Eco Epidemiology

You might also like

Download as pdf or txt
Download as pdf or txt
You are on page 1of 12

REVIEW doi: 10.5216/rpt.v42i1.

23586

A DISTANT ECHO OF ECO-EPIDEMIOLOGY: A REVIEW

Fernando Dias de Avila-Pires 1

ABSTRACT
(SLGHPLRORJ\LVKHUHGH¿QHGDV³WKHVWXG\RIGLVWULEXWLRQIUHTXHQF\DQGFDXVHVRIKXPDQGLVHDVHV
DQGDOVRWKHVWXG\RIWKUHDWVWRKHDOWKDQGWKHSUDFWLFHVRISXEOLFKHDOWKIRUWKHSUHYHQWLRQRIVSHFL¿F
diseases and all risks to health”. )RUPHUO\ GLUHFWHG WR SKHQRPHQD DIIHFWLQJ SRSXODWLRQV UHVXOWV
RI HSLGHPLRORJLFDO LQYHVWLJDWLRQV KDYH EHHQ DSSOLHG WR LQGLYLGXDOV HVSHFLDOO\ LQ ZKDW FRQFHUQV
ULVNZKDWEHFDPHNQRZQDV³WKHJUHDWIDOODF\´$QRWKHUGLVWRUWLRQEHFDPHNQRZQDV³EODFNER[
HSLGHPLRORJ\´WKHDGRSWLRQRIVDQLWDU\DQGSXEOLFKHDOWKPHDVXUHVZLWKRXWDVRXQGNQRZOHGJHRI
XQGHUO\LQJELRORJLFDOIDFWRUVLQIDYRURIWKHLQYHVWLJDWLRQRIWKHFRUUHODWHVRIULVN7KLVOHGWRWKH
WKHRU\WKDWGLVHDVHVFRXOGEHSUHYHQWHGE\DOWHULQJWKHHQYLURQPHQWZLWKRXWWKHQHHGIRUGHWDLOHG
NQRZOHGJH RI SDWKRJHQLF PHFKDQLVPV )LQDOO\ 6XVVHU DQG 6XVVHU DGYRFDWHG D SDUDGLJP IRU DQ
HPHUJHQWHUDRIHFRHSLGHPLRORJ\FDOOHGWKH³&KLQHVHER[HV´ LQDQDOOXVLRQWRWKHVHWVRIER[HV
ZKHUHHDFK¿WVLQVLGHDODUJHUER[7KLVSDSHUGLVFXVVHVLQJUHDWHUGHWDLOWKHGLVSXWHVDURXQGVXFK
FRQFHSWVDQGWKHSLWIDOOVIRUWKHDSSOLFDWLRQRIHSLGHPLRORJLFDOWKHRULHVWRSXEOLFKHDOWK

.(<:25'6(FRHSLGHPLRORJ\(SLGHPLRORJ\%ODFNER[3XEOLFKHDOWK5LVN

RESUMO
(FRVGLVWDQWHVGDHFRHSLGHPLRORJLDUHYLVmRGHFRQFHLWRV

(SLGHPLRORJLD p GH¿QLGD DTXL FRPR R HVWXGR GD GLVWULEXLomR IUHTXrQFLD H FDXVDV GDV GRHQoDV
KXPDQDV H FRP R HVWXGR GRV ULVFRV SDUD D VD~GH H SUiWLFDV GH VD~GH S~EOLFD SDUD D SUHYHQomR
GHWRGRVRVULVFRVSDUDDVD~GH'LULJLGDLQLFLDOPHQWHDRVIHQ{PHQRVTXHDIHWDPSRSXODo}HVRV
UHVXOWDGRVGHLQYHVWLJDo}HVHSLGHPLROyJLFDVWrPVLGRDSOLFDGDVDLQGLYtGXRVHPHVSHFLDOQRTXH
FRQFHUQHDULVFRVRTXH¿FRXVHQGRFRQKHFLGRFRPRDgrande falácia8PDRXWUDGLVWRUomR¿FRX

 'HSDUWDPHQWRGH0HGLFLQD7URSLFDO,QVWLWXWR2VZDOGR&UX]),2&58=5LRGH-DQHLUR%UDVLO
UHWLUHG (PDLOIDYLOD#PDWUL[FRPEU

(QGHUHoRSDUDFRUUHVSRQGrQFLD(PDLOIDYLOD#PDWUL[FRPEU

3UHVHQWHGDWWKH5RXQG7DEOH(FRHSLGHPLRORJ\;9,,,,QWHUQDWLRQDO&RQJUHVVIRU7URSLFDO0HGLFLQHDQG
0DODULDDQG;/9,,,&RQJUHVVRIWKH%UD]LOLDQ6RFLHW\RI7URSLFDO0HGLFLQH5LR
GH-DQHLUR

5HFHLYHGIRUSXEOLFDWLRQLQ$FFHSWHGLQ

Vol. 42 (1): 1-12. jan.-mar. 2013 1


FRQKHFLGDFRPRHSLGHPLRORJLDde caixa-pretaRXVHMDDDGRomRGHDo}HVVDQLWiULDVHGHVD~GH
S~EOLFDVHPFRQKHFLPHQWRGRVIDWRUHVELROyJLFRVVXEMDFHQWHVHPIDYRUGDLQYHVWLJDomRGRVIDWRUHV
GHULVFR,VVROHYRXjWHRULDGHTXHGRHQoDVSRGHULDPVHUSUHYHQLGDVSHODDOWHUDomRGRDPELHQWH
LQGHSHQGHQWH GR FRQKHFLPHQWR GHWDOKDGR GRV PHFDQLVPRV SDWRJrQLFRV )LQDOPHQWH 6XVVHU H
6XVVHU GHIHQGHUDP XP SDUDGLJPD SDUD XPD HUD HPHUJHQWH GD HFRHSLGHPLRORJLD GHQRPLQDGR
caixas chinesasXPDDOXVmRDRVFRQMXQWRVGHFDL[DVTXHVHHQFDL[DPXPDVQDVRXWUDV(VWHWUDEDOKR
GLVFXWHHPPDLRUGHWDOKHDVGLVFXVV}HVVREUHHVVHVFRQFHLWRVHDVDUPDGLOKDVTXHFHUFDPDDSOLFDomR
GDVWHRULDVHSLGHPLROyJLFDVSDUDDVD~GHS~EOLFD

'(6&5,725(6 (FRHSLGHPLRORJLD(SLGHPLRORJLD&DL[DSUHWD6D~GHS~EOLFD5LVFR

,1752'8&7,21

,Q'DUUHOO+XIISXEOLVKHGDERRN How to lie with statisticsWKDW


VKRZVKRZWRSUHVHQWGDWDLQDQXQFRQYHQWLRQDOZD\LQRUGHUWRSURYH\RXUSRLQWRU
WRPLVOHDG\RXURSSRQHQWVWKURXJKWKHPDQLSXODWLRQRIVWDWLVWLFDOFKDUWVDQGGDWD
6WDWLVWLFV KDYH PXFK WR GR ZLWK HSLGHPLRORJ\ EXW VWDWLVWLFV DUH D
GRXEOHHGJHGZHDSRQDQGDVVXFKZHPXVWXVHWKHPZLWKJUHDWFDUH:KDWHYHU
UHVRXUFHVIRUPXODHDQGFDOFXODWLRQVZHSHUIRUPWKHUHVXOWVZLOOEHQREHWWHUWKDQ
WKHRULJLQDOKDUGGDWDDQGWKHFRUUHODWLRQVGHULYHGIURPRXUDQDO\VHVPXVWEHYDOLG
IURPELRORJLFDODQGHFRORJLFDOSRLQWVRIYLHZ
, DP IRQG RI WKH (GLWRU¶V TXRWDWLRQ DJDLQVW WKH PLVXVH RI VWDWLVWLFDO
FRUUHODWLRQVLQDLVVXHRIWKHNew England Journal of Medicine5HIHUULQJ
WR WKH JUHDW GHEDWH FRQFHUQLQJ WKH UHODWLRQVKLS EHWZHHQ FLJDUHWWH VPRNLQJ DQG
OXQJFDQFHUKHSRVHVWKHTXHVWLRQ³:K\GRHVJHWWLQJFDQFHUPDNHRQHVPRNHVR
PXFK"´DVDVPDOOER\PLJKWDVNKLVPRWKHUDIWHUSDVVLQJVHYHUDOFULSSOHGSHGGOHUV
LQWKHVWUHHW³:K\GRHVVHOOLQJSHQFLOVFXWRIIERWK\RXUOHJV"´
(SLGHPLRORJ\LVWKHVHDUFKIRUFDXVHVRIGLVHDVHVDQGKHDOWKKD]DUGVDQG
WKHHVWDEOLVKPHQWRIFRUUHODWLRQV,WVRULJLQDOPHDQLQJZDVUHFHQWO\GLVFXVVHGE\
3LQRDQG+HUQiQGH]  
&RXUD  GH¿QHGHSLGHPLRORJ\DV

