Identification of adult risk factors has contributed to a decrease in the occurrence of cardiovascular diseases and some types of cancer, particularly in developed countries. However, the prevailing etiologic model emphasizes risk factors associated with life style and occupational exposures. This emphasis leads to an excessive individualization of risk, weakening the link between epidemiology and public health. This article comments on the opinions of epidemiologists concerning the failures, limitations, and evolution of modern epidemiology that have helped redirect the field's theoretical underpinnings. Alternatives to the current model tend to integrate findings from molecular biology with classic risk factors and early adverse conditions in life, taking into account all these causal influences in hierarchical levels of organization. The author identifies and comments on three important approaches in this evolution: molecular epidemiology, the theory of early life factors, and multilevel models.
Chronic Disease; Molecular Epidemiology; Risk Factors