Epidemiology

A large part of contemporary phenomenology of medicine has been devoted to accounts of health and illness, arguing that they contribute to the improvement of healthcare. Less focus has been paid to the issue of prevention of disease and the associated difficulty of adhering to health-promoting behaviours, which is arguably of equal importance. This article offers a phenomenological account of this disease prevention, focusing on how we – as embodied beings – engage with health-promoting behaviours. It specifically considers how we (...) engage with oral hygiene regimes to prevent periodontitis and why we are not good at it. The article suggests that poor adherence to health-promoting behaviours can be explained with reference to the concept of the absent body, as prevention of disease is generally concerned with pre-symptomatic illness experience. The final section contains a discussion of some strategies for the improvement of disease prevention based on this viewpoint. (shrink)

In this paper, we analyse the relation between the use of environmental data in contemporary health sciences and related conceptualisations and operationalisations of the notion of environment. We consider three case studies that exemplify a different selection of environmental data and mode of data integration in data-intensive epidemiology. We argue that the diversification of data sources, their increase in scale and scope, and the application of novel analytic tools have brought about three significant conceptual shifts. First, we discuss the EXPOsOMICS (...) project, an attempt to integrate genomic and environmental data which suggests a reframing of the boundaries between external and internal environments. Second, we explore the MEDMI platform, whose efforts to combine health, environmental and climate data instantiate a reframing and expansion of environmental exposure. Third, we illustrate how extracting epidemiological insights from extensive social data collected by the CIDACS institute yields innovative attributions of causal power to environmental factors. Identifying these shifts highlights the benefits and opportunities of new environmental data, as well as the challenges that such tools bring to understanding and fostering health. It also emphasises the constraints that data selection and accessibility pose to scientific imagination, including how researchers frame key concepts in health-related research. (shrink)

Bioethics, Volume 36, Issue 6, Page 687-698, July 2022.

COVID-19 began in China in December 2019. As of January 2021, over a hundred million instances had been reported worldwide, leaving a deep socio-economic impact globally. Current investigation studies determined that artificial intelligence (AI) can play a key role in reducing the effect of the virus spread. The prediction of COVID-19 incidence in different countries and territories is important because it serves as a guide for governments, healthcare providers, and the general public in developing management strategies to battle the disease. (...) The prediction proved beneficial in the early months of 2020 to alert nations and territories in danger of an outbreak, allowing them to take preventative measures. Despite the fact that the COVID-19 outbreak has expanded to practically every location on the planet, the prediction has value in terms of monitoring the intensity of the spread and recovery, as well as determining the likelihood of a sequel or tertiary epidemic. COVID-19, like influenza, could become a seasonal or recurring epidemic in the future. COVID-19 activity must so be predicted and monitored now and in the future. (shrink)

Like COVID-19, new infectious disease outbreaks emerge almost annually, and studies predict that this trend will continue due to a variety of factors, including an aging population, ease of travel, and globalization of the economy. In response to episodic public health crises, governments and organizations develop, implement, and enforce policies, procedures, protocols, and programs. The epidemiological triad is both a model of disease causation and fundamentally used to design and deploy such control measures. Here we adapt this model to the (...) workplace setting and use the epidemiological triad to characterize the related ethical challenges in implementing the control measures employers face as a guide for a workplace intervention framework. Through this approach, our aim is to show how an integrated ethical framework, grounded in epidemiological principles, has important implications for how we categorize, understand, and resolve the difficult decisions that emerge in the workplace under pandemic conditions. (shrink)

How could the initial, drastic decisions to implement “lockdowns” to control the spread of COVID-19 infections be justifiable, when they were made on the basis of such uncertain evidence? We defend the imposition of lockdowns in some countries by first, and focusing on the UK, looking at the evidence that undergirded the decision, second, arguing that this provided us with sufficient grounds to restrict liberty given the circumstances, and third, defending the use of poorly-empirically-constrained epidemiological models as tools that can (...) legitimately guide public policy. (shrink)

The COVID-19 pandemic has made it especially visible that mortality data are a key component of epidemiological models, being a single indicator that provides information about various health aspects, such as disease prevalence and effectiveness of interventions, and thus enabling predictions on many fronts. In this paper we illustrate the interrelation between facts and values in death statistics, by analyzing the rules for death certification issued by the World Health Organization. We show how the notion of the underlying cause of (...) death can change in view of public health goals. This brings us to a general point about how non-epistemic factors, such as values and goals, are reflected in the choice of different measures in epidemiological models. We finally argue that this analysis is not only relevant from a theoretical point of view but also has important practical consequences. (shrink)

In the ongoing pandemic, death statistics influence people’s feelings and government policy. But when does COVID-19 qualify as the cause of death? As philosophers of medicine interested in conceptual clarification, we address the question by analyzing the World Health Organization’s rules for the certification of death. We show that for COVID-19, WHO rules take into account both facts and values.