WKHVWXG\RIGLVWULEXWLRQIUHTXHQF\DQGFDXVHVRIKXPDQGLVHDVHVDQG
DOVRWKHVWXG\RIWKUHDWVWRKHDOWKDQGWKHSUDFWLFHVRISXEOLFKHDOWKIRU
WKHSUHYHQWLRQRIVSHFL¿FGLVHDVHVDQGWRDOOULVNVWRKHDOWK

7KLVLVWKHGH¿QLWLRQ,ZLOODGRSWLQWKHIROORZLQJWH[W
, DJUHH ZLWK 6WDOORQHV¶   FRQWHQWLRQ WKDW RQO\ RQH HSLGHPLRORJ\
H[LVWV WKRXJK , FDQQRW DJUHH WKDW ³WKH VDPH WRRO FDQ EH HPSOR\HG LQ GLIIHUHQW
ZD\V´,KDYHSURSRVHGHOVHZKHUHWKDWWRGHDOZLWKPXOWLGLVFLSOLQDU\SUREOHPVZH
PXVWEHHTXLSSHGZLWKDPDQLIROGWRROOLNHD6ZLVVDUP\NQLIH:HPXVWKDYHD
IDLUXQGHUVWDQGLQJDQGDELOLW\WRXVHWKHSDUWLFXODUWRROVDQGUHVHDUFKPHWKRGVRIWKH
GLVWLQFWDUHDVRINQRZOHGJHLQYROYHGIURPWKRVHRIWKHVRFLDOVFLHQFHVWRWKRVHRI
WKHQDWXUDOVFLHQFHVDQGPDWKHPDWLFV

2 5(9,67$'(3$72/2*,$7523,&$/
,WLVLPSRUWDQWWREHDULQPLQGWKDWHPSLULFDOSXEOLFKHDOWKSUDFWLFHVKDYH
OHDGWRDQLPSURYHPHQWLQOLYLQJFRQGLWLRQVWKURXJKWKHFHQWXULHVHVSHFLDOO\WKH
SUDFWLFHVFRQFHUQHGZLWKSXEOLFK\JLHQHDQGVDQLWDWLRQLUUHVSHFWLYHRIWKHWKHRULHV
LQYROYHGPLDVPDWLFFRQWDJLRXVRUWKHPLFURELDOLQIHFWLRQVRI3DVWHXU7KH¿UVW
H[DPSOHWKDWFRPHVWRPLQGLVWKHFRQWURORIPDODULDLQDQFLHQW5RPHWKURXJKWKH
GLJJLQJRIFDQDOVDQGWKHGUDLQDJHRIPDUVKHV7KHPLDVPDWLFWKHRU\SHUVLVWHGXQWLO
WKHWLPHVRI3DVWHXU±DQGDIRUPRILWOLQJHUVWRWKLVGD\XQGHUWKHJXLVHRISROOXWLRQ
7KH KLVWRULFDO FKDQJHV LQ WKH WKHRULHV RI GLVHDVH ± IURP PLDVPDWLF WR PLFURELDO
LQIHFWLRQ ± GLG QRW DOWHU HSLGHPLRORJLFDO FRUUHODWLRQV EDVHG XSRQ SRSXODWLRQ
HQYLURQPHQWVWXGLHV7KLVYLHZZRXOGODWHUEHODEHOHG³EODFNER[HSLGHPLRORJ\´
DQGVWDQGDWWKHFHQWHURIDELWWHUGHEDWH
,Q WKLV UHYLHZ RI WKH OLWHUDWXUH , GLG QRW DWWHPSW WR DQDO\]H WKH YDVW
DPRXQWRISXEOLFDWLRQVRQWKLVFRPSOH[VXEMHFWEXWWRKLJKOLJKWWKHUHOHYDQWLVVXHV
GLVFXVVHGE\HSLGHPLRORJLVWVFRQFHUQLQJWKHKHDOWKRISRSXODWLRQVDQGLWVLPSDFW
XSRQWKHKHDOWKRILQGLYLGXDOV
5HFHQWUHYLHZVRIWKHKLVWRULFDOGHYHORSPHQWRIHSLGHPLRORJ\DUHWKRVH
RI 3HDUFH   &RXUD   5RWKPDQ   DQG 6XVVHU DQG 6WHLQ  
$Q HDUOLHU DQDO\VLV RI HSLGHPLF WKHRU\ ZDV SXEOLVKHG E\ 6HUÀLQJ  $V D
FRPSUHKHQVLYHWH[WRIHSLGHPLRORJ\DQGDGLVFXVVLRQRILWVSULQFLSOHVPHWKRGV
SLWIDOOVDQGDFKLHYHPHQWV,FRQVLGHU3HOOHU¶VWH[W  VRIDUWREHXQVXUSDVVHG

7+(25,*,162)$)$//$&<

,Q WKH 1LQHWHHQWK &HQWXU\ WKH FRQFHSW RI society ZDV HVWDEOLVKHG DQG
6RFLRORJ\ZDVERUQ+HUEHUW6SHQFHU 5XPQH\ $XJXVW&RPWH  .DUO
0DU[ 0DU[DQG(QJHOV ePLOH'XUNKHLP  DQG0D[:HEHU  
ODLGWKHIRXQGDWLRQVRIWKLVQHZ¿HOG
:KHQ'XUNKHLPSURSRVHGKLVUXOHVIRUWKHVWXG\RIVRFLRORJ\KHGHVFULEHG
WKHHPHUJHQFHRIQHZSURSHUWLHVDULVLQJIURPWKHFRPELQDWLRQRIHOHPHQWVSUHVHQW
LQDORZHUKLHUDUFKLFDOOHYHORIFRPSOH[LW\7KLVPHDQVLQVKRUWWKDWWKHZKROHLV
ODUJHUWKDQWKHVXPRILWVSDUWV,QRUGHUWRH[SODLQWKLVFRQFHSW'XUNKHLPPHQWLRQHG
WKHQDWXUHRIFHOOVIRUPHGE\PLQHUDOSDUWLFOHVWKHLUOLYLQJSURSHUWLHVDUHQRWIRXQG
LQWKHDWRPVRIK\GURJHQR[\JHQRUFDUERQ/LIHemergesIURPWKHLQWHJUDWLRQRI
WKHHOHPHQWVRIDFHOOEXWLWLVQRWSUHVHQWLQHDFKRILWVSDUWLFOHV,QWKHVDPHPDQQHU
WKHSURSHUWLHVRIDVRFLHW\DVDZKROHDUHQRWIRXQGLQHDFKLQGLYLGXDOWKDWPDNHXS
DSDUWLFXODUVRFLDOJURXS$V'XUNKHLPSRLQWHGRXWNotre règle n'implique donc
aucune conception métaphysique, aucune spéculation sur le fond des êtres. Similar
UHPDUNVZHUHPDGHE\%HUWDODQII\  DQGPRUHUHFHQWO\E\%HUJDQGL  .
6HH DOVR 5RELQVRQ   6HOYLQ   6FKZDUW]   DQG 0RUJHQVWHUQ
 RQWKHVXEMHFWRIOHYHOVRIFRPSOH[LW\DQGHFRORJLFDOFRUUHODWLRQV
/XGZLJYRQ%HUWDODQII\RULJLQDOO\DQHPEU\RORJLVWGLVFXVVHGWKHFRQFHSW
RIOHYHOVRIFRPSOH[LW\GXULQJWKHVSXEOLVKHGDQDEVWUDFWRQKLVWKHRULHVLQ

