Reflections on Epidemiology and Public Health

I've been thinking a lot lately about the subject of epidemiology and it's relationship to public health, and what originally drew me to the field. What it comes down to is recognizing that there is more to health than individuals and individual behaviors. I saw this clearly as an undergraduate working with girls from the neighborhoods of Dorchester and Roxbury. We were attempting to teach them about nutrition and encouraging them to increase their physical activity, but in neighborhoods with no grocery stores or places to buy fresh and healthy food and high crime rates, it felt pretty futile. I also see it pretty clearly now in the field of HIV and sexual health outcomes. Women across the world are vulnerable because of their social and economic position, and telling a woman to get her partner to wear a condom is not an effective HIV prevention strategy when her husband will physically beat her or if her clients will pay 4 times as much to have sex without a condom.

So, context clearly matters. Understanding the structural factors related to health outcomes involves understanding why people come to be exposed to risk or protective social factors, determining the social conditions under which individual risk factors are related to outcomes. Efforts to reduce risk by changing behavior will be ineffective unless there is an understanding of the process that leads to the risky behavior. I am taking a social epidemiology class this semester which focuses on study design and methods in this area, such as understanding the effects of neighborhood poverty on health outcomes. Duh. It seems intuitive to me, I mean isn't public health based on structural solutions to health problems (such as safe drinking water)? It is a bit perplexing that this philosophy is considered social epidemiology and not just epidemiology. Sometimes I feel like my department is moving towards a biomedical approach to epidemiology, in which the emphasis is placed on individual risk factors, individual treatments, and individual outcomes.

What is the mission of public health and epidemiology becoming? A professor of mine wrote a column in todays News and Observer (the local paper) that is thought provoking. The UNC School of Public Health received a very generous gift last year, but what are the implications of that gift on our school's mission and research directions?
http://www.newsobserver.com/opinion/columns/story/987167.html