Defining and identifying causal intervention effects for transmissible infectious disease outcomes is challenging because a treatment – such as a vaccine – given to one individual may affect the infection outcomes of others. Epidemiologists have proposed causal estimands to quantify effects of interventions under contagion using a two-person partnership model. These simple conceptual models have helped researchers develop causal estimands relevant to clinical evaluation of vaccine effects. However, many of these partnership models are formulated under structural assumptions that preclude realistic (...) infectious disease transmission dynamics, limiting their conceptual usefulness in defining and identifying causal treatment effects in empirical intervention trials. In this paper, we propose causal intervention effects in two-person partnerships under arbitrary infectious disease transmission dynamics, and give nonparametric identification results showing how effects can be estimated in empirical trials using time-to-infection or binary outcome data. The key insight is that contagion is a causal phenomenon that induces conditional independencies on infection outcomes that can be exploited for the identification of clinically meaningful causal estimands. These new estimands are compared to existing quantities, and results are illustrated using a realistic simulation of an HIV vaccine trial. (shrink)

This book presents a comprehensive theory of the ethics and political philosophy of public health surveillance based on reciprocal obligations among surveillers, those under surveillance, and others potentially affected by surveillance practices. Public health surveillance aims to identify emerging health trends, population health trends, treatment efficacy, and methods of health promotion--all apparently laudatory goals. Nonetheless, as with anti-terrorism surveillance, public health surveillance raises complex questions about privacy, political liberty, and justice both of and in data use. Individuals and groups can (...) be chilled in their personal lives, stigmatized or threatened, and used for the benefit of others when health information is wrongfully collected or used. Transparency and openness about data use, public involvement in decisions, and just distribution of the benefits of surveillance are core elements in the justification of surveillance practices. Understanding health surveillance practices, the concerns it raises, and how to respond to them is critical not only to ethical and trustworthy but also to publicly acceptable and ultimately sustainable surveillance practices. The book is of interest to scholars and practitioners of the ethics and politics of public health, bioethics, privacy and data technology, and health policy. These issues are ever more pressing in pandemic times, where misinformation can travel quickly and suspicions about disease spread, treatment efficacy, and vaccine safety can have devastating public health effects. (shrink)

Epidemiological models have played a central role in the COVID-19 pandemic, particularly when urgent decisions were required and available evidence was sparse. They have been used to predict the evolution of the disease and to inform policy-making. In this paper, we address two kinds of epidemiological models widely used in the pandemic, namely, compartmental models and agent-based models. After describing their essentials—some real examples are invoked—we discuss their main strengths and weaknesses. Then, on the basis of this analysis, we make (...) a comparison between their respective merits concerning three different goals: prediction, explanation, and intervention. We argue that there are general considerations which could favour any of those sorts of models for obtaining the aforementioned goals. We conclude, however, that preference for particular models must be grounded case-by-case since additional contextual factors, as the peculiarities of the target population and the aims and expectations of policy-makers, cannot be overlooked. (shrink)

Although every emerging infectious disease occurs in a unique context, the behaviour of previous pandemics offers an insight into the medium- and long-term outcomes of the current threat. Where an informative historical analogue exists, epidemiologists and policymakers should consider how the insights of the past can inform current forecasts and responses.

The novel coronavirus disease is regarded as one of the most imminent disease outbreaks which threaten public health on various levels worldwide. Because of the unpredictable outbreak nature and the virus’s pandemic intensity, people are experiencing depression, anxiety, and other strain reactions. The response to prevent and control the new coronavirus pneumonia has reached a crucial point. Therefore, it is essential—for safety and prevention purposes—to promptly predict and forecast the virus outbreak in the course of this troublesome time to have (...) control over its mortality. Recently, deep learning models are playing essential roles in handling time-series data in different applications. This paper presents a comparative study of two deep learning methods to forecast the confirmed cases and death cases of COVID-19. Long short-term memory and gated recurrent unit have been applied on time-series data in three countries: Egypt, Saudi Arabia, and Kuwait, from 1/5/2020 to 6/12/2020. The results show that LSTM has achieved the best performance in confirmed cases in the three countries, and GRU has achieved the best performance in death cases in Egypt and Kuwait. (shrink)

A nonlinear differential equation model is proposed to study the dynamics of HIV/aids and its effects on workforce productivity. The disease-free equilibrium point of the model is shown to be locally asymptotically stable when the associated basic reproduction number R0\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\mathcal{{R}}_{0}$$\end{document} is less than unity. The model is also shown to exhibit multiple endemic states for some parameter values when R0 1\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\mathcal{{R}}_{0}>1$$\end{document}. Global asymptotic (...) stability of the disease-free equilibrium is guaranteed only when the fractions of the Susceptible subclass populations are within some bounds. Optimal control analysis of the model revealed that the most cost effective strategy that should be adopted in the fight against HIV/aids spread within the workforce is one that seeks to prevent infections and the treatment of infected individuals. (shrink)

