Mervyn Susser Research Articles

Invited Perspective: The Mysterious Case of Social Determinants of Health.

Invited Perspective: The Mysterious Case of Social Determinants of Health.

Δημόσια υγεία και Βιοηθική: το έργο του επιδημιολόγου Mervyn Susser

The multidisciplinary academic and practical field of public health is increasingly interesting for researchers in bioethics. The current paper, whose aim is to explore the origins of the enquiries of bioethics with respect to public health, focuses on the 1960’s and 1970’s, a period when modern bioethics developed, but also a period when important developments occurred in public health. At that time, the scientific field of epidemiology draws the attention of pioneers in public health and many would describe it as a period of historical transition, in the development and establishment of modern epidemiological methods.The paper draws on the work of the epidemiologist Mervyn Susser, one of the great personalities of epidemiology in the 20th Century, and an exponent of a type of epidemiology that is deeply rooted in public health. He was a fighter for social justice, who, in his long scientific career, strived to demonstrate the interdependency of social injustice and the health of populations and who combined anti-apartheid politics, clinical practice, sociology, epidemiology, the study of the scientific method and history. His work ranks him amongst the founders of scientific areas such as social epidemiology, life-course epidemiology, genetic epidemiology, the epidemiology of neuro-developmental disorders and global health. The work of Susser in the 1960’s and 1970’s and its relevance to bioethics is presented in three phases: The first refers to causality in epidemiology, the second to the history of responsibilities in public health and the third to issues of ethics in epidemiology.It is concluded that the relationship between public health and bioethics shows strong common interests that are established and expanded in the 1960’s and 1970’s by scientists such as the epidemiologist Mervyn Susser. In the 21st Century, this relationship provides the basis for the cooperation between ethics and a public health- based epidemiology, in order to achieve a bioethically committed global social justice.

Eco-epidemiology: towards epidemiology of complexity

In order to solve public health problems posed by the epidemiology of risk factors centered on the individual and neglecting the causal processes linking the risk factors with the health outcomes, Mervyn Susser proposed a multilevel epidemiology called eco-epidemiology, addressing the interdependence of individuals and their connection with molecular, individual, societal, environmental levels of organization participating in the causal disease processes. The aim of this epidemiology is to integrate more than a level of organization in design, analysis and interpretation of health problems. After presenting the main criticisms of risk-factor epidemiology focused on the individual, we will try to show how eco-epidemiology and its development could help to understand the need for a broader and integrative epidemiology, in which studies designed to identify risk factors would be balanced by studies designed to answer other questions equally vital to public health.

Mervyn Susser (1921-2014): Fighter for Social Justice and Pioneer in Epidemiology.

The article discusses the life and work of epidemiologist Mervyn Susser. Topics include Susser's work campaigning against the apartheid system of racial segregation, his focus, with his wife Zena Stein, on health and social injustice while running a clinic for non-Whites in South Africa, and Susser and Stein's work fighting the HIV/AIDS epidemic that broke out in the 1980s.

Mervyn Susser and community psychiatry.

Mervyn Susser's contributions to community psychiatry from 1957-1968 comprised a creative and significant phase of his career, though less well known than his other work. This included work in Salford, a town next to Manchester, where he developed a programme to improve community health (including mental health care), as well as a programme of research on mental disorders. The publication of his book, Community Psychiatry: Epidemiologic and Social Themes (1968) attempted to set the stage for the practice of psychiatry in the community and to establish a future direction for development of the field.

Mervyn Susser and the logic of scientific discovery.

Paediatric and Perinatal EpidemiologyVolume 28, Issue 6 p. 476-478 Commentary Mervyn Susser and the Logic of Scientific Discovery Alfredo Morabia, Corresponding Author Alfredo Morabia Barry Commoner Center for Health and the Environment, Queens College, City University of New York, New York, NY Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY Correspondence: Alfredo Morabia, Barry Commoner Center for Health and the Environment, Queens College, CUNY, 65-30 Kissena Boulevard, Flushing, NY 11367, USA. E-mail: [email protected]Search for more papers by this author Alfredo Morabia, Corresponding Author Alfredo Morabia Barry Commoner Center for Health and the Environment, Queens College, City University of New York, New York, NY Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY Correspondence: Alfredo Morabia, Barry Commoner Center for Health and the Environment, Queens College, CUNY, 65-30 Kissena Boulevard, Flushing, NY 11367, USA. E-mail: [email protected]Search for more papers by this author First published: 13 November 2014 https://doi.org/10.1111/ppe.12159Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Volume28, Issue6November 2014Pages 476-478 RelatedInformation

Mervyn Susser, the last of the three American classical epidemiology tenors

Mervyn Susser passed away on August 14, 2014. Obituaries in the lay press [1] and in epidemiologic literature [2] justly lauded the extraordinary trajectory that took this self-made epidemiologist from South Africa to New York City, in a tale that combined anti-apartheid politics, clinical medicine, sociology, epidemiology, epistemology, and history. Testimonies also unanimously insisted on the key complicity between Mervyn Susser and his lifetime companion Zena Stein, as well as on the epidemiologic triplet formed by Mervyn Susser, Zena Stein, and their son Ezra Susser.

