The science of epidemiology and the methods needed for public health assessments: a review of epidemiology textbooks

OBJECTIVES: Epidemiology is often described as ‘the science of public health’. Here we aim to assess the extent that epidemiological methods, as covered in contemporary standard textbooks, provide tools that can assess the relative magnitude of public health problems and can be used to help rank and assess public health priorities. STUDY DESIGN: Narrative literature review. METHODS: Thirty textbooks were grouped into three categories; pure, extended or applied epidemiology, were reviewed with attention to the ways the discipline is characterised and the nature of the analytical methods described. RESULTS: Pure texts tend to present a strict hierarchy of methods with those metrics deemed to best serve aetiological inquiry at the top. Extended and applied texts employ broader definitions of epidemiology but in most cases, the metrics described are also those used in aetiological inquiry and may not be optimal for capturing the consequences and social importance of injuries and disease onsets. CONCLUSIONS: The primary scientific purpose of epidemiology, even amongst ‘applied’ textbooks, is aetiological inquiry. Authors do not readily extend to methods suitable for assessing public health problems and priorities.