Birth cohort studies can be used not only to generate population-level quantitative data, but also to recompose persons. The crux is how we understand data and persons. Recomposition entails scavenging for various data. It foregrounds the perspective and subjectivity of survey participants, but without forgetting the partiality and incompleteness of the accounts that it may generate. Although interested in the singularity of individuals, it attends to the historical and relational embeddedness of personhood. It examines the multiple and complex temporalities that (...) suffuse people’s lives, hence departing from linear notions of the life course. It implies involvement, as well as reflexivity, on the part of researchers. It embraces the heterogeneity and transformations over time of scientific archives and the interpretive possibilities, as well as incompleteness, of birth cohort studies data. Interested in the unfolding of lives over time, it also shines light on meaningful biographical moments. (shrink)

Were governments justified in imposing lockdowns to contain the spread of the COVID-19 pandemic? We argue that a convincing answer to this question is to date wanting, by critically analyzing the factual basis of a recent paper, “How Government Leaders Violated Their Epistemic Duties During the SARS-CoV-2 Crisis” (Winsberg et al. 2020). In their paper, Winsberg et al. argue that government leaders did not, at the beginning of the pandemic, meet the epistemic requirements necessitated to impose lockdowns. We focus on (...) Winsberg et al.’s contentions that knowledge about COVID-19 resultant projections were inadequate; that epidemiologists were biased in their estimates of relevant figures; that there was insufficient evidence supporting the efficacy of lockdowns; and that lockdowns cause more harm than good. We argue that none of these claims are sufficiently supported by evidence, thus impairing their case against lockdowns, and leaving open the question of whether lockdowns were justified. (shrink)

We were slightly concerned, upon having read Eric Winsberg, Jason Brennan and Chris Surprenant’s reply to our paper “Were Lockdowns Justified? A Return to the Facts and Evidence”, that they may have fundamentally misunderstood the nature of our argument, so we issue the following clarification, along with a comment on our motivations for writing such a piece, for the interested reader.

Models not only represent but may also influence their targets in important ways. While models’ abilities to influence outcomes has been studied in the context of economic models, often under the label ‘performativity’, we argue that this phenomenon also pertains to epidemiological models, such as those used for forecasting the trajectory of the Covid-19 pandemic. After identifying three ways in which a model by the Covid-19 Response Team at Imperial College London may have influenced scientific advice, policy, and individual responses, (...) we consider the implications of epidemiological models’ performative capacities. We argue, first, that performativity may impair models’ ability to successfully predict the course of an epidemic; but second, that it may provide an additional sense in which these models can be successful, namely by changing the course of an epidemic. (shrink)

Nyansa nye sika na w'akyekyere asie. One critical factor that has contributed to the spread of the virus COVID-19 and resulting illnesses and deaths is both the conceptual and the ethical confusion between the prioritization of individual rights over social duties. The adherence to the belief in the priority of rights over duties has motivated some individuals to refrain from social distancing and, as a result, has placed themselves and other individuals at serious risk to health and life. My argument (...) is that the ethical enjoinder of social duty possesses priority over the ethical value of individual rights especially in times of global crisis. I demonstrate this point by arguing that the concept of individual right is derivative from the concept of social duty and through the argument that the concept of social duty is more efficacious in addressing global threats to human life than is the concept of individual rights. What is needed is an in-depth revision of the moral ordering of rights and duties and a vision of the human being as inherently other directed with duties toward others. I shall examine two specific ethical systems, that of Confucian and African, Akan moral philosophy that exemplify such a revision of the moral order. (shrink)

How is scientific data used to represent phenomena and as evidence for claims about phenomena? In this paper, I propose that a specific type of claims – evidential claims – is involved in data practices to define and restrict the representational and evidential content of a dataset. I present an account of data practices in the epidemiology of the exposome based on the notion of evidential claims, which helps unpack the approaches, assumptions and warrants that connect different stages of research. (...) I identify three different strategies to generate different types of evidential claims in this case. The macro strategy, which individuates the dataset that serves as the initial evidential space for research. The micro strategy, which is used to generate evidential claims about the microscopic and individual component of target phenomena. The association strategy, that uses evidence from the other strategies to identify a dataset as representation of the different levels and relations of exposure and disease. Differentiating between these strategies sheds light on the multi-faceted landscape of biomedical research on environment and health; and the roles of data and evidence in the process of inquiry. (shrink)

We investigate the effects of self-protection awareness on the spread of disease from the aspect of resource allocation behavior in populations. To this end, a resource-based epidemiological model and a self-awareness-based resource allocation model in complex networks are proposed, respectively. First of all, we study the coupled disease-awareness dynamics in complex networks with fixed degree heterogeneity. Through extensive Monte Carlo simulations, we find that overall the self-awareness inhibits the spread of disease. More importantly, the influence of the self-awareness on the (...) spreading dynamics can be divided into three phases. In phase I, the self-awareness is relatively small and the outbreak of the epidemic can not be suppressed effectively. While, in phase II, the epidemic size is significantly reduced. Finally, in phase III, there is a sufficiently large value of self-awareness, the disease cannot outbreak anymore. Further, we study the impact of degree heterogeneity on the coupled disease-awareness dynamics and find that the network heterogeneity plays the role of “double-edged sword” in that it can either suppress or promote the epidemic spreading. Specifically, when the basic infection rate is relatively small, it promotes the spread of disease under the condition that there is a relatively small self-awareness. While, when the basic infection rate is relatively large, it inhibits the outbreak of epidemic at a relatively small self-awareness; in turn, it promotes the outbreak of epidemic at a relatively large self-awareness. (shrink)

