79
policy. In professional practice and in our training programs, great vigilance and
personal integrity are required to counter the influence of financially interested parties
and corrupt/morally bankrupt governments (Soskolne 2017; Soskolne and Baur 2019).
In particular, the seduction by moneyed interests in using academics to downplay or
deny the seriousness of hazards must be recognized. These are the studies that will
infiltrate the scientific literature to cast doubt and foment uncertainty (Michaels
2008, 2020). So infamous are some examples of these misdeeds that books and documentaries have explored and exposed them. The epidemiologist made aware of these
misdeeds will be better equipped to recognize their appearance in other contexts.
2 Precaution and the Precautionary Principle
Sometimes, especially in dealing with complex mixtures of exposure, it is not possible to generate compelling evidence, one way or the other, in terms of identifying
that substance which should be regulated to eliminate exposures. When we are concerned about environmental exposures to which large-scale population exposures
occur, then, even in the presence of scientific uncertainty, limited evidence supports
action. (Hill 1965; Soskolne 2005). It is the Precautionary Principle (PP) that
encourages policies to protect human health and the environment in the face of
uncertain risks (Kriebel et al. 2001).
In 1965, Hill provided what has become the foundation for rational approaches
to using science to inform policy. Because uncertainty is inherent to all scientific
knowledge, those in the applied science of epidemiology have embraced Hill’s concluding remarks in which he posits:
All scientific work is incomplete – whether it be observational or experimental. All scientific work is liable to be upset or modified by advancing knowledge. That does not confer
upon us a freedom to ignore the knowledge we already have, or to postpone the action that
it appears to demand at a given time (p. 300).
The need for action is required in the face of knowledge. The presence of uncertainty shall not be used as a reason for postponing cost-effective measures to prevent
potentially harmful exposures, especially when they are pervasive. The role of the
PP is to provide transparency in weighing risks from action (i.e., a policy intervention) against risks from inaction.
The need to be preventative and invoke the PP when harms could be so far- reaching
globally becomes all the more significant and deserving of attention (Soskolne 2005).
3 Different Levels of Prevention in Public Health
Epidemiology training until the early 1990s included only three levels of prevention
when discussing chronic, non-communicable diseases. These were: Primary,
Secondary and Tertiary Prevention. It was in 1993, and then through its second
Epidemiology and Public Health Under Siege: In Whose Best Interests?
policy. In professional practice and in our training programs, great vigilance and
personal integrity are required to counter the influence of financially interested parties
and corrupt/morally bankrupt governments (Soskolne 2017; Soskolne and Baur 2019).
In particular, the seduction by moneyed interests in using academics to downplay or
deny the seriousness of hazards must be recognized. These are the studies that will
infiltrate the scientific literature to cast doubt and foment uncertainty (Michaels
2008, 2020). So infamous are some examples of these misdeeds that books and documentaries have explored and exposed them. The epidemiologist made aware of these
misdeeds will be better equipped to recognize their appearance in other contexts.
2 Precaution and the Precautionary Principle
Sometimes, especially in dealing with complex mixtures of exposure, it is not possible to generate compelling evidence, one way or the other, in terms of identifying
that substance which should be regulated to eliminate exposures. When we are concerned about environmental exposures to which large-scale population exposures
occur, then, even in the presence of scientific uncertainty, limited evidence supports
action. (Hill 1965; Soskolne 2005). It is the Precautionary Principle (PP) that
encourages policies to protect human health and the environment in the face of
uncertain risks (Kriebel et al. 2001).
In 1965, Hill provided what has become the foundation for rational approaches
to using science to inform policy. Because uncertainty is inherent to all scientific
knowledge, those in the applied science of epidemiology have embraced Hill’s concluding remarks in which he posits:
All scientific work is incomplete – whether it be observational or experimental. All scientific work is liable to be upset or modified by advancing knowledge. That does not confer
upon us a freedom to ignore the knowledge we already have, or to postpone the action that
it appears to demand at a given time (p. 300).
The need for action is required in the face of knowledge. The presence of uncertainty shall not be used as a reason for postponing cost-effective measures to prevent
potentially harmful exposures, especially when they are pervasive. The role of the
PP is to provide transparency in weighing risks from action (i.e., a policy intervention) against risks from inaction.
The need to be preventative and invoke the PP when harms could be so far- reaching
globally becomes all the more significant and deserving of attention (Soskolne 2005).
3 Different Levels of Prevention in Public Health
Epidemiology training until the early 1990s included only three levels of prevention
when discussing chronic, non-communicable diseases. These were: Primary,
Secondary and Tertiary Prevention. It was in 1993, and then through its second
Epidemiology and Public Health Under Siege: In Whose Best Interests?