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. 2000 Jan;90(1):25–33. doi: 10.2105/ajph.90.1.25

To boldly go....

J B McKinlay 1, L D Marceau 1
PMCID: PMC1446117  PMID: 10630133

Abstract

The threshold of the new millennium offers an opportunity to celebrate remarkable past achievements and to reflect on promising new directions for the field of public health. Despite historic achievements, much will always remain to be done (this is the intrinsic nature of public health). While every epoch has its own distinct health challenges, those confronting us today are unlike those plaguing public health a century ago. The perspectives and methods developed during the infectious and chronic disease eras have limited utility in the face of newly emerging challenges to public health. In this paper, we take stock of the state of public health in the United States by (1) describing limitations of conventional US public health, (2) identifying different social philosophies and conceptions of health that produce divergent approaches to public health, (3) discussing institutional resistance to change and the subordination of public health to the authority of medicine, (4) urging a move from risk factorology to multilevel explanations that offer different types of intervention, (5) noting the rise of the new "right state" with its laissez-faire attitude and antipathy toward public interventions, (6) arguing for a more ecumenical approach to research methods, and (7) challenging the myth of a value-free public health.

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Selected References

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  1. Diez-Roux A. V., Nieto F. J., Muntaner C., Tyroler H. A., Comstock G. W., Shahar E., Cooper L. S., Watson R. L., Szklo M. Neighborhood environments and coronary heart disease: a multilevel analysis. Am J Epidemiol. 1997 Jul 1;146(1):48–63. doi: 10.1093/oxfordjournals.aje.a009191. [DOI] [PubMed] [Google Scholar]
  2. Epstein P. R. Emerging diseases and ecosystem instability: new threats to public health. Am J Public Health. 1995 Feb;85(2):168–172. doi: 10.2105/ajph.85.2.168. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Gori G. B. Presentation: Epidemiology and public health: is a new paradigm needed or a new ethic? J Clin Epidemiol. 1998 Aug;51(8):637–641. doi: 10.1016/s0895-4356(98)00021-3. [DOI] [PubMed] [Google Scholar]
  4. HILL A. B. THE ENVIRONMENT AND DISEASE: ASSOCIATION OR CAUSATION? Proc R Soc Med. 1965 May;58:295–300. doi: 10.1177/003591576505800503. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Krieger N. Epidemiology and the web of causation: has anyone seen the spider? Soc Sci Med. 1994 Oct;39(7):887–903. doi: 10.1016/0277-9536(94)90202-x. [DOI] [PubMed] [Google Scholar]
  6. Krieger N. Sticky webs, hungry spiders, buzzing flies, and fractal metaphors: on the misleading juxtaposition of "risk factor" versus "social" epidemiology. J Epidemiol Community Health. 1999 Nov;53(11):678–680. doi: 10.1136/jech.53.11.678. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Krieger N., Zierler S. What explains the public's health?--A call for epidemiologic theory. Epidemiology. 1996 Jan;7(1):107–109. doi: 10.1097/00001648-199601000-00020. [DOI] [PubMed] [Google Scholar]
  8. Last J. M. Global change: ozone depletion, greenhouse warming, and public health. Annu Rev Public Health. 1993;14:115–136. doi: 10.1146/annurev.pu.14.050193.000555. [DOI] [PubMed] [Google Scholar]
  9. Loomis D., Wing S. Is molecular epidemiology a germ theory for the end of the twentieth century? Int J Epidemiol. 1990 Mar;19(1):1–3. doi: 10.1093/ije/19.1.1. [DOI] [PubMed] [Google Scholar]
  10. Mackenbach J. P. Public health epidemiology. J Epidemiol Community Health. 1995 Aug;49(4):333–334. doi: 10.1136/jech.49.4.333. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. McKinlay J. B., Marceau L. D. A tale of 3 tails. Am J Public Health. 1999 Mar;89(3):295–298. doi: 10.2105/ajph.89.3.295. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. McKinlay J. B. Some contributions from the social system to gender inequalities in heart disease. J Health Soc Behav. 1996 Mar;37(1):1–26. [PubMed] [Google Scholar]
  13. McMichael A. J. Invited commentary--"molecular epidemiology": new pathway or new travelling companion? Am J Epidemiol. 1994 Jul 1;140(1):1–11. doi: 10.1093/oxfordjournals.aje.a117153. [DOI] [PubMed] [Google Scholar]
  14. McMichael A. J. The health of persons, populations, and planets: epidemiology comes full circle. Epidemiology. 1995 Nov;6(6):633–636. [PubMed] [Google Scholar]
  15. Nijhuis H. G., van der Maesen L. J. The philosophical foundations of public health: an invitation to debate. J Epidemiol Community Health. 1994 Feb;48(1):1–3. doi: 10.1136/jech.48.1.1-a. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Pearce N., McKinlay J. B. Dissent: Back to the future in epidemiology and public health: response to Dr. Gori. J Clin Epidemiol. 1998 Aug;51(8):643–649. doi: 10.1016/s0895-4356(98)00054-7. [DOI] [PubMed] [Google Scholar]
  17. Petitti D. B. Associations are not effects. Am J Epidemiol. 1991 Jan 15;133(2):101–102. doi: 10.1093/oxfordjournals.aje.a115848. [DOI] [PubMed] [Google Scholar]
  18. Potter J. D. Reconciling the epidemiology, physiology, and molecular biology of colon cancer. JAMA. 1992 Sep 23;268(12):1573–1577. [PubMed] [Google Scholar]
  19. Robert S. A. Community-level socioeconomic status effects on adult health. J Health Soc Behav. 1998 Mar;39(1):18–37. [PubMed] [Google Scholar]
  20. Rose G. Sick individuals and sick populations. Int J Epidemiol. 1985 Mar;14(1):32–38. doi: 10.1093/ije/14.1.32. [DOI] [PubMed] [Google Scholar]
  21. Savitz D. A. The alternative to epidemiologic theory: whatever works. Epidemiology. 1997 Mar;8(2):210–212. [PubMed] [Google Scholar]
  22. Shy C. M. The failure of academic epidemiology: witness for the prosecution. Am J Epidemiol. 1997 Mar 15;145(6):479–487. doi: 10.1093/oxfordjournals.aje.a009133. [DOI] [PubMed] [Google Scholar]
  23. Susser M. Does risk factor epidemiology put epidemiology at risk? Peering into the future. J Epidemiol Community Health. 1998 Oct;52(10):608–611. doi: 10.1136/jech.52.10.608. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Susser M. Epidemiology in the United States after World War II: the evolution of technique. Epidemiol Rev. 1985;7:147–177. doi: 10.1093/oxfordjournals.epirev.a036280. [DOI] [PubMed] [Google Scholar]
  25. Susser M., Susser E. Choosing a future for epidemiology: II. From black box to Chinese boxes and eco-epidemiology. Am J Public Health. 1996 May;86(5):674–677. doi: 10.2105/ajph.86.5.674. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Susser M. The logic in ecological: II. The logic of design. Am J Public Health. 1994 May;84(5):830–835. doi: 10.2105/ajph.84.5.830. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Susser M. What is a cause and how do we know one? A grammar for pragmatic epidemiology. Am J Epidemiol. 1991 Apr 1;133(7):635–648. doi: 10.1093/oxfordjournals.aje.a115939. [DOI] [PubMed] [Google Scholar]
  28. The distinction between public health and community/social/preventive medicine. J Public Health Policy. 1985 Dec;6(4):435–439. [PubMed] [Google Scholar]

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