Editorial
Translational public health: rehearsing the evidence until the task is done
Gabriel M. Leung and Selena Gray
J Public Health 2008 30: 217-218; doi:10.1093/pubmed/fdn066 [Full Text] [PDF]
“…..Contributors to the first set of articles in the new ‘Perspectives’ section have focused on this same task through a different set of philosophical prisms.4–9 To their credit they decided to revisit, with fresh reasoning, the whole idea of causality in the public health sciences. The five authors, from as many countries, debate whether traditional approaches to defining and eliciting robust evidence of causality is still relevant in the current era of molecular epidemiology on the one hand and a neoclassical focus on multi-level environmental determinants of health on the other….”
Perspectives
Ian McDowell
From risk factors to explanation in public health
Journal of Public Health Advance Access published on July 11, 2008
J Public Health 2008 30: 219-223; doi:10.1093/pubmed/fdn051 [Full Text] [PDF]
“….How do we conclude that we actually understand, or can explain something? As with Popper's demonstration that the only proof of a hypothesis lies in failure to disprove it, we cannot prove understanding. An explanation is good only until we find a superior one. The minimal criteria are that explanations should span several layers of causal processes. They should incorporate a plausible theory, or theories, that trace the connections between the levels. There should be an analysis both of the dynamics of the process (‘why did this occur?’); and of its functioning (‘how do the processes operate?’). Desirable features include parsimony; presentation in the form of a mathematical model to permit empirical testing, and the ability to cover individual cases as well as patterns of cases. …”
Causes in epidemiology: the jewels in the public health crown
Journal of Public Health Advance Access published on July 11, 2008
J Public Health 2008 30: 224-225; doi:10.1093/pubmed/fdn052 [Full Text] [PDF]
“…..Causal models are necessary but insufficient (to echo an epidemiological refrain) in the art and science of causality. Models are a simplification of reality—they help us conceptualize cause, but no causal answers pop out. The counterfactual (model) has no reality (by definition); the reliable trial design that mimics the counterfactual model so yielding causality has not yet been achieved—which is why systematic reviews, meta-analyses and numerous checklists on quality control and assessment of trials are available or in development; and we now know the causal interpretation problems of the other study designs that only conform with difficulty to the counterfactual model, but will always comprise the vast bulk of public health evidence…”
C. Mary Schooling
Explanations in practice
Journal of Public Health Advance Access published on July 11, 2008
J Public Health 2008 30: 226-227; doi:10.1093/pubmed/fdn055 [Full Text] [PDF]
“….Ian McDowell's thought-provoking piece provides an all-encompassing up-to-date framework for public health explanations rooted in earlier paradigms and acknowledging the political agenda involved in the practice of public health. The challenge is how to use a diffuse and multi-layered framework to generate equitable strategies to improve global public health, firstly how to operationalize the framework in day-to-day practice and secondly how much emphasis to place on causality and explanation at each level….”
Alistair Woodward
Explanations adequate for public health
Journal of Public Health Advance Access published on July 11, 2008
J Public Health 2008 30: 228-229; doi:10.1093/pubmed/fdn053 [Full Text] [PDF]
“…What do we mean by ‘risk factors’? The simplest reading would be any quantitative research that attempts to relate exposures, broadly defined, to particular health outcomes. ‘Exposures’ may be located at any level of complexity, from genome to geo-politics; the independent variables might be upstream, downstream or side-stream. Health outcomes may be measured in tissues, or individuals or populations, and amidst this variety, it is only measurement that the investigations have in common…”
Ana V. Diez Roux
Towards a realistic and relevant public health: the challenges of useful simplification
Journal of Public Health Advance Access published on July 11, 2008
J Public Health 2008 30: 230-231; doi:10.1093/pubmed/fdn054
“….Ultimately, because the goal of public health is to improve health, the key challenge is figuring out how to identify the interventions or policies that are most likely to improve the health of populations in the absence of complete and full understanding of all the complex processes involved. But this ultimately is what makes our work as public health researchers both intellectually interesting and (hopefully) relevant to society. McDowell's thoughtful commentary stimulates us to continue our work towards this goal….”
Ian McDowell
Rejoinder
Journal of Public Health Advance Access published on July 11, 2008
J Public Health 2008 30: 232-233; doi:10.1093/pubmed/fdn056 [Full Text] [PDF]
‘…..the next challenge will be to develop analytic approaches capable of handling greater dynamic complexity. My goal was to propose some criteria by which new analytic approaches could ultimately be judged. In the meantime, I agree with all of the commentators that we absolutely need to get on with developing and testing interventions, even in the absence of full comprehension of the processes involved…”
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