EPIDEMIOLOGY AND THE WEB OF CAUSATION - HAS ANYONE SEEN THE SPIDER
EPIDEMIOLOGY AND THE WEB OF CAUSATION - HAS ANYONE SEEN THE SPIDER
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DOI：
10.1016/0277-9536(94)90202-x
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发表时间：
1994-10-01
影响因子：
5.4
通讯作者：
KRIEGER, N
中科院分区：
文献类型：
--
作者：
KRIEGER, N
“多重因果”是当代流行病学的经典，其隐喻和模型是“因果之网”。“互联网”在1960年的美国流行病学教科书中首次被阐述，它仍然是一个被广泛接受但缺乏详细说明的模型，部分反映了当代流行病学方法对疾病因果关系的流行病学理论的压力。本文论述了网络的起源、特点和存在的问题。包括它对生物医学个人主义框架的隐性依赖，以指导对纳入网络的因素的选择。提出了假定的“蜘蛛”的下落问题，作者考察了流行病学理论的几种当代方法，包括那些强调生物进化和适应的方法，以及那些强调疾病的社会生产的方法。为了更好地整合生物学和社会学对当前和不断变化的人口健康和疾病模式的理解，本文提出了一个发展流行病学理论的生态社会框架。这种替代方法的特点进行了讨论，提供了一个初步的形象，并鼓励辩论。
Multiple causation' is the canon of contemporary epidemiology, and its metaphor and model is the 'web of causation.' First articulated in a 1960 U.S. epidemiology textbook, the -web' remains a widely accepted but poorly elaborated model, reflecting in part the contemporary stress on epidemiologic methods over epidemiologic theories of disease causation. This essay discusses the origins, features, and problems of the 'web.' including its hidden reliance upon the framework of biomedical individualism to guide the choice of factors incorporated in the 'web.' Posing the question of the whereabouts of the putative 'spider,' the author examines several contemporary approaches to epidemiologic theory, including those which stress biological evolution and adaptation and those which emphasize the social production of disease. To better integrate biologic and social understandings of current and changing population patterns of health and disease, the essay proposes an ecosocial framework for developing epidemiologic theory. Features of this alternative approach are discussed, a preliminary image is offered, and debate is encouraged.