The epistemic values at the basis of epidemiology and public health

Abstract

In the middle of the severest public health crisis of the 21 st century thus far, scholars in the humanities and health and social sciences have accelerated their reflections about public health, its evidence base, its normative dimensions, as well as its successes, failures, and pitfalls. In this paper, we aim to contribute to this global thinking about public health by focusing on one particular aspect, namely its dependence on epidemiology as the main generator of evidence for public health interventions and policy. Our argument is that while it is undeniable that epidemiology (and its sub-fields) have made very many significant contributions both to enlarge our knowledge of disease and its causation, prevalence, and incidence and to channel public health interventions, it also has its limits. The limitations of epidemiology lie in the (implicit) epistemic assumptions which involve focusing on (aggregates of) individuals and obscure the key role of the social level of analysis. These limitations, however, are also an opportunity to highlight and rethink a more distinctly social approach to health and disease, and one that is genuinely population in character. Our argument applies broadly, but the COVID-19 pandemic makes it an urgent topic to address.