Continuing the debate on the philosophy of modern public health: social quality as a point of reference

Our 1994 invitation reviewed

In the second edition of 1999 of this journal Douglas Weed commented on our 1994 initiative to stimulate discussion on the philosophical foundations of public health.1 2 We are pleased with Douglas Weed's response. It enables us to develop our own views and take new steps. The unacceptable state of health in numerous countries around the world forces us to question old and new approaches in public health and policies associated with public health.3 We will reflect on various aspects of Douglas Weed's article and do so with reference to new conceptualisations of the notions of public and health as they relate to the concept of social quality.

In our 1994 contribution, we argued that mainstream epidemiology increasingly serves as a tool of molecular biology, and that consequently, social epidemiology tends to become a contradiction in terms. We state here in advance, however, that we do not criticise the significance of this scientific work in the context of medical policies, but we do have questions regarding it as the scientific cornerstone of modern public health. In 1994, theLancet editors concluded that common epidemiological research has always been based on simplistic notions of causality.4 Reference was made to the Leeds Declaration of 1993, which states that traditional epidemological methods are too blunt to dissect the complexities of today's health problems.5 The Research Unit in Health and Behavioural Chance at Edinburgh University concluded that mainstream epidemiology has little to offer in modernising public health, that its positivistic orientation underscores a principal weakness in its understanding of the social dynamics of health and disease, therefore undermining its ability to effect change in public health.6

The fundamental issue concerns what we precisely mean by the causes and effects in modern public health issues. This point was discussed by …