Explanations and Ideologies of Mortality Patterns

Over the past century two ideas of disease causation have coexisted and sometimes competed: causal necessity or the idea that specific diseases cannot occur in the absence of specific causes; and causal sufficiency the idea that multiple causes can result in the same disease. With reference to first the evolution of epidemiology and public health in the United States since the mid-nineteenth century and second the formulation of public health strategies for the developing countries from the 1940s to the 1980s the article explores ways in which these notions of causality have been used to explain changes in mortality to justify public policies and to advance the claims of various groups of public health professionals. While the relative importance given to causal sufficiency and necessity reflects the state of knowledge about the most prevalent diseases in specific settings and about the disease process it also reflects political ideologies and deeply held assumptions about the nature of society the individuals responsibility for his own well-being and moral responsibility. (SUMMARY IN FRE AND SPA) (EXCERPT)