``Controversies in epidemiology'', teaching causality in context at the University at Albany, School of Public Health

Abstract

Social inequalities relate not only to disparities in health but also are the social context for theories of disease causality being legitimized or denied. In the discipline of epidemiology, conventional discussions on whether or not a given exposure "causes" a specific disease are framed almost exclusively as debates of validity and whether there is sufficient accumulation of evidence to satisfy "Hill's Causal Criteria". However, the way in which the conceptualization of disease processes is restricted to conform to the current causal paradigm, which is based on socially determined ideas of individualism, reductionism, monocausality and the legitimacy of social inequalities, can be identified as a fundamental assumption underlying conventional epidemiological debates of causality. Any argument that social inequalities are an important determinant of poor public health must also explicitly critique the current causal paradigm, which disallows epidemiologists from conceptualizing social relationships as causal of poor health in populations.