Commentary: Causes of incidence and causes of cases—a Durkheimian perspective on Rose

Abstract

Geoffrey Rose's seminal 1985 article ‘Sick Individuals and Sick Populations’ and his 1992 book ‘The Strategy of Preventive Medicine’, have made a huge impact on the fields of epidemiology and public health. A casual Social Sciences Citation Index search yielded over 700 citations of this work. The central lesson that has been integrated into the field is that ‘a large number of people at a small risk may give rise to more cases of disease than the small number who are at high risk’.^1(p.37) This insight, which has profound implications for intervention and prevention strategies, has been incorporated into research contexts through an understanding of the difference between measures of absolute and relative risk. But there is another aspect to Rose's work that has had a more difficult hearing and that runs counter to mainstream epidemiological approaches solidified under the risk factor paradigm. This is Rose's contention that the causes of cases of disease and the causes of disease incidence may be different and require different types of research strategies. In particular he argues that ‘to find the determinants of prevalence and incidence rates, we need to study characteristics of populations, not characteristics of individuals.^1(p.34) This issue has become a central theme in the ‘epidemiology wars’² with factions sympathetic to Rose's position arguing that epidemiology has lost its public health relevance because of a myopic concentration on individual-level risk factors.³