Making the world a better place

In a recent post I mentioned a bold aspiration, to make the world a better place. This is an implicit aim that many of us share as we contemplate our life's work from our different professional and occupational vantage points.  Even when we consciously aspire to make the world a better place and proclaim this out loud, which we seldom do because it seems grandiloquent, we even more rarely pause to reflect on what we mean by 'better.'

I tried to do it on September 22, 1997 in Boston, when the American College of Epidemiology gave me the Lilienfeld Award, which is the ACE's mark of distinction for lifetime achievement in epidemiology. As quid pro quo when the ACE gave me the Lilienfeld Award, I was required to give a little talk. I skimmed over the achievements of epidemiology. We all knew these achievements. Many of us recite them with pride in our introductory lecture to incoming students at the beginning of each new academic year. Instead, while all of us were digesting an unusually good meal at the annual ACE banquet, I asked - but didn't try to answer - an unsettling philosophical question.  My question can be summarized: will our descendants 100 years, or 500 years, or 1000 years, from now still regard what we did to improve the human condition, as the best, or the right thing to do? Will what we have done to clarify causes and achieve control of diseases, injuries and premature death still be considered improvements? I confessed to some scepticism and even cynicism during the discussion after my talk. It was a unique pleasure to harangue a large cluster of epidemiologists with such profound but unanswerable questions on my 71st birthday! (I'm told that my 1997 Lilienfeld Award address is posted on the ACE website, so readers of this blog can dig it up from the ACE archives if they wish).

We believe the greatest contributions of epidemiology to improving the human condition include control, sometimes elimination, of dangerous communicable diseases, clarifying the causes and initiating and maintaining surveillance systems to delineate the burden of diseases like cancer, heart disease, stroke, diabetes, industrial and traffic-related injury and death, mortality and disability of mothers and infants associated with childbirth, and evaluation of health care systems and services. All these are desirable uses of epidemiology. Governments seek our help to address questions that concern them: which health services, for instance, provide best value for professional expertise and money invested in them?  

My personal contributions have been development and application of a useful epidemiological model of many diseases; standardizing epidemiological terminology (compiling and editing the Dictionary of Epidemiology); editing a comprehensive reference textbook of public health, and helping to develop  guidelines for ethical conduct of epidemiological practice and research. I've done or taken part in a few other things too, but those four distinctly different achievements are enough to make me feel that my professional life hasn't been entirely wasted.   

There are other challenges to which epidemiologists, along with the rest of the world's intelligentsia, have had little or no worthwhile response. We've done almost nothing to relieve the burden of one of the most accursed afflictions of humankind, the scourge of depressive illness, as well as other mental and emotional disorders. We've done very little to alleviate the distress of dysfunctional families, who are often afflicted with domestic violence, substance abuse, etc. On an international scale we've done nothing to identify the causes and discover ways to prevent violent armed conflicts. The latest outbreak, the gratuitous violence and destruction of ancient historic sites, the obscene public executions, mass rapes and enslavement of girls and women by the Islamic State, has been unimpeded despite our efforts - which are demonstrably ineffectual. Public health sciences must get engaged with these problems! There have been almost no epidemiological studies of war, especially of the modern kind of unconventional war that has smouldered in the Middle East for several decades. 

As for the greatest danger to all living things on earth, global climate change, almost all epidemiologists, like the rest of humankind, continue to behave as if this isn't happening. 
I've fulminated on this often. I've included this as the key message in almost everything I've written and spoken in professional circles for more than a quarter of a century, so much that I've become like a broken gramophone record.  I feel more and more like Cassandra or Diogenes. 

Is it any wonder that I've turned my back on public health sciences, and taken to writing a story for children?