[The role of epidemiology in policy definition. Toward the public health required. 2008 SESPAS Report].

Epidemiology already plays a substantial role in the definition of public and corporate policies in Spain as well as in other developed countries. The World Health Organization reinforced the position of epidemiology by enshrining the notion of social health determinants and, as a result, the connection between health and social constructs has become more visible. However, the use of epidemiology is usually restricted to the development and evaluation of policies originating in health bureaucracies with health improvement as the only public objective; these are called direct health policies. This view is somewhat reductionistic insofar as health gains and losses occur mainly due to policies outside the health sector. To expand the role of epidemiology as a tool to shape policies, we need a view of exposures and effects beyond healthcare and the biological and behavioral risk factors proposed by medical paternalism. Also required are an attitude that is more participative than prescriptive and the development of more health impact assessments. In addition, the health effects of the decisions taken by politically-empowered institutions should be included in the epidemiologist's tool kit. In other words, a political epidemiology should be constructed. For this endeavor, which may be crucial to attain the public health required, public health practitioners should be more visible and credible, have greater independence from political power, provide information directly to the public and other stake holders (greater transparency), and further develop the professionalization of public health (greater competence) by working increasingly in networks of professionals rather than in bureaucratic pyramids.