Advertisement
MO BIO
MO BIO

An Evolving Science for an Evolving Time

Twenty-first century challenges to the public health of all the world’s populations require forward-looking commitments from epidemiologists.

By | January 1, 2012

image: An Evolving Science for an Evolving Time Istockphoto.com, Courtney Keating

ISTOCKPHOTO.COM, COURTNEY KEATING

Epidemiology, the study of both communicable and chronic disease epidemics, is the basic science undergirding public health and preventive medicine, much as anatomy informs surgery. This fundamental supporting science provides data and theories essential for the intelligent management of public health. We might suspect that smoking is unhealthy, but what is the risk of spending an hour inside a room filled with cigarette smoke, compared to waiting for the same amount of time at a busy bus station, breathing diesel fumes? Epidemiological studies may not give a precise answer to this question but can certainly provide general principles, and can increasingly contribute to quantifying risks.

No science is an island, including epidemiology, which is naturally influenced by wider scientific knowledge and technological advances. In some cases, however, epidemiologists have provided insights that long predated those of other disciplines. An example is the understanding that the cause of cholera had more to do with dirty water than with filthy air. This was worked out by John Snow and other pioneer epidemiologists in London in the mid-1850s, 30 years before Koch microscopically identified the cholera bacterium.

In the 20th century, epidemiologists made great progress. They helped to illuminate not only the causes of many infectious and chronic diseases, including HIV/AIDS and lung cancer, but also ways to lower the risk of acquiring them in the first place.

Without change, epidemiologists may join the dinosaurs.

Epidemiologists have also successfully confronted powerful interests, some of which seek to suppress scientific knowledge. The best example is the tobacco industry (in the West, not yet in China); another is the mining of asbestos (though not yet in Canada). Some epidemiologists study the links between the advertising of junk food, obesity, and chronic diseases such as diabetes and cancer. Unfortunately, they have not yet been too successful in reducing such advertising.

But epidemiology cannot rely on its heroic past. It needs periodic infusions of courage, lest it lapse into irrelevance. Sometimes it seems more a science employed to chase shrinking needles in an ever-growing haystack. For example, might drinking three cups of coffee per day increase one’s risk of pancreatic cancer? People who worry about this rare condition are comparatively affluent, and such studies may well get funded. But tonight, almost one-seventh of the world’s population will go to sleep hungry; perhaps two billion more people (especially women) will battle with chronic fatigue caused by iron deficiency. Epidemiologists are far less likely to grapple with such issues, which they are neither encouraged to examine nor rewarded for prioritizing. Poor people can never fund epidemiologists; rich people rarely fund studies designed to help the poor. Global and local disparities continue to widen.

With few exceptions, epidemiologists are also blind to two “elephants in the room” concerning public health. Poverty, the “elephant” discussed above, has long been present, though mostly ignored. The other elephant is of more recent origin, and unlike poverty, threatens the health of us all. That is resource depletion and its accompanying dark shadow, climate change. We are running out of oil and depleting other stocks of fossil fuel, the burning of which transfers once-buried carbon to the ocean and air. In a few decades, we are likely to run short of phosphate, which is essential for fertilizer. We are thus damaging food security and, before too long, coastal infrastructure via sea-level rise. Growth in population size and ongoing consumerism will increase the challenges even further. Since prevention is the main thrust of public health, addressing these problems sooner would be better.

Epidemiology’s constant challenge is to see the world afresh, to seek and analyze data that link phenomena otherwise taken for granted and seen as unconnected (e.g. sewage and cholera), and to assist advocates to protect public health. Poverty, resource scarcity, and to a lesser extent climate change are not yet seen by most epidemiologists as relevant to public health, just as their forebears failed to link dirty hands with childbed fever. Without change, epidemiologists may join the dinosaurs.

Colin Butler is a professor of environmental health at the National Centre for Epidemiology and Population Health, in Canberra. In 2009 he was named one of “100 doctors for the planet” by the French Environmental Health Association.

Add a Comment

Avatar of: You

You

Processing...
Processing...

Sign In with your LabX Media Group Passport to leave a comment

Not a member? Register Now!

