Epidemiologic Theory Counts

Chapter 8 analyzes how people's health has been harmed—or helped—depending on epidemiologic theory employed. For “harm,” case examples are: (1) hormone therapy, cardiovascular disease, and breast cancer, with iatrogenic disease resulting from biomedical disregard for social determinants of health; (2) peptic ulcers, H. pylori, and allergies, contrasting psychosocial and biomedical extremes; (3) diabetes and Indigenous health, tracing theorizing from “thrifty genes” and racialized disease to reckoning with the transgenerational biological embodiment of social and ecological injustice; and (4) the impact of curtailing and depoliticizing relevant timeframes for analyzing temporal trends in health inequities. For “help,” they are: (a) improving public health surveillance systems; (b) exposing discrimination as a determinant of health inequities; and (c) new national policies and global recommendations to promote health equity. Looking ahead, the chapter argues that the science of epidemiology can be improved by consciously embracing, developing, and debating epidemiologic theories of disease distribution.