The uses of 'Uses of epidemiology'.

In 1944 the Association for Education in Citizenship published a pamphlet entitled ‘Health’ by Major Jerry Morris1 (of the Royal Army Medical Corps), as one of a series of Handbooks for Discussion Groups. The preface to the pamphlets in this series said that they were intended to be used by discussion circles concerned with the social, economic and political problems that arose from the Second World War. The central problem the pamphlet dealt with was that of health as a social function: statistics on the current state of ill-health in Britain were presented (against the background of considerable improvement from the mid-19th century), the problem of socioeconomic differentials in health outlined and arguments in favour of a universal tax-funded health service presented. By way of a conclusion readers were exhorted to involve themselves in understanding—and through this improving—the health of the communities in which they lived (Box 1). In 1948—and now as a civilian—Jerry Morris became Director of the Medical Research Council Social Medicine Research Unit.2 This unit contributed importantly to the development of the methodology and practice of the epidemiology of chronic disease and in 1955 the Director published an article entitled ‘Uses of Epidemiology’ in the British Medical Journal.3 This article was expanded into a book4 which, on publication in 1957, became one of the pioneering texts of 20th century epidemiology. Major Greenwood’s 1935 Epidemics and Crowd Diseases5 had discussed occupational disease, psychological influences on morbidity, the importance of nutrition and the epidemiology of cancer, but it was largely concerned with infectious disease, as was the other pioneering text of 1957, Principles of Epidemiology by Taylor and Knowelden.6 What was new about Jerry Morris’s book was illustrated in its characteristically modest preface, which pointed out that a more accurate title would be ‘Some uses of epidemiology in the study of non-communicable disease’. The book appeared at a time when epidemiology was undergoing a fundamental change. While exemplars of noncommunicable disease epidemiology could, of course, be cited— the work of Goldberger and Sydenstricker on pellagra is the classic example—no systematic approach to the population aspects of non-communicable disease existed at the end of the Second World War.7 Uses of Epidemiology, therefore, helped create the field that it documented. The area of concern of Uses of Epidemiology was similar to that of the Handbook for Discussion Groups, although the presentation was more attuned to an academic audience. There were seven uses of epidemiology in the 1955 British Medical Journal paper and there remained seven uses in the third edition of the book in 19758 (although the order of the fifth and sixth uses switched between the second9 and third8 editions). Box 2 reproduces the ‘recapitulation’ from the first edition,4 and summarizes the way these uses were conceptualized. Epidemiology was seen as contributing to understanding the burden of disease in the community, changes in this over time (and perhaps projections of future burdens of disease), the characteristics of the health problems involved (their cause, their course, their nature and their response—or non-response—to health care) and the implications of this understanding for the health prospects of individuals. Uses of Epidemiology contained a wealth of prescient ideas, which became a cornerstone for epidemiology as it developed over the second half of the 20th century. The book was certainly well received, as the quotes from the reviews in several journals (including Nature and the British Medical Journal) on the paper © International Epidemiological Association 2001 Printed in Great Britain