidence they produce into public health policies and actions. What interests and skills should a translational epidemiologist have, and what activities should he or she engage in?

 Galea: I have deep respect for the capacity of scientists to both carry out work that generates useful knowledge and for figuring out how to translate that knowledge so that those who can take action that changes the world can do so.  So I have long felt that the issue is less about skills and more about orientation, about being focused on producing work that has relevance to the world and partnering with those who are interested in acting on our discovery science. I have intentionally stopped short of saying what I think is consequential because I trust that good epidemiologists of good conscience can hold up a mirror to ourselves and ask that question about anything that we do.   Now if you were talking about skills, one can imagine skills in public writing and communicating, but I would stop short of saying all epidemiologists need those skills. Some will be so inclined to be involved in translation and some will not be and that is fine. As long as we are asking questions of consequence there shall be plenty of opportunity for those so inclined to translate the work.

Epi  Allegiances

Epi Monitor:
Our exchange reminds me of something we published many years ago. It was also a question intended to help epidemiologists develop a code of ethics. It was asked at a meeting of the Society for Epidemiologic Research.

A professor of ethics asked epidemiologists---What are your allegiances? Do these allegiances have priorities? To the truth? To the social welfare? To employers? What is epidemiology all about?

Galea: That is an interesting and important question. I think epidemiology is unquestionably about unearthing the truth.  That is what all science is about.  But if science is about collecting knowledge, it takes wisdom to know which knowledge to look for and how to organize it.  So, while we may like to be dispassionate seekers of knowledge, our higher quest is for wisdom and that quest ineluctably tangles with the values that inform our work.  To that end we should be conscious of what those values are so we can interrogate them.  I would argue that our prejudice should lie with the quest for wisdom that can improve the health of populations, and that we should ask questions of consequence towards that end. 

Epi Monitor: Thank you very much.   ■

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