Vol. 42 (1): 1-12. jan.-mar. 2013 3


DQGDERRNLQZKHUHXSRQKHEHFDPHIDPRXVDOWKRXJKFRQWURYHUVLDO
+H VWUHVVHG WKH LPSRUWDQFH RI DYRLGLQJ ³UHGXFWLRQLVP´ DQG WKH H[WHQVLRQ RI
LGHDV DFURVV WKH EDUULHU RI KLHUDUFKLF OHYHOV$FFRUGLQJ WR WKLV ORJLFDO SULQFLSOH
FRUUHODWLRQVPXVWEHPDGHDWDVLQJOHOHYHORIFRPSOH[LW\7KHSKHQRPHQRQRIKHUG
LPPXQLW\LVDJRRGH[DPSOHLWRSHUDWHVDWWKHOHYHORISRSXODWLRQVEXWHYLGHQWO\
QRWDWWKHLQGLYLGXDOOHYHO
,WLVWKHUDLVRQG¶rWUHRIWKHDFWXDULDOLQVXUDQFHEXVLQHVVZKLFKLVVDLGWR
VXFFHHGLQWXUQLQJWKHLQFHUWLWXGHRIOLIHDQGGHDWKLQWRWKHFHUWLWXGHRISUR¿W
,Q WKH ¿HOG RI PHGLFLQH DQ H[DPSOH LV WKH FDVH ZKHQ WKH XVH RI GDWD
GHULYHGIURPVWXGLHVRISRSXODWLRQVRUJURXSVLVDSSOLHGWRLQGLYLGXDOVDWWKHFOLQLF
6WDOORQHV  DQG5RVH  FDOOHGDWWHQWLRQWRWKLVIDFW7KHGXELRXV
UHVXOWVRIVXFKSUDFWLFH HJ3RROH PDNHPDWWHUVZRUVHWKURXJKWKHGLVUHJDUG
RI WKH GLVWLQFWLRQ PDGH E\ &DQJXLOKHP    EHWZHHQ WKH WZR VHSDUDWH
PHDQLQJVRIZKDWZHUHJDUGDV³QRUPDO´ZKDWLVusual LQDSRSXODWLRQRUJURXS
DQGZKDWFRQIRUPVWRDQHVWDEOLVKHGHPSLULFDO¿[HGnormal value.
,Q HSLGHPLRORJLFDO OLWHUDWXUH UHGXFWLRQLVP ± WKH DSSOLFDWLRQ RI UHVXOWV
YDOLGLQSRSXODWLRQVWXGLHVWRLQGLYLGXDOV±EHFDPHNQRZQDV³WKHJUHDWIDOODF\´,
VWDUWLQJDÀRRGRIELWWHUDUJXPHQWV HJ6HOYLQ5RELQVRQ0RUULV
0RUJHQVWHUQ  6FKZDUW]  'LD]5RX[  0DUFK DQG 6XVVHU 
3RUWQRYHWDO $JRRGH[DPSOHLV0DUFHO*ROGEHUJ¶VSDSHURQCet obscur
objet de l’épidémiologie.
,W LV DPD]LQJ WR VHH KRZ ORQJ WKRVH LGHDV WRRN WR EH XQGHUVWRRG DQG
DFFHSWHG±LIDWDOOE\HSLGHPLRORJLVWV 5RVH6FKZDUW]DQG'LH]5RX[
  DQG HVSHFLDOO\ E\ WKRVH ZKR EHFDPH HSLGHPLRORJLVWV IURP D FOLQLFDO
EDFNJURXQGDVSRLQWHGRXWE\5RVH  0DQ\DXWKRUVFRXOGQRWXQGHUVWDQG
KRZGLVHDVHVUHVLGHLQDQLQGLYLGXDOEXWWKHFDXVHVRIGLVHDVHLQDSRSXODWLRQZRXOG
EHGLVWLQFW 6FKZDUW]DQG'LHW]5RX[ 
,QKLVVHPLQDOSDSHU5RVH  VWDWHGWKDW³WR¿QGWKHGHWHUPLQDQWV
RISUHYDOHQFHDQGLQFLGHQFHUDWHVZHQHHGWRVWXG\FKDUDFWHULVWLFVRISRSXODWLRQV
QRWFKDUDFWHULVWLFVRILQGLYLGXDOV´+HPDGHDGLVWLQFWLRQEHWZHHQWKHGHWHUPLQDQWV
RILQGLYLGXDOFDVHVDQGWKHGHWHUPLQDQWVRIWKHUDWHRILQFLGHQFHLQSRSXODWLRQV

,W KDV SURYHG HDV\ WR VKRZ VWURQJ DVVRFLDWLRQV EHWZHHQ SRSXODWLRQ
PHDQYDOXHVIRUVDWXUDWHGIDWLQWDNH versus VHUXPFKROHVWHUROOHYHODQG
FRURQDU\KHDUWGLVHDVHLQFLGHQFHVRGLXPLQWDNHversusEORRGSUHVVXUH
or energy intake versusRYHUZHLJKW

And he admonished that:

:LWKLQSRSXODWLRQVLWKDVSURYHGDOPRVWLPSRVVLEOHWRGHPRQVWUDWHDQ\
UHODWLRQEHWZHHQDQLQGLYLGXDO¶VGLHWDQGKLVVHUXPFKROHVWHUROOHYHO
DQGWKHVDPHDSSOLHVWRWKHUHODWLRQRILQGLYLGXDOGLHWWREORRGSUHVVXUH

4 5(9,67$'(3$72/2*,$7523,&$/
DQGWRRYHUZHLJKW%XWDWWKHOHYHORISRSXODWLRQVLWLVDGLIIHUHQWVWRU\
7KHGHWHUPLQDQWVRILQFLGHQFHDUHQRWQHFHVVDULO\WKHVDPHDVWKHFDXVHV
RIFDVHV