In Memoriam: Mervyn Susser, MB, BCh, DPH

In Memoriam: Mervyn Susser, MB, BCh, DPH

Gastric Cancer: A Well-Behaved Helicobacter pylori-Related Disease?

Interest in birth cohorts as a means to investigate gastric disease stemmed from a 1962 paper published in The Lancet by Mervyn Susser and Zena Stein, a South African couple who had recently immigrated to Manchester, England [1]. By a series of fortuitous circumstances Mervyn was invited to contribute a review on the epidemiology of peptic ulcer for a symposium to be published in The Practitioner, a monthly journal distributed free to UK general practitioners for 140 years. In their own words, Susser and Stein had ‘‘at most a half-dozen joint or separate publications, no track record in the subject of peptic ulcer, and no knowledge of the disease, that was a rarity in the Black South Africans among whom [they] had worked’’ [2]. While preparing the review Susser and Stein explored epidemiologic changes over time and experimented with different ways of plotting mortality data, in an attempt to determine whether mortality from peptic ulcer was constantly rising, as it was widely believed at the time. Using birth cohort analysis, a method that follows the incidence of a condition (in this case mortality from peptic ulcer) in an aggregate of individuals having a significant event in their life histories in common (in this case the year of birth), Susser and Stein detected a pattern of waxing for the late 19th century births and then waning through the births of the 20th century. Only briefly mentioned in the review for The Practitioner, their analysis was later expanded for the seminal article ‘‘Civilization and Peptic Ulcer’’ [1]. At that time, stress related to industrialization, urbanization, and the deprivations and air raids Britain endured during World War II seemed to offer a fitting explanation for the mortality trends observed. The paper, which was incorrectly assumed to provide evidence for the psychosomatic nature of peptic ulcer, became widely popular. The discovery—or, as purists would have it—the re-discovery of Helicobacter pylori by Marshall and Warren in 1984 radically changed our concepts of ulcer disease and gastric cancer [3]. Enter Amnon Sonnenberg. From 1984 on he applied birth cohort analysis to explore time trends in the mortality of a variety of gastrointestinal diseases [4–7], but it was not until the early 1990s that the crucial influence of H. pylori infection became apparent [8, 9]. In 2002, The International Journal of Epidemiology dedicated an issue to a Festschrift in honor of Mervyn Susser and Zena Stein, now both professors emeriti at the Mailman School of Public Health at Columbia University in New York. In a commentary entitled ‘‘The unresolved mystery of birth-cohort phenomena in gastroenterology’’, Sonnenberg et al. wrote that ‘‘gastric cancer is actually the only disease whose trends vary in the time-dependent fashion one would expect from a well-behaved H. pylorirelated disease.’’ In a new study published in this issue of Digestive Diseases and Sciences [10], Sonnenberg follows further the time trends of gastric cancer and peptic ulcer in six European countries for the past 56–85 years. This analysis, as it is often the case, answers some questions while generating new enigmas: what happened in Europe that caused gastric cancer mortality to rise in generations born during the first half of the 19th century, with a peak between 1870 and 1890? What caused its subsequent decline? Why do gastric and duodenal ulcers show similar time trends, but delayed by about 30 years? Do these findings still fit with the good behavior expected of a Helicobacter pylori-related disease? Figure 1 is a highly simplified attempt to provide a graphic interpretation of what may have happened. R. M. Genta (&) Caris Research Institute, Caris Life Sciences, 6655 North MacArthur Blvd, Irving 75039, Texas e-mail: robert.genta@utsouthwestern.edu

Eras in epidemiology: the evolution of ideas

Eras in epidemiology: the evolution of ideas

Commentary: Gilding the black box

Most epidemiology textbooks have the obligatory passage on ‘what is a cause?’ These discussions often start with Hume, pass reverently through Bradford-Hill and (if the book is of relatively recent vintage) end with Pearl. But as Hafeman and Schwartz1 point out in their essay, few texts in our field go on to the question that really motivates these authors, which is ‘what is a causal structure?’ The closest thing I can find on my own bookcase might be Mervyn Susser's2 ‘Causal Thinking in the Health Sciences’, now more than 35 years old and long out of print.

