Epidemiology and the People's Health: Theory and Context

by Nancy Krieger

Epidemiology is often referred to as the science of public health. However, unlike other major sciences, its theoretical foundations are rarely articulated. While the idea of epidemiologic theory may seem dry and arcane, it is at its core about explaining the people's health. It is about life and death. It is about biology and society. It is about ecology and the economy. It is about how myriad aspects of people's lives - involving work, dignity, desire, love, play, conflict, discrimination, and injustice - become literally incorporated into our bodies and manifest in our health status, individually and collectively. And it is about essential knowledge critical for improving the people's health and minimizing inequitable burdens of disease, disability, and death.

Woven from a vast array of schools of thought, including those in the natural, social, and biomedical sciences, epidemiologic theory is a rich tapestry whose time for analysis is long overdue. By tracing its history and contours from ancient societies on through the development of - and debates within - contemporary epidemiology worldwide, Dr. Krieger shows how epidemiologic theory has long shaped epidemiologic practice, knowledge, and the politics of public health. Outlining an ecosocial theory of disease distribution that situates both population health and epidemiologic theory in societal and ecologic context, she offers a more holistic picture of how we embody the human experience.

This concise, conceptually rich, and accessible book is a rallying cry for a return to the study and discussion of epidemiologic what it is, why it matters, how it has changed over time, and its implications for improving population health and promoting health equity. It should be required reading for all epidemiologists, or anyone involved in the study of human health and well-being.

Genres: Nonfiction, Health, Theory, Science

400 pages, Hardcover

First published March 23, 2011

Reviews

[Wendelle]

interesting book about the history of epidemiology or the scientific and statistical study of disease distributions.

Early on epidemiologic thinking was on unwieldy ground, subject to whims and fashions, blaming disease spread on grounds as disparate as contagion, miasma, and race and ethnic attributes. Individual differences in catching disease were explained through factors of climate adatability, personal susceptibility, race superiority or inferiority, or the conditions brought about by poverty, colonialism, or slavery. People of non-Caucasian heritage were assumed to have greater chance of carrying- and spreading- disease. At the best of times, this prodded pity from authorities. At worst, African-Americans and Jews were perceived to be 'vectors' of the disease in dehumanizing ways. Solutions proposed ranged from quarantine (and worse) of undesirable populations to sanitation and social reform.

In the mid-2oth century epidemiology has found more stable scientific consensus for its foundations in germ theory and genetic theory. The dominant theory today is the biomedical one, which attributes disease distribution to a tripartite cause of biological agents, genes and risk factors. However, there is still disagreement whether the appropriate context for disease exposure and acquisition is individualistic or 'lifestyle' responsibility, or psychosocial and sociopolitical factors.

[Harris]

A solid and fun-to-read history of the various theoretical underpinnings throughout the lifetime of epidemiology. The book makes a solid case for embracing more expansive theories based in economics, biology, history, and various social sciences as opposed to relying on simple, reductionist biomedical theory. The Zinn, Hobsbawm, and Engels citations are especially telling.

[Jessica · Rating 5 out of 5]

Excellent historical recounting of epidemiology as a field, and compelling argument on the need for strong theoretical frameworks to underpin epidemiologic research.

[Susan · Rating 4 out of 5]

This book gets off to a painfully slow start, but by the second or third chapter I was actually quite entranced by her analysis and after that I found the book interesting and useful until the very end.