[An epidemiological approach to health promotion: the ideas of Geoffrey Rose].
In this paper, we discuss some of the ideas developed by Geoffrey Rose, which are seldom explicitly expressed in the contemporary debate on health promotion. The following notions are emphasized: many health exposures and outcomes are expressed in a continuum, and do not follow the dichotomy exposed/non-exposed or diseased/ non-diseased; there is a linear relationship between certain exposures and their effects along the range of exposure levels; thus, many individuals exposed to low risk may generate more cases of a disease than few individuals exposed to high risk. In addition, there is a strong relationship between average behaviors and the occurrence of deviance, as a result of the balance between biological and social forces favoring diversity or uniformity. Thus, risk differences between defined populations involve differences in the population distributions as a whole, rather than in the proportion of individuals with high risk. Overall, these concepts favor emphasis on strategies aiming the general population, and not only the individuals considered to be at high risk of disease.
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Departamento de Epidemiologia e Métodos Quantitativos em Saúde, Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil.
Faerstein
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D004812:Epidemiologic Methods; D006293:Health Promotion; D006801:Humans; D011322:Primary Prevention; D012307:Risk Factors