Causality and the interpretation of epidemiologic evidence

There is an ongoing debate regarding how and when an agent's or determinant's impact can be interpreted as causation with respect to some target disease. The criteria of causation, originating from the seminal work of Sir Austin Bradford Hill and Mervyn Susser, are often schematically applied and, furthermore, there is a tendency to misinterpret the lack of evidence for causation as evidence for lack of a causal relation. There are no criteria for the assessment of evidence concerning an agent's or determinant's propensity to cause a disease, nor are there criteria to dismiss the notion of causation. In this commentary, I propose a dialogue approach for the assessment of an agent or determinant. Starting from epidemiologic evidence, four issues need to be addressed: temporal relation, association, environmental equivalence, and population equivalence. If there are no valid counterarguments, a factor is attributed the potential of disease causation. More often, there will be insufficient evidence from epidemiologic studies. In these cases, other evidence can be used that increases or decreases confidence in a factor being causally related to a disease. Even though every verdict of causation is provisional, action must not be postponed if our present knowledge appears to demand immediate measures for health protection.

Causality and the interpretation of epidemiologic evidence.

There is an ongoing debate regarding how and when an agent’s or determinant’s impact can be interpreted as causation with respect to some target disease. The so-called criteria of causation, originating from the seminal work of Sir Austin Bradford Hill and Mervyn Susser, are often schematically applied disregarding the fact that they were meant neither as criteria nor as a checklist for attributing to a hazard the potential of disease causation. Furthermore, there is a tendency to misinterpret the lack of evidence for causation as evidence for lack of a causal relation. There are no criteria in the strict sense for the assessment of evidence concerning an agent’s or determinant’s propensity to cause a disease, nor are there criteria to dismiss the notion of causation. Rather, there is a discursive process of conjecture and refutation. In this commentary, I propose a dialogue approach for the assessment of an agent or determinant. Starting from epidemiologic evidence, four issues need to be addressed: temporal relation, association, environmental equivalence, and population equivalence. If there are no valid counterarguments, a factor is attributed the potential of disease causation. More often than not, there will be insufficient evidence from epidemiologic studies. In these cases, other evidence can be used instead that increases or decreases confidence in a factor being causally related to a disease. Even though every verdict of causation is provisional, action must not be postponed until better evidence is available if our present knowledge appears to demand immediate measures for health protection.

A conversation with Mervyn Susser. Interview by Nigel Paneth.

A conversation with Mervyn Susser. Interview by Nigel Paneth.

Two lives, three legs, one journey: a retrospective appreciation of Zena Stein and Mervyn Susser.

Two lives, three legs, one journey: a retrospective appreciation of Zena Stein and Mervyn Susser.

Zena Stein, Mervyn Susser and epidemiology: observation, causation and action.

Zena Stein, Mervyn Susser and epidemiology: observation, causation and action.

Looking back on "causal thinking in the health sciences".

It has now been over a quarter of a century since the publication of Mervyn Susser's Causal Thinking in the Health Sciences (1973, Oxford University Press), the first book-length treatment of causal reasoning and inference in our field. Major contributions of this work were its holistic focus on the origins of health outcomes in the context of ecologic systems and its invigoration of the literature on causal criteria in epidemiology. Although a recent resurgence of interest in social context has revivified many points made by Susser, a formal basis for causal analysis consistent with this ecologic perspective has failed to emerge in public health research. Susser's discussion of causal criteria, on the other hand, helped spur a vigorous dialogue that has persisted unabated to the present day. Although the basic outline of the criteria has evolved little, their applications, interrelations, and relative contributions to causal judgments have been the subject of continued and sometimes contentious debate.

Epidemiology of chronic non-infectious disease: current status and future perspective

Epidemiology is one of the oldest bran-ches of medical science and was for manyyears among the most important, for thegood reason that its practice required onlythe use of records, simple arithmetic, andsome clinical acumen. Its history and evo-lution were described by Mervyn Susser ina keynote paper given at the Pan AmericanEpidemiology Congress in Salvador in April1995, which was published in an expandedversion a year later (Susser & Susser

Editor's Note: A Final Tribute to Reviewers

Editor's Note: A Final Tribute to Reviewers Mervyn Susser, and Mary E. Northridge CopyRight https://doi.org/10.2105/AJPH.88.2.187 Published Online: October 07, 2011

Editor's Note: Reviewing for the Journal

Editor's Note: Reviewing for the Journal Mervyn Susser, and Mary E. Northridge CopyRight https://doi.org/10.2105/AJPH.86.2.161 Published Online: October 07, 2011