The Global Burden of Disease Study is one of the largest-scale research collaborations in global health, producing critical data for researchers, policy-makers, and health workers about more than 350 diseases, injuries, and risk factors. Such an undertaking is, of course, extremely complex from an empirical perspective. But it also raises complex ethical and philosophical questions. In this volume, a group of leading philosophers, economists, epidemiologists, and policy scholars identify and discuss these philosophical questions. Better appreciating the philosophical dimensions of a (...) study like the GBD can make possible a more sophisticated interpretation of its results, and it can improve epidemiological studies in the future, so that they are better suited to produce results that help us to improve global health. (shrink)

In recent decades, social and behavioral scientists have begun to explore how and why human beings thrive or flourish and to consider whether traits indicative of thriving or flourishing may themselves influence physical well-being. This stands in contrast to the historical tendency in these fields to focus on pathology: mental illness, psychological dysfunction, deviant behavior, social problems, and so on. In epidemiology, too, the influence of pathology is seen in a tacit emphasis on risk factors for disease outcomes and for (...) rates of morbidity and mortality, as opposed to, say, protective factors promotive of good health. Methodologically, there is nothing substantial that would prohibit looking at the world... (shrink)

This chapter suggests that descriptive epidemiological studies like the Global Burden of Disease Study can usefully be divided into four tasks: describing individuals’ health states over time, assessing their health states under a range of counterfactual scenarios, summarizing the information collected, and then packaging it for presentation. The authors show that each of these tasks raises important and challenging ethical questions. They comment on some of the philosophical issues involved in measuring health states, attributing causes to health outcomes, choosing the (...) counterfactual against which to assess causes, aggregating and summarizing complex information across multiple domains, discounting, age-weighting, handling fetal deaths, measuring health inequalities, representing uncertainty, and assessing personal responsibility for health outcomes. (shrink)

In the present study we analyze if the risk concept of the hegemonic epidemiologychanges its nature in purportedly alternative currents as ecoepidemiology and socialepidemiology focused in multilevel analysis.We analyze the way this concept is distinguishedin every current and its relationship with other epidemiologic key notions as cause. We findthat the risk concept and the notion of cause remain relatively unchanged among the differentcurrents even when there is some theoretical discussion about the complexity of multilevelsystems and other explanations for the events. (...) Finally we discuss some consequences aboutthe appropriation of the risk concept in multiple interventions in the health field. We indicatethat the fragmented nature of the risk concept is problematic because it can make thesocial aspects of the disease considered only in a functional perspective. Alternatively to thatwe develop the vulnerability concept as a knowledge framed in a hermeneutical perspective.The vulnerability concept acts as a mediator knowledge between epidemiology and theinterventions in the health field. In the same way we point out some concerns from the anthropologicalfield about the simplification of social senses and omission of meanings aboutthe health of the communities. (shrink)

The highly contagious 2019 novel coronavirus disease (COVID-19) outbreak has not only impacted health systems, economies, and governments, it has also rapidly grown into a global health crisis, which is now threatening the lives of millions of people globally. While, on one hand, medical institutions are critically attempting to find a cure, on the other hand, governments have introduced striking measures and policies to curtail the rapid spread of the disease. Although COVID-19 has achieved pandemic status and is predominantly viewed (...) as a biomedical issue, it is argued that it should also be treated as a psychological crisis. This paper also reviews the literature to examine and comment on the detrimental effects of isolation, which has been enforced as one of the primary preventative measures to manage the spread of COVID-19. This paper further outlines key recommendations that should be addressed across different levels to buffer against the known adverse effects of isolation, which is especially relevant for the current COVID-19 situation, where a large proportion of the global population is isolated, confined, and/or quarantined. (shrink)

One need only look in any newspaper and observe the flourishing market in promises of good health through diets or ways of inhabiting the earth to find evidence that the “configurationist model,” suggested by Charles Rosenberg in 1992 to characterize one archetypal response to explain epidemics in the history of the West, is still very much alive. For Rosenberg, in the long history of attempts to explain epidemic diseases, two fundamental approaches existed and often coexisted in the West: contamination and (...) configuration. While the former, reductionist and monocausal, consisted in the “idea of person-to-person contagion, of the transmission of some morbid material from one individual to another,” the latter implies “a vision of health as a balanced, integrated, and value-imparting relationship between humankind and its environment.” From the eighteenth through the mid-nineteenth century, configurationist arguments, refined notably in miasma theory, clearly dominated medical and nonmedical thinking in Europe and North America. For the adherents of this theory, epidemic diseases could be caused by a very wide range of environmental factors: topography, air, water, food, miasmas, or garbage. By the end of the nineteenth century, this approach, which focused more on factors from the social environment, like urbanization, working conditions, and poor education, was undermined by germ theory, which directed medical opinion toward contamination in “its modern, laboratory-oriented guise.” However, as Rosenberg states, “an interest in environmental determinants of health and disease remained alive and in continued dialogue with the new bacteriological etiology.” The contributions in this volume dealing with views on health, the natural environment, and disease in nineteenth- and twentieth-century Europe confirm this last statement. We argue that, in present times, the notion of “exposome,” coined by Christopher Paul Wild and defined as a person’s global exposure to the environmental factors potentially altering health and leading to our modern epidemics of chronic diseases, relates to this long history of Western medical thinking that focuses on the role of the environment to account for health and disease. Taking this long run of history into account, this books addresses the issue of how humankind has observed, imagined, and conceptualized the links between the environment and health in a broad geographical framework. (shrink)

