Sick Individuals and Sick Populations

Empirical research into the causes and mechanisms of illness is often defined in terms of study of the determinants of the distribution of the disease; but the authors should not forget that the more widespread is a particular cause, the less it explains the Distribution of cases.

Abstract

Aetiology confronts two distinct issues: the determinants of individual cases, and the determinants of incidence rate. If exposure to a necessary agent is homogeneous within a population, then case/control and cohort methods will fail to detect it: they will only identify markers of susceptibility. The corresponding strategies in control are the 'high-risk' approach, which seeks to protect susceptible individuals, and the population approach, which seeks to control the causes of incidence. The two approaches are not usually in competition, but the prior concern should always be to discover and control the causes of incidence.