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Letters Physical inactivity and cognitive health

Postmodern epidemiology: public health informed by evidence

BMJ 2019; 365 doi: https://doi.org/10.1136/bmj.l2379 (Published 04 June 2019) Cite this as: BMJ 2019;365:l2379

Postmodern epidemiological patterns

Epidemiological patterns are models of morbidity-mortality or ways of measuring sickness and death that are more prevalent in a given society at specific historical moments. These models are made up of the three key components of epidemiology--that is, the causes and types of the disease, its effects and the populations involved.

Since the end of the eighteenth century this set of knowledge and practices accumulated to deal with the disease has been formalized and systematized, thus taking shape what we know today as epidemiology and public health, sciences dedicated to the study and cure of diseases and their consequences in populations. Currently, social changes are transforming both epidemiological patterns and the scientific and political ways of managing them.

Since the mid-twentieth century a new epidemiological transition has been taking place that generates new epidemiological, postindustrial or postmodern patterns.

There has been a reduction in avoidable morbidity and mortality and a consequent increase in the quality of life related to the health and general welfare of the population in all developed countries and in many developing countries. At the same time, new morbidities arise that progressively acquire an important specific weight.

In general, this new epidemiological profile can be characterized:

• Regarding the most prevalent types and causes of diseases, there has been a spectacular increase in cancer, avoidable accidents (traffic accidents, work accidents), cardiovascular diseases closely related to consumption patterns in general, and food consumption in particular, and the emergence of numerous mental health problems.
• Period of decreasing mortality and high prevalence of chronic and degenerative diseases that draw a state of pluripathologic patterns.
• The populations involved or affected are now local and global at the same time, both because of the new population recomposition that the global migratory phenomenon implies and because of the global nature of the risks of the contemporary world.

A series of causes explain the change towards these postmodern epidemiological profiles. They include the new mode of production and its unavoidable risks, the extraordinary increase in life expectancy in Western societies, the increase in health education levels of the population, the improvement in the quality and efficiency of health care services, the important work of public health devices for the rigorous investigation of the health situation and the design of intervention campaigns, the improvement of the training of professionals, the political action or the cultural exigencies that place the individual human welfare in the apex of ideals.

References
1. Gil-García E, López Fernández LA. Opiniones y discursos en torno a la gripe A en Andalucía. Aracena: Editorial Doble J, 2010.
2. Gil-González D et al. Valoración de los objetivos de desarrollo del milenio mediante la revisión de la literatura científica. Rev. Esp. Salud Pública, 2008; 82 (5).
3. Health Development Agency. Grading evidence and recommendations for public health interventions: developing and piloting a framework. Disponible en: www.nice.org.uk/nice-Media/docs/grading_evidence.pdf, 2009.
4. Institute of Medicine. The future of Public’s Health in the 21st Century. Washington: National Academy of Sciences, 1988.
5. Jameson F. El posmodernismo o la lógica cultural del capitalismo avanzado. Barcelona: Paidós, 2008.
6. Kaptchuk TJ. The double-blind, randomized, placebo-controlled trial:gold standard or golden calf? J Clin Epidemiol, 2001; 54:541-9.
7. Krieger N. Theories for social epidemiology in the 21 st century: an ecosocial perspective. Int J Epidemiol, 2001; 30(4):668-677.
8. Livi Bacci M. Historia mínima de la población mundial. Barcelona: Ariel, 2008.
9. Martínez-Hernáez A. Antropología y salud mental: dilemas y desafíos contemporáneos. En:Beiruti N, García Galán R, González Rojo E. (Eds). Salud mental en la inmigración. Granada:Escuela Andaluza de Salud Pública, 2008 (p 33-50).
10. Segura del Pozo J. Salud pública y algo más. Programar en salud (3). La población diana. En: http://www.madrimasd.org/blogs/salud_publica/2009/06/18/120427 [consultado 2 junio 2019].

Competing interests: No competing interests

11 June 2019
Moises A. Santos-Peña
Medical Doctor and Professor. Intensive Care Unit and Head of the Department of Epidemiology
Rocha-Hernandez Juan F., Rodriguez-Roque María O., Vazquez-Cáceres Amaury, Guardado-Alvarez María del C., Zorrilla-Mendez Idolidia
Gustavo Aldereguia University General Hospital
Ave 5 de Septiembre and 51-A street. Cienfuegos, Cuba 55100