LabX Media Group Passport Logo

Comments

Avatar of: hpaa46

hpaa46

Posts: 1

January 10, 2012

This is the essential call-to-action for epidemiologists  They, seizing the mandate of the essay, will play a critical role is promoting the role of science in public decision-making.  The essay also suggests a way to overcome the main barrier to international cooperation and the fullest use of science in general and epidemiology in particular: national sovereignty. 
  In 1992, the UN Secretary-General, Boutros
Boutros-Ghali, wrote :

"While
respect for the fundamental sovereignty and integrity of the state remains
central, it is undeniable that the centuries-old doctrine of absolute and exclusive
sovereignty no longer stands, and was in fact never so absolute as it was
conceived to be in theory. A major intellectual requirement of our time is to
rethink the question of sovereignty -- not to weaken its essence, which is
crucial to international security and cooperation, but to recognize it may take
more than one form and perform more than one function. This perception could
help solve problems both within and among states. And  underlying the rights of the individual and
the rights of peoples is a dimension of universal sovereignty that resides in
all humanity and provides all peoples with legitimate involvement in issues
affecting the world as a whole. It is a sense that increasingly finds
expression in the gradual expansion of international law."

 from:
Boutros-Ghali, Empowering the United Nations, 71 For.Aff. 89,98-99 (Winter
1992/92)

Avatar of:

Posts: 0

January 10, 2012

This is the essential call-to-action for epidemiologists  They, seizing the mandate of the essay, will play a critical role is promoting the role of science in public decision-making.  The essay also suggests a way to overcome the main barrier to international cooperation and the fullest use of science in general and epidemiology in particular: national sovereignty. 
  In 1992, the UN Secretary-General, Boutros
Boutros-Ghali, wrote :

"While
respect for the fundamental sovereignty and integrity of the state remains
central, it is undeniable that the centuries-old doctrine of absolute and exclusive
sovereignty no longer stands, and was in fact never so absolute as it was
conceived to be in theory. A major intellectual requirement of our time is to
rethink the question of sovereignty -- not to weaken its essence, which is
crucial to international security and cooperation, but to recognize it may take
more than one form and perform more than one function. This perception could
help solve problems both within and among states. And  underlying the rights of the individual and
the rights of peoples is a dimension of universal sovereignty that resides in
all humanity and provides all peoples with legitimate involvement in issues
affecting the world as a whole. It is a sense that increasingly finds
expression in the gradual expansion of international law."

 from:
Boutros-Ghali, Empowering the United Nations, 71 For.Aff. 89,98-99 (Winter
1992/92)

Avatar of:

Posts: 0

January 10, 2012

This is the essential call-to-action for epidemiologists  They, seizing the mandate of the essay, will play a critical role is promoting the role of science in public decision-making.  The essay also suggests a way to overcome the main barrier to international cooperation and the fullest use of science in general and epidemiology in particular: national sovereignty. 
  In 1992, the UN Secretary-General, Boutros
Boutros-Ghali, wrote :

"While
respect for the fundamental sovereignty and integrity of the state remains
central, it is undeniable that the centuries-old doctrine of absolute and exclusive
sovereignty no longer stands, and was in fact never so absolute as it was
conceived to be in theory. A major intellectual requirement of our time is to
rethink the question of sovereignty -- not to weaken its essence, which is
crucial to international security and cooperation, but to recognize it may take
more than one form and perform more than one function. This perception could
help solve problems both within and among states. And  underlying the rights of the individual and
the rights of peoples is a dimension of universal sovereignty that resides in
all humanity and provides all peoples with legitimate involvement in issues
affecting the world as a whole. It is a sense that increasingly finds
expression in the gradual expansion of international law."

 from:
Boutros-Ghali, Empowering the United Nations, 71 For.Aff. 89,98-99 (Winter
1992/92)

Avatar of:

Posts: 0

January 11, 2012

The expansion of
international law is a possible utopia that has to be approached with great
caution.  It should start by
international action to first and foremost help remove from the world the worse
and most damaging of all environmental problems: extreme poverty, lack of
education, particularly for women, corruption, lack of liberty and civil
rights. Next, international law has to be guided by serious science instead of
science influenced by politicians. Resource scarcity is a very old tale. Since
Malthus, proved by facts to be 100% wrong, the same happened to all the
doomsayers since. But people and the media forget very fast their demise and
immediately accept the next fad. The eugenics movement lasted decades, killed
and damaged millions of lives.  Was
supported by the "intelligentsia" in the USA and Europe and vanished
at the end of World War II due to the nazi excesses. Radical and
"precautionary principle" environmentalism tread the same path. The
bogus crisis that supported eugenics was "save the human race". The
crisis now supported by climate and environmental catastrophists has the battle
cry "save the planet". 
To find out about resource scarcity read "The ultimate resource
2" by Julian L. Simon, an extremely serious study based in facts and not
in feelings and the evening news. I bet human ingenuity will solve the phosphate
problem.

Avatar of:

Posts: 0

January 11, 2012

Dear Francisco,

Thanks. I read much of Julian Simon's work in the 1990s. I wish it were so easy. Overall, yes, the Malthusian trap has been avoided at the global scale, so far. However, on a smaller scale, ingenuity has not solved resource scarcity; there are many examples including Rwanda in 1994, Somalia last year and already this year South Sudan, where hunger and fighting have caused MSF staff to flee, with at least 3,000 deaths.

Back to Simon: I recommend Vaclav Smil's recent paper in American Scientist ("Global Energy: The Latest Infatuations"), where Smil quotes Jonathon Swift: "This all brings to mind Lemuel Gulliver’s visit to the grand academy of Lagado: No fewer than 500 projects were going on there at once, always with anticipation of an imminent success, much as the inventor who “has been eight years upon a project for extracting sunbeams out of cucumbersâ€쳌 believed that “in eight years more, he should be able to supply the governor’s gardens with sunshine, at a reasonable rateâ€쳌—but also always with
complaints about stock being low and entreaties to “give … something as an
encouragement to ingenuity.â€쳌  (The article has a very nice drawing of the cucumber enthusiast.)

I am all in favour of ingenuity - and one example of ingenuity is to educate people, especially women and girls. We need to do much more in that direction, rather than rely mostly on techno-fixes. The New York Times just reported that companies face fines this
year for not using mandated cellulosic ethanol (ie ethanol from
non-food, eg corn stover, poplar trees or switchgrass).. this "solution"
was legislated .. to me this is rather Swiftian. http://www.nytimes.com/2012/01... conservation and reduction is also a form of ingenuity; surely Simon would approve (Simon also supported education). Last comment: my experience in India especially cautions me to consider education statistics critically .. not all literacy or education is equal; there are issues of quality also, and even if literacy is said to be increasing it may not be so. Many people and organisations have incentives to exaggerate, for good or bad.Best wishes

Avatar of:

Posts: 0

January 11, 2012

Excellent point. It appears that
public health is a misnomer in the sense that it refers to bulk of the
population with little commandeering power on health and regulatory issues. The
burden of disease estimates do not give the economic burden of disease, which
affects any country that does not have universal socialized medicine. Epidemiology
tends to be straight jacketed by the enforcement of boundaries to the discipline
imposed by the myopic view of the practitioners. For instance, if we take the
government funded health research, will the allocation of funds be seen towards
diseases and remedies that the top 1% of the economically stratified people
alone can afford? Epidemiology becomes straight jacketed primarily because
major issues of importance of equity and opportunity which underlie several
disorders and their handling are considered to be in the province of politics
and ideology rather than in the context humanism and mutual concern. The
changes required are extensive and not just limited to epidemiology, which is
but a manifestation of deeper interactions.