This paper considers an important recent contribution by Miguel Hernán to the ongoing debate about causal inference in epidemiology. Hernán rejects the idea that there is an in-principle epistemic distinction between the results of randomized controlled trials and observational studies: both produce associations which we may be more or less confident interpreting as causal. However, Hernán maintains that trials have a semantic advantage. Observational studies that seek to estimate causal effect risk issuing meaningless statements instead. The POA proposes a solution (...) to this problem: improved restrictions on the meaningful use of causal language, in particular “causal effect”. This paper argues that new restrictions in fact fail their own standards of meaningfulness. The paper portrays the desire for a restrictive definition of causal language as positivistic, and argues that contemporary epidemiology should be more realistic in its approach to causation. In a realist context, restrictions on meaningfulness based on precision of definition are neither helpful nor necessary. Hernán’s favoured approach to causal language is saved from meaninglessness, along with the approaches he rejects. (shrink)

In current philosophical discussions on evidence in the medical sciences, epidemiology has been used to exemplify a specific version of evidential pluralism. According to this view, known as the Russo–Williamson Thesis, evidence of both difference-making and mechanisms is produced to make causal claims in the health sciences. In this paper, I present an analysis of data and evidence in epidemiological practice, with a special focus on research on the exposome, and I cast doubt on the extent to which evidential pluralism (...) holds in this case. I start by focusing on the claim that molecular data allows for the production of mechanistic evidence. On the basis of a close look at the ways in which molecular data is used in exposome research, I caution against interpretations in terms of mechanistic evidence. Secondly, I expand my critical remarks on the thesis by addressing the conditions under which data is categorised as evidence in exposome research. I argue that these show that the classification of a dataset as a type of evidence is dependent on the ways in which the data is used. This is in contrast with the approach of evidential pluralism, where evidence is classified in different types on the basis of its intrinsic properties. Finally, I come back to what I consider the core of the thesis and suggest that the epidemiological research analysed in the paper indicates different interpretations of evidential pluralism and its applicability in the health sciences. (shrink)

This article is an introduction to the Synthese Special Issue, Philosophy of Epidemiology. The overall goals of the issue are to revisit the state of philosophy of epidemiology and to provide a forum for new voices, approaches, and perspectives in the philosophy of epidemiology literature. The introduction begins by drawing on Geoffrey Rose’s work on how to conceptualize and design interventions for populations, rather than individuals. It then goes on to highlight some themes that emerged in the articles that make (...) up the issue: philosophy of epidemiology and epidemiological theory—what they are and what they ought to be, pluralism in measurement and causal attribution, epistemic and non-epistemic values in disputes epidemiological practices, decentering philosophy of epidemiology’s Eurocentrism, letting pragmatism guide uses of big data in epidemiology, and revisiting the lessons of classic texts in epidemiological causal inference. The introduction concludes with comments on a philosophy of epidemiology debate we see on, regarding the politics of philosophy of epidemiology. (shrink)

Epidemiology is the core discipline underlying health research. Measuring health, identifying causes of ill health, and intervening to improve health are all key tenets of the discipline. Concerned with the “who,” “when,” “why,” and “where” of health, epidemiology is essential in informing clinical decision-making through evidence-based medicine. Traditionally the study of the occurrence and distribution of disease and determinants, epidemiology is a dynamic discipline that is increasingly being applied in differing disciplines, even beyond health. This chapter is designed as a (...) basic introduction to epidemiology, the terminology used, and the principles in epidemiologic practice. Using public health as a framework, this chapter will also give an overview of both the traditional and more contemporary applications of epidemiology. (shrink)

