Breilh, Jaime. Epidemiología: economía, medicina y política. [Epidemiology:economics, medicine, and politics.] Mexico City: Fontamara, 1988. 4th Edición.240 p.First Edition Universidad Central (Equador), 1979.
2nd. Edition Universidad Santo Domingo (Dominican Republic ), 1981.
3rd. Edition Fontamara (Mexico), 1986.
5th. Edition Fontamara (Mexico), 1989. First Edition in Portuguse: Epidemiologia: Economia, Política e Saúde. SãoPaulo: UNESP- HUCITEC, 1991.
Objective: To present a critique of the traditional study of epidemiology and to offer a new approach.
Methodology: Historical-structural analysis.
Results: The author asserts that research on health, both clinical and epidemiological, is biased toward the biological domain. Although environmental influences are acknowledged as a cause of disease, the definition given to environment (especially in relation to problems of contamination) excludes the causative role played by socioeconomic factors. The functionalist focus of most epidemiological investigation omits the analysis of social structure when explaining the health/disease dynamic. In addition, the topic has gone through various stages of interpretation, ranging from the uni-causal (disease resulting from the action of a pathogenic agent) to the multi-causal (disease as the outcome of a variety of factors, including the “ecological triad” of Leavell and Clark.). In recent decades, researchers have developed an alternative methodology, relying on the theory of historical materialism. The author considers this approach more adequate to explain the health/disease process, and he criticizes traditional categories of epidemiology invoked to explain disease. He also emphasizes the need to consider the historical character of census data as well as the limitations of data published in official demographic compendia. He criticizes the international system of classifying disease according to clinical as opposed to social indicators.
Conclusions: At present, health and medicine are viewed and analyzed through a biological lens. Yet, the epidemiological models applied to health are closely connected to economic, political, and social processes. A critical examination of the concepts of traditional epidemiology thus raises a challenge for the discipline, namely, that the theoretical foundation of historical materialism should inform the in-depth study of health and disease.
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