Schwartz S, Susser E, Susser M
Joseph L. Mailman School of Public Health (Epidemiology), New York, New York, USA.
Annu Rev Public Health. 1999;20:15-33. doi: 10.1146/annurev.publhealth.20.1.15.
This paper considers ways of thinking about causes and prevention that could guide epidemiology beyond the present era. Discontent with modern epidemiology, in the face of its substantial achievements, is taken as a sign that the guiding principles of the discipline warrant reconsideration. To begin this task, current practices are placed within an historical perspective, in a review of the dominant ideas of successive eras in epidemiology. Then the premises and constraints of the present era of chronic disease epidemiology, with its risk factor paradigm, are specified. Finally, elements of a causal paradigm for an emerging era are proposed. This paradigm encourages thinking about causes at multiple levels of organization and within the historical context of both societies and individuals. The proposed approach aims to preserve and build on the contributions of past eras, as well as the present one.
本文探讨了一些关于病因及预防的思考方式，这些方式能够引领流行病学超越当前时代。尽管现代流行病学取得了显著成就，但对其不满被视为该学科的指导原则需要重新审视的一个信号。为了开展这项任务，我们将当前的实践置于历史视角下，回顾流行病学各个相继时代的主导思想。接着明确了当前慢性病流行病学时代及其危险因素范式的前提和局限。最后，提出了一个新兴时代因果范式的要素。这种范式鼓励在组织的多个层面以及社会和个体的历史背景中思考病因。所提出的方法旨在保留并借鉴过去时代以及当前时代的贡献。
