What matters most: quantifying an epidemiology of consequence.
Risk factor epidemiology has contributed to substantial public health success. In this essay, we argue, however, that the focus on risk factor epidemiology has led epidemiology to ever increasing focus on the estimation of precise causal effects of exposures on an outcome at the expense of engagement with the broader causal architecture that produces population health. To conduct an epidemiology of consequence, a systematic effort is needed to engage our science in a critical reflection both about how well and under what conditions or assumptions we can assess causal effects and also on what will truly matter most for changing population health. Such an approach changes the priorities and values of the discipline and requires reorientation of how we structure the questions we ask and the methods we use, as well as how we teach epidemiology to our emerging scholars.
Department of Epidemiology, Columbia University, New York, NY.
Katherine
K
Keyes
Department of Epidemiology, Boston University School of Public Health, Boston, MA. Electronic address: sgalea@bu.edu.
Sandro
S
Galea
D015984:Causality; D004812:Epidemiologic Methods; D004813:Epidemiology / Q000592:standards* / Q000639:trends; D005260:Female; D006801:Humans; D008297:Male; D011634:Public Health; D012307:Risk Factors; D012941:Social Responsibility
Causal inference; Causes; Consequentialism; Consequentialist epidemiology; Interaction; Prevalence