Critical epidemiological literacy: understanding ideas better when placed in relation to alternatives

Abstract

This article describes contrasting ideas for a set of topics in epidemiological thinking. The premise underlying this contribution to the special edition is that researchers develop their epidemiological thinking over time through interactions with other researchers who have a variety of in-practice commitments, such as to kinds of cases and methods of analysis, and not simply to a philosophical framework for explanation. I encourage discussants from philosophy and epidemiology to draw purposefully from across a range of topics and contrasting positions, and thereby pursue critical thinking in the sense of understanding ideas and practices better when we examine them in relation to alternatives. After an initial topic concerning practices for developing epidemiological literacy, a number of conceptual steps follow—the characterization of the very phenomena we might be concerned with, the scope and challenges of the field of epidemiology, the formulation of categories—before linking associations, predictions, causes and interventions and examining the confounding of purported links. Building on that conceptual basis, the remaining topics consist of issues or angles of analysis related to the complexities of inequalities within and between populations, context, and changes over the life course. The organization of topics derives from a graduate course that I teach that aims for epidemiological literacy, not technical ability in statistical formulas and data analysis, and shares the underlying premise and critical thinking goals of this article. During the topic-by-topic description, some assertions about explanation and intervention emerge, notably, that epidemiological–philosophical discussion about causality often leaves unclear or unexamined whether a modifiable factor shown to have been associated with a difference in the data from past observations should be thought of as factor that, when modified, would generate that difference going forward. The article concludes with a “Limitations of this Study” section that teases out different kinds of description–prescription relationship that are implied in undertaking philosophy of epidemiology and identifies some other considerations that are implied but not emphasized by this article.