6FKZDUW]   GHHPHG WKHVH DWWHPSWV ³D ORJLFDO IDOODF\ LQKHUHQW LQ
PDNLQJFDXVDOLQIHUHQFHVIURPJURXSGDWDWRLQGLYLGXDOEHKDYLRUVDQGZDVIROORZHG
E\DKRVWRIFULWLFV´. 2QHRIWKHFULWLFVZDV 3HDUFH  
6FKZDUW] DQG 'LH]5RX[ FRPPHQWLQJ RQ 5RVH¶V SDSHU ZHUH WKH RQO\
DXWKRUV WR UHIHU WR 'XUNKHLP¶V WKHRU\ RI VRFLDO IDFWV DV EHLQJ DW WKH URRW RI WKH
H[SODQDWLRQRIWKHHSLGHPLRORJLFDOIDOODF\
2QHPLJKWDUJXHZLWKWKHSULQFLSOHRISUHFDXWLRQDQGSUHYHQWLRQRIULVN
DVDSSOLHGWRLQGLYLGXDOSDWLHQWVEXWUHVXOWVDUHGHEDWDEOHDQGFHUWDLQO\LWLVQRW
DSSOLFDEOHWRPHQWDOGLVHDVHVZKHUHDGLDJQRVLVFDUULHVVHULRXVOHJDOFRQVHTXHQFHV
$V IRU WKH TXHVWLRQV UDLVHG E\ WKH PXOWLFDXVDOLW\ RI GLVHDVHV .ULHJHU
GLVFXVVHGWKHSUREOHPVLQUHODWLRQWRWKHWKHRU\RIWKH³ZHERIFDXVDWLRQ´ .ULHJHU
 ,QKHUSDSHU.ULHJHUOLVWVWKHWH[WERRNVSXEOLVKHGLQWKH8QLWHG6WDWHVVLQFH
 GHDOLQJ ZLWK HSLGHPLRORJLFDO WKHRU\ KLVWRU\ DQG WKH ³ZHE RI FDXVDWLRQ´
7KHLGHDRIWKHZHERIFDXVDWLRQDVRSSRVHGWRVLQJOHFDXVHFRUUHODWLRQVZDV¿UVW
SURSRVHGE\%ULDQ0DF0DKRQHWDO.LQ
$QRWKHUFRPPRQVRXUFHRIHUURUZKHQHVWDEOLVKLQJDFRUUHODWLRQLVWKH
GLVUHJDUGIRUWKHVHDUFKIRUDELRORJLFDOEDVLVWKDWPD\MXVWLI\DQDVVRFLDWLRQDIDFW
WKDWKDVEHHQSRLQWHGRXWE\VHYHUDODXWKRUVVXFKDV3HOOHU  6XVVHU  
DQG&KLD  7KLVLVZHOOLOOXVWUDWHGLQ0F&RUPLFN¶V  SDSHUFRPPHQWLQJ
RQ5RVH¶V  FULWLFDODUJXPHQWDQGVWDWLQJWKDWGLHWDU\PDQLSXODWLRQVKDYHYHU\
OLPLWHGHIIHFWVXSRQFKROHVWHUROOHYHOVMXVWDVWKHUHGXFWLRQRIVDOWLQWDNHKDVOLWWOH
UHVXOWLQORZHULQJEORRGSUHVVXUH
7KLVFRQIXVLRQLVFRPSRXQGHGE\DSRRUXQGHUVWDQGLQJRIWKHFRQFHSW
RIGLVHDVHDQGWKHODFNRIGLVWLQFWLRQEHWZHHQZKDWLVUHDOREMHFWLYH±DQGGLUHFWO\
REVHUYDEOHDQGZKDWLVFRQVWUXFWHG $YLOD3LUHV 3DWKRORJLFDOOHVLRQVDUH
present in individuals7KH\PD\EHDQDO\]HGDWVXFFHVVLYHOHYHOVRIRUJDQL]DWLRQ
PROHFXODU FHOOXODU DQG KLVWRORJLFDO HDFK RQH ZLWK LWV SDUWLFXODU DQG OLPLWHG
FKDUDFWHULVWLFV7KH\OHDYHLPSULQWVLQIRVVLOVDQGDUHWKXVIRXQGLQWKHUHPDLQVRI
DQLPDOVWKDWOLYHGDQGGLHGORQJEHIRUHPDQDSSHDUHGXSRQWKH(DUWK7KHQDWXUHRI
OHVLRQVPD\EHLGHQWL¿HGPDFURVFRSLFDOO\PLFURVFRSLFDOO\RUWKURXJK'1$DQDO\VLV
Diseases WKRXJK,DUHDEVWUDFWFRQFHSWV7KH\DUHVRFLDOFRQVWUXFWV7KH\
DUH FROOHFWLYH DQG FRPSRVLWH FDWHJRULHV WKDW UHVXOW IURP WKH VXP RI FRPELQHG
REVHUYDWLRQVRILQGLYLGXDOFDVHKLVWRULHVUHFRUGHGLQGLVWLQFWSODFHVDQGDWGLIIHUHQW
WLPHVE\GLIIHUHQWREVHUYHUV7KHIXOOUDQJHRISRVVLEOHVLJQDOVDQGV\PSWRPVDUH
VHOGRPLIDWDOOSUHVHQWLQDVLQJOHSDWLHQW$FKDUDFWHULVWLFRIWKHFRPSRVLWHRU
FROOHFWLYHTXDOLW\RIGLVHDVHGHVFULSWLRQVLVWKHIUHTXHQWXVHRITXDOLI\LQJH[SUHVVLRQV
VXFKDV“LQPDQ\FDVHV´³IUHTXHQWO\´³LWPD\RFFXU´³LWZDVREVHUYHGWKDW´$OVR
WH[WERRNGUDZLQJVXVXDOO\UHSUHVHQWDFRPSRVLWHSLFWXUHRIDFROOHFWLYHGHVFULSWLRQ

Vol. 42 (1): 1-12. jan.-mar. 2013 5


217+(1$785(2)(3,'(0,2/2*,&$/5(6($5&+

0RUJHQVWHUQ   GHILQHG HFRORJLFDO UHVHDUFK DV ³HPSLULFDO


LQYHVWLJDWLRQVLQYROYLQJWKHJURXSDVWKHXQLW\RIDQDO\VLV´,WLVXVHG±DQGXVHIXO
±IRUJHQHUDWLQJRUWHVWLQJHWLRORJLFDOK\SRWKHVHVH[SODLQLQJGLVHDVHRFFXUUHQFH
DQG IRU HYDOXDWLQJ WKH HIIHFWLYHQHVV RI SXEOLFKHDOWKRULHQWHG LQWHUYHQWLRQV VHH
DOVR5RELQVRQ 
6XVVHUDQG6XVVHU D DUHFUHGLWHGZLWKWKHSURSRVDORIDUHGLUHFWLRQ
RI HSLGHPLRORJLFDO UHVHDUFK DQG WUDLQLQJ LQ HSLGHPLRORJ\ XQGHU WKH QDPH
Eco-Epidemiology  0DUFKDQG6XVVHU .7KH\FODLPWKDWWKHHSLGHPLRORJLFDO
UHVHDUFK RI ODWH KDV EHFRPH IRFXVHG SULPDULO\ RQ WKH VWXG\ RI ULVN DQG XSRQ
LQGLYLGXDOULVNEHKDYLRU 0RUDELD6XVVHU6XVVHU 
6XVVHU   FRQVLGHUHG WKDW HSLGHPLRORJLFDO UHVHDUFK GLUHFWHG DW
SUREOHP VROYLQJ DQG DW WKH SUHYHQWLRQ RI GLVHDVH LQ SXEOLF KHDOWK KDG GHFOLQHG
WRZDUGVDQGZDVSDVVpE\WKHV)XUWKHUPRUHKHFULWLFL]HGWKHWUDQVLWLRQ
IURPLQIHFWLRXVWRFKURQLFGLVHDVHVZKLFKZRXOGEHWHUPHGWKH³HSLGHPLRORJLFDO
WUDQVLWLRQ´E\2PUDQ  
$FFRUGLQJWR:HHG  3HWR  QDPHG ³EODFNER[HSLGHPLRORJ\´
WKHLJQRUDQFHRIELRORJLFDOIDFWRUVLQIDYRURIWKHLQYHVWLJDWLRQRIFRUUHODWHVRIULVN
$WWKHVDPHWLPH/RRPLVDQG:LQJ  FULWLFL]HGWKRVHRIKLVFRQWHPSRUDULHV
ZKRZHUH³JXLGHGE\WKHSULQFLSOHWKDWWKHRULJLQVRIGLVHDVHDUHHQYLURQPHQWDOLQ
DYHU\EURDGVHQVH´ZKDWKHGHHPHGWKH³EODFNER[”YLHZ7KLVOHGWRWKHWKHRU\
WKDWGLVHDVHVFRXOGEHSUHYHQWHGE\DOWHULQJWKHHQYLURQPHQW³ZLWKRXWWKHQHHGIRU
GHWDLOHGNQRZOHGJHRISDWKRJHQLFPHFKDQLVPV´ZKLOH6DYLW]GHIHQGHGWKHWUDGLWLRQ
RI³EODFNER[´HSLGHPLRORJ\DUJXLQJWKDWLWDOORZVIRUGLVHDVHSUHYHQWLRQLQWKH
DEVHQFHRIDFOHDUXQGHUVWDQGLQJRILWVPHFKDQLVPV
/DWHU6XVVHUDQG6XVVHU D GHFODUHGWKDW

7KHSUHVHQWHUDRIHSLGHPLRORJ\LVFRPLQJWRDFORVH7KHIRFXVRQULVN
IDFWRUVDWWKHLQGLYLGXDOOHYHO±WKHKDOOPDUNRIWKLVHUD±ZLOOQRORQJHU
VHUYH:HQHHGWREHFRQFHUQHGHTXDOO\ZLWKFDXVDOSDWKZD\VDWWKH
VRFLHWDOOHYHODQGZLWKSDWKRJHQHVLVDQGFDXVDOLW\DWWKHPROHFXODUOHYHO

