IJE Advance Access originally published online on April 1, 2005
International Journal of Epidemiology 2005 34(2):239-241; doi:10.1093/ije/dyi034
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Editorial |
Photography as a metaphor for (epidemiological) research
Department of Social Medicine, Canynge Hall, Whiteladies Road, Bristol B58 2PR, UK. E-mail: mary.shaw{at}bristol.ac.uk
In this issue of the International Journal of Epidemiology we include a photoessay by sociologist Phil Mizen entitled ‘Emerging into the light: working children's photo-diaries’.1 The images in this essay were an integral part of research conducted on working children in England and Wales—both a form of data and a conduit for the elicitation of interview data—thereby revealing more and greater details than other methods alone would have generated. These selected images from Mizen's work, and other such photoessays that we are featuring in the International Journal of Epidemiology, show how photographs can be a powerful mode of communication and, hopefully, invoke reflection and discussion. The use of photography in social science research has come a long way since the rather less critical use of cameras for recording the visual by early anthropologists (see Figure 1). It should be pointed out that anthropologists have been at the forefront when it comes to recognizing the potential of photography in research,2 particularly through visual ethnography whereby photography has been used to empower rather than to objectify research participants (formerly subjects).
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Figure 2 is of a rather different ilk, and can perhaps be read as a metaphor for epidemiological (or indeed any kind of) research. This photograph was taken with a pinhole camera. This is the most simple method of capturing an image—a light-sensitive material is held inside a light-tight container, and exposed for a set amount of time (in this case guesstimated) to light, via a pinhole (with no lens). This is basically the way that all cameras work, but most are more sophisticated. The more technologically advanced the camera, the sharper and more detailed the image tends to be, and the greater the scope for capturing the image (in more varied light conditions, for example). Likewise in epidemiological research, the more precise and sensitive our tools of measurement, the more accurate and reliable will be the results. However, as this image shows, even the crudest tool can capture the essence of the subject—sometimes the less sophisticated will suffice. In both areas, of course, where we choose to focus our attention (point our camera) in the first place will impact on what we see in our results. Sometimes serendipity intervenes: this pinhole image was actually an unplanned double exposure. Two square images overlap to make one rectangular one, but the final result is only slightly disjointed and the duality adds a certain ghostly air to the image; mishaps can on occasion produce provocative results.
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Another parallel between epidemiology and photography is that both are becoming increasingly encumbered, paralysed even, by the growing importance of recognizing and safeguarding identifiable information. The ‘subjects’ of the photograph in Figure 2 (if indeed there are any) are either dead or inanimate, and they cannot therefore give their permission for this image to be taken or indeed published. With the widespread and increasing use of the world wide web as a form of communication publishers are becoming increasingly stringent about gaining the appropriate permission for photographs which show identifiable individuals. Many epidemiological studies are likewise now struggling with the predicament of retrospective consent from the participants of studies launched decades ago but now producing fruitful results. Both photography and epidemiology are therefore facing the challenge that as more becomes possible, due to technological advances, less may become permissible.
Technological developments, however, should not seduce us into thinking that what we do is more scientific than it really is. A classic example of this in epidemiology, and social science, is the measurement of socioeconomic position—we may feed the coded results of surveys into complex statistical models but the reality of the concept is rather more slippery.3,4 We might like to think that we are being planned and precise, but a bit like pinhole photography, it can be somewhat more hit and miss than that. However, as with the example of the crudest technology producing recognizable and useful results given above, even the crudest measure of socioeconomic position, and of the equally elusive notion of ‘health’, tends to find evidence of an association. This is not to say that we should forego the advantages that technological and methodological advances bring, or to condone the use of crude measure over complex ones—just as I would not suggest using a pinhole camera to take those all-important wedding photos—far from it. But perhaps we should be broad-minded enough to recognize the persistence of art in science.
In this volume of the International Journal of Epidemiology a range of papers contribute to the body of evidence of the pervasiveness of socioeconomic inequalities in health across European countries, as well as pointing to the prevalence of internationally collaborative research. Kunst et al.5 present the results of an international collaboration which brings together data for 10 European countries (with even more authors), documenting changes in self-reported health between the 1980s and 1990s. Dalstra and colleagues6 (five of whom are authors on the Kunst paper) have compared eight European countries at one time point in the 1990s, finding large variations in the size and pattern of socioeconomic differentials for various chronic diseases. Mackenbach and colleagues7 (four of whom are colleagues on the Dalstra paper) study the shape of relationship between income and health, reporting less improvement in self-assessed health per unit of rising income in the higher income range, a result which suggests that income redistribution may be a means of improving population health.
In this rapidly changing technological world, just as socioeconomic inequalities in health remain virtually ubiquitous, so too photographs remain a great communicator, humbly reminding us of the people who make up populations. The images that accompany the paper on tooth loss in a Chinese population by Abnet8 in this volume are an example of that connective power. I often use photographs in presentations (see Figure 3 as an example, also on a dental theme), and when I do, they always lead to lively comments (though that may say something about my relative talents as a researcher and a photographer). These last two examples point to one key difference between photography and the research enterprise: ‘Photographed images do not seem to be statements about the world so much as pieces of it, miniatures of reality that anyone can make or acquire’ (1977:4).9
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References
1 Mizen P. Emerging into the light: working children's photo-diaries. Int J Epidemiol 2005;34:257–59.
2 Pink S. Doing Visual Ethnography: Images, Media and Representation in Research. Sage: London, 2001.
3 Galobardes B, Shaw M, Lawlor D, Lynch J, Davey Smith G. Glossary: Indicators of socioeconomic position: Part I. J Epidemiol Community Health (in press).
4 Galobardes B, Shaw M, Lawlor D, Lynch J, Davey Smith G. Glossary: Indicators of socioeconomic position: Part II. J Epidemiol Community Health (in press).
5 Kunst A, Bos V, Lahelma E et al. Trends in socioeconomic inequalities in self-assessed health in 10 European countries. Int J Epidemiol 2005;34:295–305.
6 Dalstra J, Kunst J, Boreel C et al. Socio-economic differences in the prevalence of common diseases: an overview of eight European countries. Int J Epidemiol 2005;34:316–26.
7 Mackenbach J, Martikainen O, Looman C et al. The shape of the relationship between income and self-assessed health: an international study. Int J Epidemiol 2005;34:286–93.
8 Abnet CC, Qiao Y-L, Dawsey SM, Taylor PR, Mark SD. Tooth loss is associated with increased risk of total death and death from upper gastrointestinal cancer, heart disease, and stroke in a Chinese population based cohort. Int J Epidemiol 2005;34:467–74.
9 Sontag S. On Photography. Penguin Books: London, 1977.
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