Problem setting. Studying the factors that determine health shows that medicine is important along with biogenetic and environmental factors. However, the leading factors of health in modern conditions are the level and quality of life of people, the level of their health culture and lifestyle. This increases the role of researches on social and cultural conditions and determinants of health in the framework of not only medical sciences, but also the sociology of medicine, health and disease, wellness studies. Recent research (...) and publications analysis. Development of the sociology of medicine and health has received significant support after the report of the Minister of Health of Canada M. Lalonde, “A new perspective on the health of Canadians”, in which new strategies of forming a culture of public health and improving the quality of life and people’s well-being were proposed. Sociological analysis of the problems of health and the development of healthcare has been significantly developed in the works of such researchers in Western Europe and North America, as R. Dubo, Т. MacKeown, V. Navarro, I. Illich, E. Friedson, I. Zola, S. Szreter, A. Williams, R. Stevens, K. Winter, A. Titmonas, N. Gail, C. Lafontaine, E. Annandale, D. Mechanic, G. Weiss, K. White, S. Blum, D. Black, H. Freeman, S. Levine, F. Wolinsky, J. Gable, M. Elston, N. Hart, J. Travis and others. Such Russian and Ukrainian scientists have contributed to the development of the sociology of medicine and health, as V. Lupandin, A. Izutkin, A. Sahno, J. Lisicin, N. Vinogradov, V. Dil’man, I. Brehman, G. Caregorodcev, V. Dimov, V. Kochenov, I. Zhuravleva, N. Grigor’eva, K. Habibulin, A. Reshetnikov, E. Dmitrieva, N. Antonova, G. Apanasenko, V. Petlenko, L. Sushhenko, I. Gorbas’, G. Slabkij, V. Moskalenko, T. Gruzeva, O. Cimbrovskij, N. Panina, Y. Golovaha, O. Balakireva, N. Ringach, R. Levin, I. Venirchuk, N. Soboleva, G. Chepurko and others. Paper objective. Consideration of the main problems of modern sociology of health and healthcare as the objects of sociological research. Paper main body. Problem field of the sociology of health and medicine has a wide range of different aspects of the study of values, knowledge, ideas, norms, as well as indicators, conditions and factors of health, its pathologies at the individual, group, national and global levels. Sociology studies the development of healthcare system and medical services from an institutional point of view, considering it as a modern complex institutional phenomenon. An important aspect of sociological analysis of this institution are the manifestations of socio-economic, territorial, gender, ethnic inequality in access to medical care, health improvement and health culture. The manifestations of subnational and global gaps in access to medical care and health improvement are considered by experts as the most acute problems of modern health care. Sociological approach involves understanding the inter-institutional relations of the development of medical and healthcare through the study of their economic, political, legal, cultural, vocational, scientific, technical, information and communicative manifestations. In Ukraine, the sociology of medicine and health shows achievements in the empirical field of research and is progressively developing within the framework of academic science and universities in the medical and sports fields. Actual problems of sociological analysis of the state of health and its preservation are studies of causes of high morbidity and mortality, low birth rates, gender analysis of health and causes of morbidity, issues of the quality and accessibility of medical services, the effectiveness of health care reform, prospects for the development of insurance medicine in Ukraine, ways to increase public health culture. Conclusions of the research. Modern sociology makes an important contribution to health management as a comprehensive area of modern science about problems of public and individual health, institutional foundations of healthcare, trends and prospects for the transformation of medicine and health culture in the context of globalization and internetization of society and implementation of sustainable development strategies. The development of sociology of medicine and health is an important element in the scientific, informational and analytical support of effective policies in the field of maintaining health, improving the welfare of society and people’s happiness. (shrink)

In this essay, I argue that Ted Poston's theory of explanatory coherentism is well-suited as a tool for causal explanation in the health sciences, particularly in epidemiology. Coherence has not only played a role in epidemiology for more than half a century as one of Hill's viewpoints, it can also provide background theory for the development of explanatory systems by integrating epidemiologic evidence with a diversity of other error-independent data. I propose that computational formalization of Hill's viewpoints in an explanatory (...) coherentist framework would provide an excellent starting point for a formal epistemological (knowledge-theoretical) project designed to improve causal explanation in the health sciences. As an example, I briefly introduce Paul Thagard's ECHO system and offer my responses to possible objections to my proposal. (shrink)

In political philosophy and in economics, unfair inequality is usually assessed between individuals, nowadays often on luck-egalitarian grounds. You have more than I do and that's unfair. By contrast, in epidemiology and sociology, unfair inequality is traditionally assessed between groups. More is concentrated among people of your class or race than among people of mine, and that's unfair. I shall call this difference the egalitarian ‘divorce’. Epidemiologists, and their ‘divorce lawyers’ Paula Braveman, Norman Daniels, and Iris Marion Young, explain that (...) not every inequality between individuals is an inequity. Only inequality between social status groups is unfair. Only such inequality stems from problems like partiality, discrimination, oppression, inequality-related population health problems, and unfair distribution of prospects. And it alone is actionable. By contrast, inequality between individuals, e.g. in longevity, is natural, inevitable, less important, or otherwise less informative — not unjust. In ‘divorce trial’ mode, I respond to epidemiologists that group inequalities lack the intrinsic disvalue that they ascribe them. They may be instrumentally or contingently bad or wrong, not essentially so. I then shift to ‘remarriage’: although group inequalities lack intrinsic badness or wrongness, for multiple reasons they remain useful to measure. (shrink)