7KLVSDSHUZDVIROORZHGE\Part 2GHDOLQJZLWKWKHIXWXUHRIHSLGHPLRORJ\
6XVVHUDQG6XVVHUE DVZHZLOOVHHEHORZ
6XVVHUDQG6XVVHU E DGYRFDWHGDSDUDGLJPIRUDQHPHUJHQWHUDRI
HFRHSLGHPLRORJ\FDOOHG³&KLQHVHER[HV´ LQDQDOOXVLRQWRWKHVHWVRIER[HVZKHUH
HDFK¿WVLQVLGHDODUJHUER[$WWKHVDPHWLPHWKH\VWUHVVHGWKDWWKHDGRSWLRQRIWKH
HFRHSLGHPLRORJ\SDUDGLJPLVQRWDFDOOIRUPRUHVWXGLHVRIDQHFRORJLFDOQDWXUH
EXWDFDOOWRH[DPLQHWKHEHKDYLRURIGLVHDVHDWWKRVHOHYHOVRIRUJDQL]DWLRQEH\RQG
DQGZLWKLQWKHLQGLYLGXDO$EULHIUpVXPpRIWKHEODFNER[GHEDWHLVIRXQGLQ:HHG
 %XWDVODWHDVDXWKRUVVXSSRUWHGWKHLGHDRIDQHSLGHPLRORJ\GLUHFWHG

6 5(9,67$'(3$72/2*,$7523,&$/
WRZDUGV SXEOLF KHDOWK DQG WKH DQDO\VLV DQG SUHYHQWLRQ RI ULVN .RRSPDQ 
*UHHQODQGDQG5RELQV*UHHQODQGHWDO 
,Q  6FKZDUW] ( 6XVVHU DQG 0 6XVVHU DQWLFLSDWHG D IXWXUH IRU
epidemiology. &ULWLFLVPV FRQFHUQLQJ SUHPDWXUH DQG GXELRXV DVVRFLDWLRQ RI ULVN
IDFWRUVDQGGLVHDVHWKHLQDGHTXDF\RIHSLGHPLRORJ\WRSURYLGHVROXWLRQVWRSXEOLF
KHDOWKLVVXHVDQGWKHQHJOHFWRIWKHVRFLDOHQYLURQPHQWZKHUHGLVHDVHRFFXUDPRQJ
RWKHUVIRUPHGWKHEDVLVRIWKHLUDUJXPHQWV
$QRWKHUVRXUFHRIFRQIXVLRQ LV WKH XVH RI IDOVH XQLWV DJJUHJDWHV RU
FDWHJRULHVRIDQDO\VLVVXFKDVUDFH,QDPHVVDJHIRUDQRQOLQHGLVFXVVLRQJURXS
6WHSKHQ0RUVH  FDOOHGDWWHQWLRQWRWKHIDFWWKDWGH¿QLWLRQVRIUDFHHWKQLFLW\
FXOWXUHDQGQDWLRQDOLW\DUHRIWHQXVHGLQDFFXUDWHO\LQWKHHSLGHPLRORJLFDOOLWHUDWXUH
&DWHJRULHVVXFKDVHispanic, CaucasianDQGAfrican-AmericanKDYHQRPHDQLQJ
as applied to disease
$V5RVH  VWUHVVHGFRQIRXQGLQJJHQHWLFRUEHKDYLRUDOFKDUDFWHULVWLFV
RIindividualsZLWKWKHLQFLGHQFHRIGLVHDVHVLQgroups or populationsLVDUHJUHWWDEOH
HUURUDQGPLJUDQWVZKDWHYHUWKHFRORURIWKHLUVNLQWHQGWRDFTXLUHWKHGLVHDVHUDWHV
RIWKHLUFRXQWU\RIDGRSWLRQ
$WWHPSWVDWHUDGLFDWLQJVXFKFRQIRXQGLQJYDULDEOHVIURPHSLGHPLRORJLFDO
DQDO\VHVKDYHVRIDUEHHQLQQRFXRXV6HHIRULQVWDQFH6PDMH  7HPSOHWRQ
 5RRW  3HQD  DQG%UDGE\  

ECO,1(&2(3,'(0,2/2*<

,Q  (]UD 6XVVHU UHYLYHG WKH GHEDWH RYHU WKH LPSRUWDQFH RI
ULVNIDFWRUV RU EODFN ER[ HSLGHPLRORJ\ DQG WKH LQGLYLGXDOL]DWLRQ RI WKH LGHD RI
ULVN:KLOHVKHDFFHSWHGWKHDUJXPHQWVSXWIRUZDUGE\*UHHQODQGHWDO  DQG
RWKHUVVKRZLQJWKHLPSRUWDQFHRIWKHDQDO\VLVRIULVNDVDEDVLVIRUWKHXQGHUVWDQGLQJ
RIWKHFDXVHVDQGWKHLPSURYHPHQWRISXEOLFKHDOWKVKHGHSORUHVWKHOLPLWDWLRQRI
HSLGHPLRORJ\WRZKDWEHFDPHNQRZQDVEODFNER[UHVHDUFKDQGLQVLVWHGRQWKH
QHHGIRUFRQVLGHUDWLRQRIPXOWLSOHOHYHOVRIFDXVDWLRQ$WWKHVDPHWLPHVKHFDXWLRQV
DJDLQVWUHGXFWLRQLVPDQGDGYRFDWHVWKHXVHRIGLIIHUHQWDSSURDFKHVIRUWKHFRUUHFW
LGHQWL¿FDWLRQRIWKHFDXVDOUHODWLRQVKLSVDWHDFKOHYHO6KHUHIHUUHGLQSDVVLQJWRWKH
UHODWLRQRIHSLGHPLRORJ\WRKXPDQHFRORJ\DQGWRWKHXVHRIGLIIHUHQWPHDQLQJVRI
WKHWHUPHFRORJ\E\HSLGHPLRORJLVWV
+XPDQHFRORJ\LVQRWUHVWULFWHGWRKHDOWKPDWWHUV $YLOD3LUHV 
(FRORJLFDO VWXGLHV LQ HSLGHPLRORJ\ GR QRW DOZD\V LPSO\ WKH XVH RI
ecological VV  WKHRULHV DQG SULQFLSOHV ZKLFK DUH EDVHG XSRQ WKH FRQFHSW RI
ecosystem, GH¿QHGE\7DQVOH\  DV³DQRSHQV\VWHPRIFLUFXODWLRQRIQXWULHQWV
DQGWKHWUDQVIHURIHQHUJ\WKURXJKDKLHUDUFKLFDOVXFFHVVLRQRIWURSKLFOHYHOVIURP
SURGXFHUV JUHHQ SODQWV  WR SULPDU\ FRQVXPHUV SUHGDWRUV SDUDVLWHV DQG ¿QDOO\
GHFRPposers”.

