Describing Community Health Risks: Can Epidemiology Be Improved?

Abstract

Environmental threats are one of the highest concerns of communities seeking to improve public health. University researchers seek to assist communities with these concerns by providing technical expertise. But these community-science collaborations are often frustrating to both parties. Communities often find that the scientific studies have not proven what they believe the problem to be, while scientists often feel at least pestered, if not manipulated, by the dirty politics of the community. This paper investigates the proposition that environmental scientists must learn to combine their quantitative studies with qualitative views on the community and its health, if their studies are to be useful and indeed even fully accurate. The goal of the presentation is to explore changes in the methods of one particular field, environmental epidemiology, that might make it more relevant to current environmental debates. After a brief history of the field, limitations in the current practice of epidemiology are presented. These can be grouped under two headings: an over-emphasis on quantitative results, and an underestimation of uncertainties in study results. Some suggestions are given for changes that might address these problems, and make epidemiology more useful for citizens and policy-makers. These are: 1. nest quantitative results in qualitative descriptions of study populations; 2. fit two different kinds of statistical models one very simple, the other quite complex; 3. conduct sensitivity analyses; and 4. use precautionary guidelines for causal inference. It is concluded that environmental epidemiology serves a particular societal function; which is to inform citizens and policy makers about environmental hazards that, perhaps, should be the subject of legal and economic interventions. For this reason, methods could be changed to improve the fit of the science to this function. There remains, however, much to be done to revise and refine this perspective, and to make the suggestions sufficiently specific that they can be put into practice.