Epidemiology is an essential tool of public health, which largely relies on collection, collation, analysis and interpretation of data and actions based on the information gleaned from the data. Such data-intensive processes lead to unique ethical issues relating to autonomy of the data generator, privacy, confidentiality and justice. In this chapter, we attempt to describe the ethical issues in data handling in epidemiology using two examples, public health surveillance and Big Data analytics in digital epidemiology. One of the unique ethical (...) issues that arises in public health surveillance is the difficulty in operationalizing autonomy, as any individual refusing to share surveillance data will compromise the effectiveness of the surveillance. The need to balance the benefits of health security with the risks of infringement into individual privacy and confidentiality lies as the undercurrent of the ethics of public health surveillance. Big Data analytics is becoming increasingly popular in public health. The rich variety of the data, while offering chances of multilevel, multivariate analysis of disease models, also raises concern of biases in data collection due to huge variations in the sources of the data. The high velocity of the data also throws open opportunities for rapid analysis and interventions to improve population health. The power of Big Data analytics needs to be harnessed with the important ethical principles of public health in mind. (shrink)

In current mental health care psychiatric conditions are defined as compilations of symptoms. These symptom-based disease categories have been severely criticised as contingent and boundless, facilitating the rise to epidemic proportions of such conditions as depression. In this article we look beyond symptoms and stress the role of epidemiology in explaining the current situation. By analysing the parallel development of cardiovascular disease and depression management in Finland, we argue, firstly, that current mental health care shares with the medicine of chronic (...) somatic conditions an attachment to risk factor epidemiology, which accentuates risk and prevention in disease management. However, secondly, due to the symptom-based definitions of psychiatric conditions, depression management cannot differentiate properly between symptoms, signs and risk factors such as, for example, cardiovascular medicine, but treats symptoms as signs or risk factors in contexts of treatment and prevention. Consequently, minor at-risk conditions have become difficult to separate from proper cases of depression. (shrink)

In this paper, I aim to identify the different cognitive, contextual and social values involved in epidemiological research on Chagas disease. As it is considered as a ‘neglected tropical disease’ by the World Health Organization, I will try to unfold the many senses of ‘neglected’ and in which sense different non-cognitive values can be manifested in research on this disease through a pluralism of disciplines and methods. The point of departure of this investigation is a model that explains the dynamics (...) of scientific activity. The model is the one developed by Hugh Lacey, based on the notion of strategies of research, in which scientific research has to be socially framed. I will try to show that the social, political and economic conditions of certain populations, which define their ‘neglected’ character, constitute a perspective that needs to be considered in epidemiological research. Finally, this perspective is defined in the moment of adoption of strategies of research that reflects the social and ethical values adopted by scientists in Chagas disease investigations. (shrink)

This paper poses the question of whether people have a duty to participate in digital epidemiology. While an implied duty to participate has been argued for in relation to biomedical research in general, digital epidemiology involves processing of non-medical, granular and proprietary data types that pose different risks to participants. We first describe traditional justifications for epidemiology that imply a duty to participate for the general public, which take account of the immediacy and plausibility of threats, and the identifiability of (...) data. We then consider how these justifications translate to digital epidemiology, understood as an evolution of traditional epidemiology that includes personal and proprietary digital data alongside formal medical datasets. We consider the risks imposed by re-purposing such data for digital epidemiology and propose eight justificatory conditions that should be met in justifying a duty to participate for specific digital epidemiological studies. The conditions are then applied to three hypothetical cases involving usage of social media data for epidemiological purposes. We conclude with a list of questions to be considered in public negotiations of digital epidemiology, including the application of a duty to participate to third-party data controllers, and the important distinction between moral and legal obligations to participate in research. (shrink)

Chagas disease or American trypanosomiasis is an important health problem in Latin America. Due to the mobility of Latin American population around the world, countries without vector presence started to report disease cases. We developed a deterministic compartmental model in order to gain insights into the disease dynamics in a scenario without vector presence, considering congenital transmission and transmission by blood transfusion. The model was used to evaluate the epidemiological effect of control measures. It was applied to demographic data from (...) Spain and sensitivity analysis was performed on model parameters associated with control strategies. (shrink)

Medical theory and practice in the second half of the 20th century were transformed by the idea of risk, and, in particular, by the concept of the "risk factor." Many historians have described how the concept of the risk factor emerged in the actuarial science of the life insurance industry in the early 20th century and entered medicine through the Framingham Heart Study, specifically with its July 1961 article, "Factors of Risk in the Development of Coronary Heart Disease," in the (...) Annals of Internal Medicine. This story, while plausible, is incorrect.New techniques of digital history enable a new kind of research: full-text searching of publications in medicine, public health, and other... (shrink)

The importance of legal epidemiology in public health law research has undoubtedly grown over the last five years. Scholars and practitioners together have developed guidance on best practices for the field, including: placing emphasis on transdisciplinary collaborations; creating valid, reliable, and repeatable research; and publishing timely products for use in decision-making and change. Despite the energy and expertise researchers have brought to this important work, they name significant challenges in marshalling the diverse skill sets, quality controls, and funding to implement (...) legal epidemiology activities. The Centers for Disease Control and Prevention has worked to develop cross-cutting research and translation on issues of national priority in legal epidemiology, and has explored ways to overcome some of these challenges. As such, this article describes a case study of the use of law to characterize states' prior authorization policies regarding medication used to treat attention-deficit/hyperactivity disorder, a central component of a broader effort to improve behavior therapy options for young children with ADHD. This article highlights the types of legal epidemiology work we have undertaken, the application of this work to an emerging public health problem, and the lessons learned in creating impactful research for the field. (shrink)

