Epidemiologic measures and policy formulation: lessons from potential outcomes

This paper provides a critique of the common practice in the health-policy literature of focusing on hypothetical outcome removal at the expense of intervention analysis. The paper begins with an introduction to measures of causal effects within the potential-outcomes framework, focusing on underlying conceptual models, definitions and drawbacks of special relevance to policy formulation based on epidemiologic data. It is argued that, for policy purposes, one should analyze intervention effects within a multivariate-outcome framework to capture the impact of major sources of morbidity and mortality. This framework can clarify what is captured and missed by summary measures of population health, and shows that the concept of summary measure can and should be extended to multidimensional indices.