Lost in Causality: How Epidemiology’s Counterfactual Causal Inference Revolution Upholds Class, Race and Gender Inequities

Abstract

We critique empiricism, the dominant epistemology in epidemiology and public health from a scientific realist perspective. Building on our previous work, we also take on the popular counterfactual/potential outcomes epistemology based on its neglect of ontology and shunning causal mechanisms which are reduced to statistical methods (e.g., mediation). We the argue that ontology, epistemology, axiology and ethics constitute a philosophical system in epidemiology, and, in particular in social epidemiology and health equity/social inequalities research that ends up supporting capitalism, patriarchal/gendered and racialize social systems.