A history of epidemiologic methods and concepts



Robert Beaglehole

Director, Chronic Diseases and Health Promotion, World Health Organization, 1211 Geneva 27, Switzerland (email:



Editor: Alfredo Morabia
Publisher: Birkhäuser, Basel; 2004
ISBN: 3-7643-6818-7; softcover; 405 pages; price Swiss francs 130

This enthralling book is divided into two parts. The first part consists of a 125-page essay by Professor Morabia on the evolution of epidemiologic methods and concepts. This essay builds on and provides an introduction to the second part – a series of papers on epidemiology, most of which have been published over the last few years in the journal Social and Preventive Medicine.

The extended introductory essay outlines the work of people who contributed to the development and elucidation of epidemiologic methods and concepts. This book is essentially an epidemiologist's view of the development of ideas. The broader task of explaining the development of epidemiology and its connections to society at large is the task of historians of science (see, for example, the book by Vinten-Johansen et al. Cholera, chloroform, and the science of medicine: a life of John Snow, published by Oxford University Press in 2003).

Morabia's essay is fascinating. He is one of the very few practising epidemiologists with a deep interest in the history of epidemiologic methods. The particular combination of his interests gives a special credibility to his essay, which describes how epidemiologic thinking has developed from the 18th century around two key ideas: concepts concerned with populations and group comparisons – the hallmarks of modern epidemiology. Without these two simple ideas, and their integration, we would still be struggling to make causal judgments in epidemiology. And without a strong basis for assigning causality, epidemiology would be powerless. The contributions published in this book demonstrate that epidemiology is continuing to evolve. Morabia asks interesting questions, for example, was Hippocrates an epidemiologist (clearly not) and does the Book of Daniel in the Bible describe the first epidemiologic trial (again, no). He also gives a compelling argument for the late emergence of epidemiology – most likely because it was dependent on the development of the idea of probability.

The papers in the second part deal with material that will be familiar to most epidemiologists and covers ground ranging from Snow and Farr to the history of study designs, bias, confounding and causality. Richard Doll writes lucidly on the history of cohort studies, and a study of recent textbooks illustrates how new epidemiology is as a discipline and how its fundamental ideas have evolved rapidly over the last half century.

The justification proposed for the book is the idea – perhaps difficult to examine formally – that epidemiologists will be better scientists if they are aware of the origins of the ideas they use and how these ideas have evolved. The editor proposes that the book will be of interest to epidemiology students. Certainly, it will resonate with many post-graduate students though I doubt whether the average participant in a basic epidemiology course will engage with more than a few of the ideas presented.

The ideas aired in this book are of more than just of academic interest. However, we need to understand much more about how these ideas have been put to good use. I encourage Morabia for his next project to go beyond methodological considerations and consider the applications of epidemiology to efforts to improve population health.

World Health Organization Genebra - Genebra - Switzerland