Chapter 3: The urban health niche: a new paradigm in healthy city planning
With increasing urbanization and the resulting spread of sedentary lifestyles, there has, as we noted in Chapter 2, been a marked transformation in the problematization of health, with a transition from infectious to chronic disease aetiology. The primary focus of contemporary epidemiology has shifted towards conceptualizing causality as well as isolating causes (Susser, 1991). This has led to the evolution of more sophisticated and holistic paradigms of epidemiology involving a range of complexities of multiple levels, multiple causal pathways, and non-linear interactions, as well as temporal dynamism. Such paradigms have been based on a bottom-up approach, which strives to understand and influence disease causation from a molecular level, moving upwards towards the population level, as well as the more conventional top-down approach, which starts at the population level and studies disease causation as a result of the processes and mechanisms intrinsic to it. Vandenbroucke (1988) had strongly argued for the former, stating that disease (cancer) incidence rates can best be explained by the interplay between genes and environment. N. Pearce (1996), on the other hand, posited that the bottom-up approach is reductionist and positivistic and the aetiologic framework of a disease should be conceptualized at the population level. The individual-versus-population approach often creates a conceptual disconnect often acting as a bottleneck for effective formulation and implementation of public health intervention strategies.
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