From evidence based bioethics to evidence based social policies. [Commentary]

L.G.A. Bonneux

Onderzoeksoutput: Bijdrage aan wetenschappelijk tijdschrift/periodieke uitgaveArtikelWetenschappelijkpeer review


In this issue, Norwegian authors demonstrate that causes of early expulsion out the workforce are rooted in childhood. They reconstruct individual biographies in administrative databases linked by an unique national identification number, looking forward 15 years in early adulthood and looking back 20 years till birth with close to negligible loss to follow up. Evidence based bioethics suggest that it is better to live in a country that allows reconstructing biographies in administrative databases then in countries that forbid access by restrictive legislation based on privacy considerations. The benefits of gained knowledge from existing and accessible information are tangible, particularly for the weak and the poor, while the harms of theoretical privacy invasion have not yet materialised. The study shows once again that disadvantage runs in families. Low parental education, parental disability and unstable marital unions predict early disability pensions and premature expulsion out gainful employment. The effect of low parental education is mediated by low education of the index person. However, in a feast of descriptive studies of socio-economic causes of ill health we still face a famine of evaluative intervention studies. An evidence based social policy should be based on effective interventions that are able to break the vicious circles of disability handed down from generation to generation.Natural selection is for biology what the human life course is for epidemiology: an overarching framework needed to understand the occurrence of disease in the iography of the individual person. The life course of human beings as a history of health and disease starts long before conception, in the genes and life course of their parents. The odds at facing a successful life are entirely different if conception started with the rape of a young teenager by an HIV positive warrior in a horrifying African civil war or as the consequence of the deep desire to raise a child among a healthy and wealthy European loving couple. To expect a life in good health, healthy parents have to provide their offspring with good genes, food, shelter, love, an upbringing and an education. However, a general problem of human life course epidemiology is that the human life course is a lot longer than the scientific career of epidemiologists. While there is a scope for ambitious programmes of prospective research spanning multiple generations, such programmes will nevertheless run into questions not addressed by the original design. In this issue, the Norwegian study of Gravseth et al. show how existing data from administrative databases can be put to good use to understand disabling processes originating in youth.
Originele taal-2Engels
Pagina's (van-tot)483-485
TijdschriftEuropean Journal of Epidemiology
Nummer van het tijdschrift8
StatusGepubliceerd - 2007


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