Epidemiology and public health under siege: In whose best interests?

Abstract

Epidemiology is a core science that informs the development of rational public health policy. The obligation of epidemiologists, as part of the community of health scientists, is to protect public health and safety from established, as well as suspected avoidable harms. This obligation is discussed in the context of ecological and related environmental damage. It underscores why ecological integrity is a concern for those in public health and, indeed, with the survival of our species. Because health protection is central to public health’s mission, the four-level framework for the prevention of disease and premature death is considered; namely: Primordial, Primary, Secondary, and Tertiary Prevention. The first two of these are more related to concerns for ecological integrity, tying nicely into preventing our species’ demise and possible extinction. Being an applied, soft science, epidemiology provides the core scientific methods for health protection. Epidemiological evidence-coming from a soft science- can be influenced by interests that manipulate the scientific method to cast doubt, thus fomenting uncertainty designed to mislead both the public and policy-makers. Because of this, some ethical and practical dimensions of influence that result in delayed policy action are identified, to help us better control influences that derail science counter to the public interest. Some examples highlight the challenges posed, making the solutions that follow more tractable. To protect the public interest and better ensure the sustainability of life on Earth, the need for vigilance by professionals with the capacity to speak truth to power is noted. Additionally emphasized is the need to train students to diagnose scientific misconduct and to devise and provide effective strategies for calling it to account.