International Journal of Epidemiology 2001;30:435-439
© International Epidemiological Association 2001
Reiterations |
Commentary: Causes of incidence and causes of cases—a Durkheimian perspective on Rose
Geoffrey Rose's seminal 1985 article ‘Sick Individuals and Sick Populations’ and his 1992 book ‘The Strategy of Preventive Medicine’, have made a huge impact on the fields of epidemiology and public health. A casual Social Sciences Citation Index search yielded over 700 citations of this work. The central lesson that has been integrated into the field is that ‘a large number of people at a small risk may give rise to more cases of disease than the small number who are at high risk’.1(p.37) This insight, which has profound implications for intervention and prevention strategies, has been incorporated into research contexts through an understanding of the difference between measures of absolute and relative risk. But there is another aspect to Rose's work that has had a more difficult hearing and that runs counter to mainstream epidemiological approaches solidified under the risk factor paradigm. This is Rose's contention that the causes
Two central concepts—cause and the relationship between wholes and parts
Rose's notion of cause
Relationship between wholes and parts
Situations in which causes of incidence and causes of cases warrant separate consideration
Causes of incidence as antecedents of particular identified causes of cases
Inability to detect individual-level factors due to relative ubiquity within a population
Contextual effects
Influence of the mean level (incidence or prevalence) of the disease on disease risk
Definition of health and illness
Notes
References
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