Por uma epidemiologia da saúde coletiva

Abstract

Criticism regarding the so-called modern epidemiology has been present in the Latin-American epidemiological literature for quite some time. More recently, howe- ver, similar criticism has increasingly been present in the international literature. The- se criticisms differ in their diagnosis and, as a consequence, in the alternatives pro- posed. While some stress the theoretical aspects, others stress the empirical ones. As a whole, however, authors state the inade- quacies of epidemiology in solving the health problems of populations that cur- rently challenge it. The aim of this essay was first to present these criticisms in a systematic way, and second to delineate a group of propositions that could contribute to the discussion of the role of epidemio- logy in forming the field of collective health. The criticisms were organized in five categories according to their views on the epidemiology crisis: a crisis of its dominant paradigm; a crisis in its ability of theoretical formulation; a crisis resulting from the rupture of its historical commit- ments; a crisis in its relationship with the public health practice; and, a crisis in its explanatory skills, as a consequence of the conflict of results generated by studies in similar topics. It is understandable that such criticisms have stimulated the deve- lopment of alternative and useful epidemi- ological knowledge; even so, very often, this happens out of the central core of epide- miology. The possible alternatives are organizedorganized around three axes:1) the inequa- lities in health; 2) the environment, the quality of life, and the concepts and the measurements of health; 3) the evaluation and choice of health technologies and in- terventions. From these axes it is possible: a) to recover many of the important expe- riences accumulated in the history of epi- demiology and many other subjects that focus on the different aspects of health and its determinants; b) to redirect the theore- tical, methodological, and operational de- velopment of epidemiology; c) to move the current modus operandi of the scientific practice of epidemiology, to orient it towards prevention and the development of new ethical bases, in consonance with its social and political commitment.