Vol. 42 (1): 1-12. jan.-mar. 2013 


6RPHDXWKRUVGH¿QHHFRORJLFDOVWXGLHVLQHSLGHPLRORJ\DVWKRVHGLUHFWHGDW
SRSXODWLRQDQDO\VHV 5RELQVRQ ZKLOHRWKHUVLQFOXGHWKHHQYLURQPHQWZLWKRXW
DSURSHUGH¿QLWLRQRIZKDWenvironmentPHDQV 'LH]5RX[ 7KHPLVXVHRI
HFRORJLFDOLGHDVDQGWHUPVKDVEHHQGLVFXVVHGLQGHWDLOE\$YLOD3LUHV  
5HIHUHQFHV WR WKH +LSSRFUDWLF LGHD RI D FORVH UHODWLRQVKLS RI GLVHDVHV
DQG WKH IDFWRUV RI D ORFDO SK\VLFDO HQYLURQPHQW ZDWHU DLU DQG SODFHV  DV WKH
EHJLQQLQJVRIHFRORJ\DUHDQDFKURQLVWLF7KHVDPHDSSOLHVWR/LQQDHXV¶WKHRULHV
RQWKH(FRQRP\RI1DWXUHWKHH[LVWLQJHTXLOLEULXPEHLQJDWWULEXWHGE\KLPWRWKH
&UHDWRU¶VGHVLJQ,Q&KDUOHV'DUZLQFDOOHGDWWHQWLRQWRDQREVHUYDEOHIDFWKH
HQYLVDJHGWREHRIIXQGDPHQWDOUHOHYDQFH³/HWLWEHERUQHLQPLQGKRZLQ¿QLWHO\
FRPSOH[DQGFORVH¿WWLQJDUHWKHPXWXDOUHODWLRQVRIDOORUJDQLFEHLQJVWRHDFKRWKHU
DQGWRWKHLUSK\VLFDOFRQGLWLRQVRIOLIH´.
7KH WZRIROG DVSHFWV RI HYROXWLRQ E\ QDWXUDO VHOHFWLRQ DV HQYLVDJHG E\
'DUZLQWXUQHGRXWWREHWKHWZRPDLQWUHQGVRIHFRORJLFDOUHODWLRQVKLSVGH¿QHG
E\(UQVW+DHFNHO  DV³WKHVWXG\RIWKHUHODWLRQVKLSVRIRUJDQLVPVZLWKRQH
DQRWKHUDQGZLWKWKHQRQELRWLFIDFWRUVRIWKHHQYLURQPHQW´
7KH PRGHUQ FRQFHSW RI WKH ecosystem ZDV RQO\ DFKLHYHG DIWHU WKH
GHPRQVWUDWLRQE\3DVWHXU  RIWKHELRORJLFDOQDWXUHRIWKHSXWUHIDFWLRQDQG
GHFRPSRVLWLRQ RI RUJDQLF PDWWHU E\ PLFURRUJDQLVPV DQG WKH QRQ H[LVWHQFH RI
ELRJHQHVLVRUVSRQWDQHRXVJHQHUDWLRQ&ODXGH%HUQDUG  DQG7\QGDOO
 GHVFULEHGFOHDUO\WKHUHF\FOLQJRIQXWULHQWVLQQDWXUH
,Q6KHOIRUGFRQVLGHUHGHFRORJ\DVSDUWRIJHQHUDOSK\VLRORJ\ZKLFK
WUHDWV WKH RUJDQLVP LQ LWV WRWDOLW\ LQ UHODWLRQ ZLWK LWV HQYLURQPHQW7KLV EHFDPH
NQRZQ DV auto ecology LQ RSSRVLWLRQ WRsynecology RU WKH HFRORJLFDO VWXG\ RI
FRPPXQLWLHV,Q&OHPHQWVDQG6KHOIRUGUHPDUNHGWKDW

7KHYHU\HVVHQFHRIHFRORJ\LVWKHV\QWKHVLVGHULYHGIURPWKHH[KDXVWLYH
DQDO\VLVRIWKHFRPPXQLW\DQGLWVKDELWDWWKHIUDJPHQWDWLRQRIDQLPDO
FRPPXQLWLHVRQWKHEDVLVRIWD[RQRPLFJURXSVLVJUHDWO\WREHGHSORUHG
VLQFHLWGHVWUR\VWKHODVWVHPEODQFHRIXQLW\

/LNHZLVH WKH HSLGHPLRORJLFDO DQDO\VHV DQG PRGHOV WKDW UHVWULFW WKH


FRPSRQHQWVRIDF\FOHRIGLVHDVHWUDQVPLVVLRQWRRQHRUDWEHVWDIHZVHOHFWHG
UHVHUYRLUVYHFWRUVDQGPDQDUHOLNHO\WROHDYHRXWPRVWRILWVUHDOQDWXUHDQGWKH
VLJQL¿FDQFHRIWKRVHF\FOHV
0HGLFDO HFRORJ\ LV FHQWHUHG RQ WKH relationships EHWZHHQ GLIIHUHQW
HOHPHQWV WKDW OHDG WR GLVHDVH LQ D ELRORJLFDO FRPPXQLW\ 0DQ LV RQH RI WKRVH
HOHPHQWV,QHSLGHPLRORJ\WKHHPSKDVLVLVXSRQDhuman populationKDUERULQJD
GLVHDVHRUFRQGLWLRQZKLFKDIIHFWVLWVKHDOWKDVPHDVXUHGE\UDWHVRISUHYDOHQFHDQG
RULQFLGHQFH $YLOD3LUHV 

8 5(9,67$'(3$72/2*,$7523,&$/
(&+2(62)$'(%$7(

/LWWOH DJUHHPHQW DURVH IURP WKRVH ORQJ DQG VRPHWLPHV DFULPRQLRXV


GHEDWHV%HLQJVRWKHIROORZLQJLVVXHVUHPDLQRSHQWRGLVFXVVLRQDQGGLVSXWH
1. The fallacyGHEDWHLQYROYLQJWKHWKHRU\RIOHYHOVRIFRPSOH[LW\DQGWKHXVH
RIGDWDYDOLGIRUSRSXODWLRQVLQWKHFOLQLF$FFRUGLQJWR5RVHWKHUHLVDJUHDW
GLIIHUHQFHEHWZHHQWKHGHWHUPLQDQWVRIWKHHWLRORJ\RILQGLYLGXDOFDVHVDQGWKH
GHWHUPLQDQWVRILQFLGHQFHUDWHLQSRSXODWLRQVLQKLVZRUGV

:LWKLQSRSXODWLRQVLWKDVSURYHGDOPRVWLPSRVVLEOHWRGHPRQVWUDWHDQ\
UHODWLRQEHWZHHQDQLQGLYLGXDO¶VGLHWDQGKLVVHUXPFKROHVWHUROOHYHO
DQGWKHVDPHDSSOLHVWRWKHUHODWLRQRILQGLYLGXDOGLHWWREORRGSUHVVXUH
DQGWRRYHUZHLJKW%XWDWWKHOHYHORISRSXODWLRQVLWLVDGLIIHUHQWVWRU\
«7KHGHWHUPLQDQWVRILQFLGHQFHDUHQRWQHFHVVDULO\WKHVDPHDVWKH
FDXVHVRIFDVHV

