Epidemiology has often been defined as the study of the distribution of
disease, together with the distribution of factors that may modify that risk
of disease. As such, epidemiology has often been reduced to a methodology
only, providing a mechanism for the study of disease that is somehow
removed, separate and apart from the populations that serve as its focus.
Epidemiology, however, is much more than that. The discipline provides
a way of perceiving and knowing the world, and of relating to the communities
whose health and disease patterns we are trying to understand. As
such, its usefulness extends past the construction of questionnaires, the
detective work inherent in tracing the source of an infection or the analysis
of data. Rather, epidemiology serves as a point of reference and a linkage
between various domains of reality: in the courtroom, between a community’s
injuries and those alleged to be responsible for those violations;
between the community striving to effectuate changes to improve its health
and environment and the lawmakers and policymakers whose actions may
dictate or control the likelihood of that change; and between “mainstream”
populations and those who become or remain marginalized and stigmatized
due to disease or perceived disease.
Many epidemiologists may balk at this use of their profession, arguing
that, at best, it is an unnecessary foray from the protected, objective world
of science into the relatively subjective and highly charged world of public
affairs and legal wars. What this view ignores, however, is our own subjectivity
as epidemiologists, inherent in our everyday decisions relating to the
value of what it is we are to study, the relative importance of the research
questions that we wish to tackle. Those decisions are not merely a function
of calculating the monetary balance between monies to be expended and
costs saved through prevented cases of disease. We make, in many ways, the
value judgments that we profess to avoid.