Real epidemiologists don't do ecological studies?

Abstract

The papers by Tapia Granados^1,2 and the accompanying commentaries^3–8 provide a most welcome debate for epidemiologists interested in the role of macro-level socioeconomic factors in determining mortality risk. Leaving aside technical arguments around the statistical methods, this work is challenging and should be of interest to many readers. The observation that mortality actually increases during periods of economic expansion, though not new, is counterintuitive and strikes deep at the heart of social epidemiology that believes improving socioeconomic conditions should be associated with better health. It is therefore unsurprising that this observation is strongly challenged. However, as Tapia Granados,^1,2 Edwards,⁴ and Rhum⁸ discuss, there are reasons (access to health care, health behaviours, working conditions, road traffic accidents, etc.) why economic upturns may be associated with worse health in the US. The fact that this paradoxical observation is in the opposite direction to the long-term trends in economic growth and life expectancy, and that epidemiological studies have consistently shown that unemployed populations have worse health than those in employment, does not necessarily refute these ecological patterns. I won't dwell on the arguments here as the papers by Tapia Grandos and the accompanying commentaries go into these in depth and make for excellent reading.