Galea responds to 'consequential(ist) epidemiology: Finally

摘要

I am grateful for Dr. Cates' comments (1) on my thoughts (2) about a consequentialist epidemiology. Although it is always heartening to read comments by a distinguished colleague who agrees with one's point of view, I am most struck by Dr. Cates' highlighting of comparable topics of epidemiology presentations past (3, 4), with subject matter presented 20 and 30 years ago that I unknowingly echoed in my paper.Is the observation that I am writing about a topic that has challenged epidemiologists for 20 years a cause for despair; that is, does a decades-long argument for an epidemiology of consequence impugn a discipline? Conversely, is the observation that we have long had voices advocating for epidemiology's engagement with the pressing public health issues of our time a cause for celebration? That is, can we really be that far removed from taking on questions that matter if we have a string of presentations, and now a paper, urging us not to take our eyes off the "prize?"The answer is probably a bit of both. We clearly have had long-standing intent to engage with the aspects of epidemiology that can bring about change and that directly tackle the health of populations. However, it is also just as clear that we have an equally long-standing worry that we are not engaging enough, not doing enough to address these issues and, implicitly, not focusing enough of our attention on the areas that I argue matter in my comment.Why would this be? It strikes me that most epidemiologists probably agree that we should engage more than we do in matters of consequence. Entrance surveys of our doctoral students repeatedly confirm that most choose the discipline out of some interest in the promotion of the health of the public. Why then does our scholarship not reflect this interest, or at least not sufficiently? I suspect that this is largely driven by the structural constraints within which we work.