6HHFRPPHQWVRQ5RVH¶VSDSHULQ(EUDKLPDQG/DX  0F&RUPLFN


 +XQWDQG(PVOLH  

2. &DXVDOLW\DQGIDXOW\FRUUHODWLRQVDIROORZXSRQWKHIDOODF\1RZDGD\VPRUH
DQGPRUHDUWLFOHVDUHEHLQJSXEOLVKHGSUHVHQWLQJGXELRXVFDXVDOFRUUHODWLRQV
%RWK3HOOHU  DQG0HUY\Q6XVVHU  GLVFXVVHGWKHIXQGDPHQWDOVRI
FDXVDOUHODWLRQVKLSVLQHSLGHPLRORJ\7KH\UHPDLQYDOLGDQGLPSRUWDQWVRXUFHV
IRU WKH XQGHUVWDQGLQJ RI WKH SUREOHPV DIIHFWLQJ WKH HVWDEOLVKPHQW RI YDOLG
FRUUHODWLRQV .DXIPDQDQG3RROH6XVVHU 
3. %ODFNER[HSLGHPLRORJ\LWFHUWDLQO\LVMXVWL¿HGZKHQQRRUOLWWOHELRORJLFDOGDWD
RQDGLVHDVHLVDYDLODEOH
4. 1RUPDOLW\ &DQJXLOKHP GLVFXVVHG LWV GRXEOH PHDQLQJ 5RVH UHLQIRUFHG WKH
QRWLRQWKDWWKDW³ODERUDWRU\µUDQJHVRIQRUPDO¶DUHEDVHGRQZKDWLVFRPPRQ
ZLWKLQWKHORFDOSRSXODWLRQ:KDWLVFRPPRQLVDOOULJKWZHSUHVXPH´
5. 5DFHHomo sapiens LVDPRQRW\SLFVSHFLHV$V5RVHVWUHVVHG³WKHUHLVDEURDG
WHQGHQF\ IRU JHQHWLF IDFWRUV WR GRPLQDWH LQGLYLGXDO VXVFHSWLELOLW\«7KXV
PLJUDQWVZKDWHYHUWKHFRORURIWKHLUVNLQWHQGWRDFTXLUHWKHGLVHDVHUDWHVRI
WKHLUFRXQWU\RIDGRSWLRQ´*HQHWLFFKDUDFWHULVWLFVVXFKDVWKHEORRGIDFWRU5K
DUHDPRUHHI¿FLHQWUHSURGXFWLYHLVRODWLQJPHFKDQLVPWKDQVNLQFRORUHWKQLFLW\
FXOWXUHUHOLJLRXVSUHFHSWVRUVRFLDOPRUHV
6. 7KH PLVXVH RI HFRORJLFDO WKHRULHV LGHDV DQG WHUPV 0HGLFDO HFRORJ\ LV
EDVHGXSRQVROLGHFRORJLFDOSULQFLSOHV$OVRWKHFDUHOHVVXVHRIFDWHJRULHVRU
DJJUHJDWHVLQLQWHUYLHZVDQGVXUYH\V $YLOD3LUHV 
 5LVN7KHUH LV PXFK FRQIXVLRQ LQ WKH FRQFHSWXDOL]DWLRQ RI KD]DUGV GDQJHU
WKUHDWV DQG ULVN$ UHFHQW UHDSSUDLVDO RI WKH HSLGHPLRORJ\ RI ULVN KXPDQ
EHKDYLRUDQGWKHFRQFHSWRIKHDOWK\OLYLQJZDVSXEOLVKHGE\&DVWLHO*XLODP

Vol. 42 (1): 1-12. jan.-mar. 2013 


DQG)HUUHLUD2WKHUJRRGVRXUFHVDPLGDFRSLRXVOLWHUDWXUHDUHWKHSDSHUVE\
/DXULW]HQDQG6DFKV  DQG$UPVWURQJ  
/HWXVQRWIRUJHWWKDWWREHDOLYHLQHYLWDEO\FDUULHVVXEVWDQWLDOULVNWROLIH

5()(5(1&(6

1. $UPVWURQJ'7KHULVHRIVXUYHLOODQFHPHGLFLQHSociol Health Ill 3: 


2. $YLOD3LUHV)'7KHXVHDQGPLVXVHRIVRPHHFRORJLFDOWHUPVDQGFRQFHSWVLQHSLGHPLRORJ\Mem
Inst Oswaldo Cruz 90
3. $YLOD3LUHV)' Fundamentos históricos da Ecologia.+RORV5LEHLUmR3UHWR
4. $YLOD3LUHV)'Princípios de ecologia médica8)6&)ORULDQySROLV
5. $YLOD3LUHV)'2QWKHFRQFHSWRIGLVHDVH. Rev Hist Humanid Méd 4:
6. $YLOD3LUHV)'+XPDQHFRORJ\VWDWLVWLFDODQDO\VLVDQGWKHORJLFRIYDOLGFRUUHODWLRQVPolítica e
Sociedade 10
 %HUJDQGL'³5HGXFWLRQLVWKROLVP´DQR[\PRURQRUDSKLORVRSKLFDOFKLPHUDRI(32GXP¶VV\VWHPV
HFRORJ\"Ludus Vitalis 3: 
8. Bernard C. Leçons sur les phénomènes de la vie comuns aux animaux et aux végétaux.YROV-%
%DLOOLqUH3DULV
 %HUWDODQII\/$Q2XWOLQHRI*HQHUDO6\VWHP7KHRU\Brit J Phil Sci 1
10. %HUWDODQII\/An Outline of a General Systems Theory*%UD]LOOHU1HZ<RUN
11. %UDGE\+5DFHHWKQLFLW\DQGKHDOWKWKHFRVWVDQGEHQH¿WVRIFRQFHSWXDOLVLQJUDFLVPDQGHWKQLFLW\
Soc Sci Med 75
12. &DQJXLOKHP * Essai sur quelques problèmes concernant le normal et le pathologique. 38)
4XDGULJH3DULV5HSULQWHG th ed as Le Normal et le Pathologique1RXYHOOHV5pÀH[LRQV
concernant le normal et le pathologique. 38)4XDGULJH3DULV
13. &DVWLHO/'*XLODP0&5)HUUHLUD06Correndo o risco: uma introdução aos riscos em saúde.
)LRFUX]5LRGH-DQHLUR
14. &KLD.(GLWRULDO(SLGHPLRORJ\LQWKHSRVWJHQRPLFHUDAnn Acad Med 29
15. &OHPHQWV)6KHOIRUG9Bio-ecology.-RKQ:LOH\1HZ<RUN
16. Comte A. Course de philosophie positive.9RO,9%DFKHOLHU3DULV
 &RXUD-5eSLGpPLRORJLHIn/HFRXUW'Dictionnaire de la pensée médicale3UHVVH8QLYHUVLWDLUH
GH)UDQFH3DULV
18. 'DUZLQ&On the origin of species by means of natural selection, or the preservation of favoured
races in the struggle for life.>TXRWDWLRQ@-RKQ0XUUD\/RQGRQ
 'LH]5RX[$ %ULQJLQJ FRQWH[W EDFN LQWR HSLGHPLRORJ\ YDULDEOHV DQG IDOODFLHV LQ PXOWLOHYHO
analysis. Amer J Publ Health 88
20. 'XUNKHLP(Les règles de la méthode sociologique. )HOL[$OFDQ3DULV
21. (EUDKLP 6 /DX ( &RPPHQWDU\ 6LFN SRSXODWLRQV DQG VLFN LQGLYLGXDOVInt J Epidemiol 30:

22. *ROGEHUJ0Cet obscur objet de l’épidémiologie. Sci Sociol Santé 1
23. *UHHQODQG 6 5RELQV - ,GHQWL¿DELOLW\ H[FKDQJHDELOLW\ DQG HSLGHPLRORJLFDO FRQIRXQGLQJInt J
Epidemiol 15
24. *UHHQODQG 6 *DJR'RPLQJXH] 0 &DVWHOmR -( 7KH 9DOXH RI ULVNIDFWRU ³EODFNER[´ 
epidemiology. Epidemiology 15
25. +DHFNHO ( Generelle Morphologie der Organismen: Algmeine Grundzüge der organischen
Formen-Wissenschaft, mecanisch begründet durch die von Charles Darwin reformiste Descendenz-
Theorie. YROV*HRUJ5HLPHU%HUOLP
26. +XII'How to lie with statistics.3HQJXLQ/RQGRQ
 +XQW.(PVOLH&&RPPHQWDU\7KHSUHYHQWLRQSDUDGR[LQOD\HSLGHPLRORJ\±5RVHUHYLVLWHGInt
J Epidemiol 30

10 5(9,67$'(3$72/2*,$7523,&$/
28. .DXIPDQ-63RROH&/RRNLQJEDFNRQ³&DXVDOWKLQNLQJLQWKHKHDOWKVFLHQFHV´An Rev Pub Health
21
 .RRSPDQ-6&RPPHQW(PHUJLQJREMHFWLYHVDQGPHWKRGVLQHSLGHPLRORJ\Amer J Pub Health
86
30. .ULHJHU1(SLGHPLRORJ\DQGWKHZHERIFDXVDWLRQKDVDQ\RQHVHHQWKHVSLGHU"Soc Sc Med 39:

31. /DXULW]HQ626DFKV/1RUPDOLW\ULVNDQGWKHIXWXUHLPSOLFLWFRPPXQLFDWLRQRIWKUHDWLQKHDOWK
VXUYHLOODQFHSociol Health Ill 23
32. /LQQDHXV&L’Équilibre de la nature-9ULQ3DULV
33. /RRPLV':LQJ6,VPROHFXODUHSLGHPLRORJ\DJHUPWKHRU\IRUWKHHQGRIWKH7ZHQWLHWK&HQWXU\"
Int J Epidemiol 19
34. 0DF0DKRQ%3XJK7),SVHQ-Epidemiologic methods./LWWOH%URZQ%RVWRQ
35. 0DUFK'6XVVHU(7KHHFR±LQHFRHSLGHPLRORJ\Int J Epidemiol 35
36. 0DU[.(QJHOV)The Individual and Society3URJUHVV3XEOLVKHUV0RVFRZ
 0F&RUPLFN-&RPPHQWDU\5HÀHFWLRQVRQVLFNLQGLYLGXDOVDQGVLFNSRSXODWLRQVInt J Epidemiol
30
38. 0RUDELD$$QQRWDWLRQ)URPGLVHDVHVXUYHLOODQFHWRWKHVXUYHLOODQFHRIULVNIDFWRUVAmer J Pub
Health 86
 0RUJHQVWHUQ + 8VHV RI HFRORJLF DQDO\VLV LQ HSLGHPLRORJLFDO UHVHDUFK Amer J Pub Health 72:

40. 0RUULV-1Uses of epidemiology/LYLQJVWRQH(GLQEXUJK
41. 0RUVH 67XEHUFXORVLV VXVFHSWLELOLW\ ³UDFH´ ³HWKQLFLW\´ ³QDWLRQDOLW\´ Owner-promed @usa.
healthnet.org $FHVVRHP'HF
42. 2PUDQ$57KHHSLGHPLRORJLFDOWUDQVLWLRQ$WKHRU\RIWKHHSLGHPLRORJ\RISRSXODWLRQFKDQJHThe
Milbank Memorial Fund Quarterly 49
43. 3DVWHXU/0pPRLUHVXUODIHUPHQWDWLRQDSSHOpHODWLTXHMém Soc Sci Agron Arts Lille 5: 13-26
  
44. Pearce N. Traditional epidemiology, modern epidemiology, and public health. Amer J Pub
Health 86: 678-683, 1996.
45. Peller S. Quantitative research in human biology and medicine. John Wright. Bristol, 1967.
46. Pena SD. Humanidade sem raças?. Publifolha. São Paulo, 2008.
 3HWR57KHQHHGIRULJQRUDQFHLQFDQFHUUHVHDUFKIn'XQFDQ5:HVWRQ6PLWK0The Encyclopedia
of Medical Ignorance2[IRUG3HUJDPRQ3UHVV
48. 3LQR&+HUQiQGH]*(QWRUQRDOVLJQL¿FDGRRULJLQDOGHOYRFDEORJULHJRepidemia\VXLGHQWL¿FDFLyQ
FRQHOODWLQRpestis. Dynamis 28
 3RROH&(GLWRULDO(FRORJLFDODQDO\VLVDVRXWORRNDQGPHWKRGAmer J Pub Health 84

50. 3RUWQRY%$'XEQRY-%DUF0(FRORJLFDOIDOODF\DVVHVVPHQWHUURUVVWHPPLQJIURPPLVJXLGHG
YDULDEOHVHOHFWLRQDQGWKHHIIHFWRIDJJUHJDWLRQRQWKHRXWFRPHRIHSLGHPLRORJLFDOVWXG\J Expos
Sci Environ Epidemiol 17
51. 5RELQVRQ: (FRORJLFDO FRUUHODWLRQV DQG WKH EHKDYLRU RI LQGLYLGXDOVAmer Sociol Review 15:
5HSULQWHG Int J Epidemiol 38
52. 5RRW07KHXVHRIUDFHLQPHGLFLQHDVDSUR[\IRUJHQHWLFGLIIHUHQFHVPhil Sci 70
53. 5RVH*6LFNLQGLYLGXDOVDQGVLFNSRSXODWLRQVInt J Epidemiol 145HSULQWHGInt J
Epidemiol 30
54. 5RWKPDQ.7KHULVHDQGIDOORIHSLGHPLRORJ\Int J Epidemiol 36
55. 5XPQH\-Herbert Spencer’s sociology:LOOLDPVDQG1RUJDWH/RQGRQ
56. 6FKZDUW] 67KH IDOODF\ RI WKH HFRORJLFDO IDOODF\ WKH SRWHQWLDO PLVXVH RI D FRQFHSW DQG WKH
FRQVHTXHQFHVAmer J Pub Health 84
 6FKZDUW]6'LH]5RX[$&RPPHQWDU\FDXVHVRILQFLGHQFHDQGFDXVHVRIFDVHV±D'XUNKHLPLDQ
SHUVSHFWLYHRQ5RVHInt J Epidemiol 30
58. 6FKZDUW]66XVVHU(6XVVHU0$IXWXUHIRUHSLGHPLRORJ\"An Rev Pub Health 20

Vol. 42 (1): 1-12. jan.-mar. 2013 11


 6HOYLQ+&'XUNKHLP¶VVXLFLGHDQGSUREOHPVRIHPSLULFDOUHVHDUFKAm J Soc 63
60. 6HUÀLQJ5(+LVWRULFDOUHYLHZRIHSLGHPLFWKHRU\Hum Biol 24
61. 6KHOIRUG9($QLPDOFRPPXQLWLHVLQWHPSHUDWH$PHULFDBull Geogr.Assoc Chicago 5
5HSULQWHG8QLYHUVLW\&KLFDJR3UHVV&KLFDJR
62. 6PDMH&7KHHWKQLFSDWWHUQLQJRIKHDOWKQHZGLUHFWLRQVIRUWKHRU\DQGUHVHDUFKSoc Health Ill 18:

63. 6WDOORQHV57RDGYDQFHHSLGHPLRORJ\An Rev Pub Health 1
64. 6XVVHU ( >]UD@ (FRHSLGHPLRORJ\ WKLQNLQJ RXWVLGH WKH EODFNER[ Epidemiology 15: 
2004.
65. 6XVVHU 0 Causal thinking in the the health sciences. Concepts and strategies in epidemiology.
2[IRUG8QLYHUVLW\3UHVV1HZ<RUN
66. 6XVVHU0(SLGHPLRORJ\WRGD\µDWKRXJKWWRUPHQWHGZRUOG¶,QW-(SLGHPLRO
 6XVVHU 0 'RHV ULVN IDFWRU HSLGHPLRORJ\ SXW HSLGHPLRORJ\ DW ULVN" 3HHULQJ LQWR WKH IXWXUH J
Epidemiol Community Health 52
68. 6XVVHU0*ORVVDU\FDXVDOLW\LQSXEOLFKHDOWKVFLHQFHJ Epidemiol Community Health 55
2001.
 6XVVHU0(FR(SLGHPLRORJ\WKLQNLQJRXWVLGHWKHEODFNER[Epidemiology 15
 6XVVHU06XVVHU(&KRRVLQJDIXWXUHIRUHSLGHPLRORJ\,(UDVDQGSDUDGLJPVAmer J Pub Health
86D
 6XVVHU06XVVHU(&KRRVLQJDIXWXUHIRUHSLGHPLRORJ\,,)URPEODFNER[WR&KLQHVHER[HVDQG
HFRHSLGHPLRORJ\Amer J Pub Health 86E
 6XVVHU06WHLQ=Eras in Epidemiology: The Evolution of Ideas2[IRUG8QLYHUVLW\3UHVV2[IRUG

 7DQVOH\$*7KHXVHDQGDEXVHRIYHJHWDWLRQDOFRQFHSWVDQGWHUPVEcology 16
 7HPSOHWRQ$5 +XPDQ UDFHV D JHQHWLF DQG HYROXWLRQDU\ SHUVSHFWLYH Amer Anthropol 100:

 7KH1HZ(QJODQG-RXUQDORI0HGLFLQH7KHJUHDWGHEDWHFRQWLQXHVThe New Engl J Med 265

 7\QGDOO - Essays on the Floating-matter of the Air in relation to Putrefaction and Infection.
/RQJDPQV*UHHQ/RQGRQ
 :HEHU0Essays in sociology5RXWOHGJH2[RQ
 :HHG'/%H\RQGEODFNER[HSLGHPLRORJ\Amer J Pub Health 88

12 5(9,67$'(3$72/2*,$7523,&$/

You might also like