Avatar of:

Posts: 0

January 11, 2012

The expansion of
international law is a possible utopia that has to be approached with great
caution.  It should start by
international action to first and foremost help remove from the world the worse
and most damaging of all environmental problems: extreme poverty, lack of
education, particularly for women, corruption, lack of liberty and civil
rights. Next, international law has to be guided by serious science instead of
science influenced by politicians. Resource scarcity is a very old tale. Since
Malthus, proved by facts to be 100% wrong, the same happened to all the
doomsayers since. But people and the media forget very fast their demise and
immediately accept the next fad. The eugenics movement lasted decades, killed
and damaged millions of lives.  Was
supported by the "intelligentsia" in the USA and Europe and vanished
at the end of World War II due to the nazi excesses. Radical and
"precautionary principle" environmentalism tread the same path. The
bogus crisis that supported eugenics was "save the human race". The
crisis now supported by climate and environmental catastrophists has the battle
cry "save the planet". 
To find out about resource scarcity read "The ultimate resource
2" by Julian L. Simon, an extremely serious study based in facts and not
in feelings and the evening news. I bet human ingenuity will solve the phosphate
problem.

Avatar of:

Posts: 0

January 11, 2012

Dear Francisco,

Thanks. I read much of Julian Simon's work in the 1990s. I wish it were so easy. Overall, yes, the Malthusian trap has been avoided at the global scale, so far. However, on a smaller scale, ingenuity has not solved resource scarcity; there are many examples including Rwanda in 1994, Somalia last year and already this year South Sudan, where hunger and fighting have caused MSF staff to flee, with at least 3,000 deaths.

Back to Simon: I recommend Vaclav Smil's recent paper in American Scientist ("Global Energy: The Latest Infatuations"), where Smil quotes Jonathon Swift: "This all brings to mind Lemuel Gulliver’s visit to the grand academy of Lagado: No fewer than 500 projects were going on there at once, always with anticipation of an imminent success, much as the inventor who “has been eight years upon a project for extracting sunbeams out of cucumbersâ€쳌 believed that “in eight years more, he should be able to supply the governor’s gardens with sunshine, at a reasonable rateâ€쳌—but also always with
complaints about stock being low and entreaties to “give … something as an
encouragement to ingenuity.â€쳌  (The article has a very nice drawing of the cucumber enthusiast.)

I am all in favour of ingenuity - and one example of ingenuity is to educate people, especially women and girls. We need to do much more in that direction, rather than rely mostly on techno-fixes. The New York Times just reported that companies face fines this
year for not using mandated cellulosic ethanol (ie ethanol from
non-food, eg corn stover, poplar trees or switchgrass).. this "solution"
was legislated .. to me this is rather Swiftian. http://www.nytimes.com/2012/01... conservation and reduction is also a form of ingenuity; surely Simon would approve (Simon also supported education). Last comment: my experience in India especially cautions me to consider education statistics critically .. not all literacy or education is equal; there are issues of quality also, and even if literacy is said to be increasing it may not be so. Many people and organisations have incentives to exaggerate, for good or bad.Best wishes

Avatar of:

Posts: 0

January 11, 2012

Excellent point. It appears that
public health is a misnomer in the sense that it refers to bulk of the
population with little commandeering power on health and regulatory issues. The
burden of disease estimates do not give the economic burden of disease, which
affects any country that does not have universal socialized medicine. Epidemiology
tends to be straight jacketed by the enforcement of boundaries to the discipline
imposed by the myopic view of the practitioners. For instance, if we take the
government funded health research, will the allocation of funds be seen towards
diseases and remedies that the top 1% of the economically stratified people
alone can afford? Epidemiology becomes straight jacketed primarily because
major issues of importance of equity and opportunity which underlie several
disorders and their handling are considered to be in the province of politics
and ideology rather than in the context humanism and mutual concern. The
changes required are extensive and not just limited to epidemiology, which is
but a manifestation of deeper interactions.

January 11, 2012

The expansion of
international law is a possible utopia that has to be approached with great
caution.  It should start by
international action to first and foremost help remove from the world the worse
and most damaging of all environmental problems: extreme poverty, lack of
education, particularly for women, corruption, lack of liberty and civil
rights. Next, international law has to be guided by serious science instead of
science influenced by politicians. Resource scarcity is a very old tale. Since
Malthus, proved by facts to be 100% wrong, the same happened to all the
doomsayers since. But people and the media forget very fast their demise and
immediately accept the next fad. The eugenics movement lasted decades, killed
and damaged millions of lives.  Was
supported by the "intelligentsia" in the USA and Europe and vanished
at the end of World War II due to the nazi excesses. Radical and
"precautionary principle" environmentalism tread the same path. The
bogus crisis that supported eugenics was "save the human race". The
crisis now supported by climate and environmental catastrophists has the battle
cry "save the planet". 
To find out about resource scarcity read "The ultimate resource
2" by Julian L. Simon, an extremely serious study based in facts and not
in feelings and the evening news. I bet human ingenuity will solve the phosphate
problem.

