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In the review that appears in this issue of the Journal of Epidemiology and Community Health (see page 181), Mackenbach1 proposes an original historical reconstruction of the relationships between epidemiology and public health, describing, in a persuasive way, a common thread that goes from Rudolf Virchow to Geoffrey Rose and to the more recent “epidemiological wars”. Among other issues, there is one in particular that is stressed by the author, which is the strong connection, among the key historical figures he refers to, between political commitment in public health and clinical or epidemiological research.
Although the sciences of evidence-based public health and of decisional theory have become much more complex and sophisticated nowadays, the lessons from Geoffrey Rose, in particular, probably deserve more attention. Let us consider, for example, decision-making in public health. As it has been brilliantly suggested by Nancy Cartwright, there are three equally important elements in the decisional process: quality of the evidence, relevance and evaluation (N. Cartwright, personal communication, 2008). It is well known that sometimes extremely sophisticated and accurate knowledge is totally irrelevant for the population’s health, while at least as often we lack essential knowledge in crucial areas of the public’s protection. We will propose examples for both problems, and will show how Geoffrey Rose’s approach is still valid but also partially unexplored.
In his work,2–4 Rose set out the main advantages and disadvantages of a “high-risk group” preventive strategy. In Rose’s words, this is a strategy with some clear and important advantages: the “high-risk” strategy produces interventions that are appropriate to the particular individuals identified and consequently has the advantage of enhanced subject motivation; it also offers a more cost-effective use of limited resources and a more favourable ratio of benefits to risks. Despite these advantages, the “high-risk” strategy …
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