Shy C M
Department of Epidemiology, School of Public Health, University of North Carolina, Chapel Hill 27599-7400, USA.
Am J Epidemiol. 1997 Mar 15;145(6):479-84; discussion 485-7. doi: 10.1093/oxfordjournals.aje.a009133.
Academic epidemiology has failed to develop the scientific methods and the knowledge base to support the fundamental public health mission of preventing disease and promoting health through organized community efforts. As a basic science of public health, epidemiology should attempt to understand health and disease from a community and ecologic perspective as a consequence of how society is organized and behaves, what impact social and economic forces have on disease incidence rates, and what community actions will be effective in altering incidence rates. However, as taught in most textbooks and as widely practiced by academicians, epidemiology has become a biomedical discipline focused on the distribution and determinants of disease in groups of individuals who happen to have some common characteristics, exposures, or diseases. The ecology of human health has not been addressed, and the societal context in which disease occurs has been either disregarded or deliberately abstracted from consideration. By essentially assuming that risk factors for disease in individuals can be summed to understand the causes of disease in populations, academic epidemiology has limited itself to a narrow biomedical perspective, thereby committing the bio-medical fallacy of inferring that disease in populations can be understood by studying risk factors for disease in individuals. Epidemiology should be redefined as a study of the distribution and societal determinants of the health status of populations. This definition provides a stronger link to be the primary mission of public health and places an appropriate emphasis on the social, economic, environmental, and cultural determinants of population health. Epidemiology must cross the boundaries of other population sciences and add to its scope a macro-epidemiology, a study of causes from a truly population perspective, considering health and disease within the context of the total human environment.
学术流行病学未能发展出科学方法和知识基础，以支持通过有组织的社区努力预防疾病和促进健康这一基本公共卫生使命。作为公共卫生的一门基础科学，流行病学应尝试从社区和生态角度理解健康与疾病，这是由于社会的组织方式和行为方式、社会和经济力量对疾病发病率有何影响，以及哪些社区行动能有效改变发病率。然而，正如大多数教科书所讲授的以及学者们广泛实践的那样，流行病学已成为一门生物医学学科，专注于在碰巧具有某些共同特征、暴露因素或疾病的个体群体中疾病的分布和决定因素。人类健康的生态学未得到探讨，疾病发生的社会背景要么被忽视，要么被刻意排除在考虑之外。通过基本上假定个体疾病的风险因素可以累加起来以理解人群中疾病的病因，学术流行病学将自身局限于狭隘的生物医学视角，从而犯了生物医学谬误，即推断通过研究个体疾病的风险因素就能理解人群中的疾病。流行病学应重新定义为对人群健康状况的分布和社会决定因素的研究。这一定义与公共卫生的主要使命建立了更紧密的联系，并适当强调了人群健康的社会、经济、环境和文化决定因素。流行病学必须跨越其他人群科学的界限，并在其范围内增加宏观流行病学，即从真正的人群视角研究病因，在整个人类环境背景下考虑健康与疾病。
