Sick Individuals and Sick Populations
Department of Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London WCIE 7HT, UK.
Based on a lecture to the Xth Scientific Meeting of the International Epidemiological Association, 27 August 1984, Vancouver.
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, wich 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 conttrol the causes of incidence.