This is the first wide-ranging, multi-authored handbook in the field of philosophy of medicine, covering the underlying conceptual issues of many important social, political and ethical issues in health care. It introduces and develops over 70 topics, concepts, and issues in the field. It is written by distinguished specialists from multiple disciplines, including philosophy, health sciences, nursing, sociology, political theory, and medicine. Many difficult social and ethical issues in health care are based on conceptual problems, most prominently on the definitions (...) of health and disease, or on epistemological issues regarding causality or diagnosis. Philosophy is the discipline that deals with such conceptual, metaphysical, epistemological, methodological, and axiological matters. This handbook covers all the central concepts in medicine, such as ageing, death, disease, mental disorder, and well-being. It is an invaluable source for laypeople, academics with an interest in medicine, and health care specialists who want be informed and up to date with the relevant discussions. The text also advances these debates and will set the agenda for years to come. (shrink)

The impending implementation of pre-exposure prophylaxis has prompted complicated bioethical and public health ethics concerns regarding the moral distribution of antiretroviral medications to ostensibly healthy populations as a form of HIV prevention when millions of HIV-positive people still lack access to ARVs globally. This manuscript argues that these questions are, in part, concerns over the ethics of the knowledge production practices of epidemiology. Questions of distribution, and their attendant cost-benefit calculations, will rely on a number of presupposed, and therefore, normatively (...) cultural assumptions within the science of epidemiology specifically regarding the ability of epidemiologic surveillance to produce accurate maps of HIV throughout national populations. Specifically, ethical questions around PrEP will focus on who should receive ARVs given the fact that global demand will far exceed supply. Given that sexual transmission is one of the main modes of HIV transmission, these questions of ‘who’ are inextricably linked to knowledge about sexual personhood. As a result, the ethics of epidemiology, and how the epidemiology of HIV in particular conceives, classifies and constructs sexual populations will become a critical point of reflection and contestation for bioethicists, health activists, physicians, nurses, and researchers in the multi-disciplinary field of global health. This paper examines how cultural conundrums within the fields of bioethics and public health ethics are directly implicated within the ethics of PrEP, by analyzing the problems of population inaugurated by the construction of the men who have sex with men epidemiologic category in the specific national context of South Africa. (shrink)

Christopher Boorse's biostatistical theory of health and disease argues that the central discipline on which theoretical medicine relies is physiology. His theory has been much discussed but little has been said about its focus on physiology or, conversely, about the role that other biomedical disciplines may play in establishing a theoretical concept of health. Since at least the 1950s, epidemiology has gained in strength and legitimacy as an independent medical science that contributes to our knowledge of health and disease. Indeed, (...) it not only provides important information about disease distribution and aetiology, but the risk-factor approach it employs seems to challenge BST's binary conception of health and disease. The objective of the article is to show, firstly, how important information deriving from descriptive and analytical epidemiology forms part of our contemporary medical concepts of health and disease, and secondly, that these elements are not taken into account by BST in a satisfactory way. The article's central contention, therefore, is that if the project of defining the theoretical concept of health is to be maintained, more importance should be accorded to the contribution made by epidemiology -- alongside physiology -- in defining health. (shrink)

It is widely accepted that the way information transfers across networks depends importantly on the structure of the network. Here, we show that the mechanism of information transfer is crucial: in many respects the effect of the specific transfer mechanism swamps network effects. Results are demonstrated in terms of three different types of transfer mechanism: germs, genes, and memes. With an emphasis on the specific case of transfer between sub-networks, we explore both the dynamics of each of these across networks (...) and a measure of their comparative fitness. Germ and meme transfer exhibit very different dynamics across linked networks. For germs, measured in terms of time to total infection, network type rather than degree of linkage between sub-networks is the primary factor. For memes or belief transfer, measured in terms of time to consensus, it is the opposite: degree of linkage trumps network type in importance. The dynamics of genetic information transfer is unlike either germs or memes. Transfer of genetic information is robust across network differences to which both germs and memes prove sensitive. We also consider function: how well germ, gene, and meme transfer mechanisms can meet their respective objectives of infecting the population, mixing and transferring genetic information, and spreading a message. A shared formal measure of fitness is introduced for purposes of comparison, again with an emphasis on linked sub-networks. Meme transfer proves superior to transfer by genetic reproduction on that measure, with both memes and genes superior to infection dynamics across all networks types. What kinds of network structure optimize fitness also differ among the three. Both germs and genes show fairly stable fitness with added links between sub-networks, but genes show greater sensitivity to the structure of sub-networks at issue. Belief transfer, in contrast to the other two, shows a clear decline in fitness with increasingly connected networks. When it comes to understanding how information moves on networks, our results indicate that questions of information dynamics on networks cannot be answered in terms of networks alone. A primary role is played by the specific mechanism of information transfer at issue. We must first ask about how a particular type of information moves. (shrink)