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The privatization of risk.

B Rockhill1

  • 1Channing Laboratory, Harvard Medical School and Brigham and Women's Hospital, Boston, Mass., USA. beverly.rockhill@channing.harvard.edu

American Journal of Public Health
|March 10, 2001
PubMed
Summary

Epidemiology

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Area of Science:

  • Epidemiology
  • Public Health
  • Biostatistics

Background:

  • Epidemiology faces criticism due to the individualization of risk factor knowledge.
  • The debate on "risk factor" epidemiology is polarized between supporters and detractors.
  • Geoffrey Rose's arguments are central to understanding the population-level nature of risk.

Purpose of the Study:

  • To re-examine Geoffrey Rose's arguments regarding risk factor epidemiology.
  • To highlight that risk factors are probabilistic concepts applicable to populations, not individuals.
  • To explore the limitations of "individual risk" estimation in public health.

Main Methods:

  • Conceptual analysis of risk factor epidemiology.
  • Revisiting Geoffrey Rose's distinction between causes of cases and causes of incidence.
  • Examination of the social, economic, and political determinants of risk factors.

Main Results:

  • Risk factor epidemiology's focus on individual prediction may be conceptually flawed.
  • Individual risk estimation has conceptual and quantitative limitations.
  • Population-level interventions are necessary to shift risk factor distributions.

Conclusions:

  • The debate on "risk factor" epidemiology may overlook the fundamental probabilistic nature of risk.
  • Public health actions should focus on shifting population distributions of risk factors.
  • Individualized risk assessment, while prominent (e.g., breast cancer), may be an ineffective primary prevention strategy at the population level.
Keywords:
Health Care and Public Health

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