Avatar of: Colin David Butler

Colin David Butler

Posts: 1457

January 11, 2012

Dear Francisco,

Thanks. I read much of Julian Simon's work in the 1990s. I wish it were so easy. Overall, yes, the Malthusian trap has been avoided at the global scale, so far. However, on a smaller scale, ingenuity has not solved resource scarcity; there are many examples including Rwanda in 1994, Somalia last year and already this year South Sudan, where hunger and fighting have caused MSF staff to flee, with at least 3,000 deaths.

Back to Simon: I recommend Vaclav Smil's recent paper in American Scientist ("Global Energy: The Latest Infatuations"), where Smil quotes Jonathon Swift: "This all brings to mind Lemuel Gulliver’s visit to the grand academy of Lagado: No fewer than 500 projects were going on there at once, always with anticipation of an imminent success, much as the inventor who “has been eight years upon a project for extracting sunbeams out of cucumbersâ€쳌 believed that “in eight years more, he should be able to supply the governor’s gardens with sunshine, at a reasonable rateâ€쳌—but also always with
complaints about stock being low and entreaties to “give … something as an
encouragement to ingenuity.â€쳌  (The article has a very nice drawing of the cucumber enthusiast.)

I am all in favour of ingenuity - and one example of ingenuity is to educate people, especially women and girls. We need to do much more in that direction, rather than rely mostly on techno-fixes. The New York Times just reported that companies face fines this
year for not using mandated cellulosic ethanol (ie ethanol from
non-food, eg corn stover, poplar trees or switchgrass).. this "solution"
was legislated .. to me this is rather Swiftian. http://www.nytimes.com/2012/01... conservation and reduction is also a form of ingenuity; surely Simon would approve (Simon also supported education). Last comment: my experience in India especially cautions me to consider education statistics critically .. not all literacy or education is equal; there are issues of quality also, and even if literacy is said to be increasing it may not be so. Many people and organisations have incentives to exaggerate, for good or bad.Best wishes

Avatar of: sitaramamv

sitaramamv

Posts: 69

January 11, 2012

Excellent point. It appears that
public health is a misnomer in the sense that it refers to bulk of the
population with little commandeering power on health and regulatory issues. The
burden of disease estimates do not give the economic burden of disease, which
affects any country that does not have universal socialized medicine. Epidemiology
tends to be straight jacketed by the enforcement of boundaries to the discipline
imposed by the myopic view of the practitioners. For instance, if we take the
government funded health research, will the allocation of funds be seen towards
diseases and remedies that the top 1% of the economically stratified people
alone can afford? Epidemiology becomes straight jacketed primarily because
major issues of importance of equity and opportunity which underlie several
disorders and their handling are considered to be in the province of politics
and ideology rather than in the context humanism and mutual concern. The
changes required are extensive and not just limited to epidemiology, which is
but a manifestation of deeper interactions.

Follow The Scientist

icon-facebook icon-linkedin icon-twitter icon-vimeo icon-youtube
Advertisement
Ingenuity
Ingenuity

Stay Connected with The Scientist

  • icon-facebook The Scientist Magazine
  • icon-facebook The Scientist Careers
  • icon-facebook Neuroscience Research Techniques
  • icon-facebook Genetic Research Techniques
  • icon-facebook Cell Culture Techniques
  • icon-facebook Microbiology and Immunology
  • icon-facebook Cancer Research and Technology
  • icon-facebook Stem Cell and Regenerative Science
Advertisement
CEM
CEM
Advertisement
The Scientist
The Scientist
Life Technologies