Editorial

Editorial

José da Rocha Carvalheiro

We began our second year with the feeling that we had won a battle in a war that has proved more difficult than we had initially expected. Following the Journal's principles strictly, that is to say, having peer review concentrated on one Associate Editor, and at least three ad hoc reviewers, with all the toing and froing that this entails, slows down the process and often makes it frustrating. We have improved the process with the Special Articles, Discussions, Drawers and Shelves. A few thematic issues are being prepared, their organizers have already been contacted and are working on them. We hope we will soon be up to date with Abrasco's members, other subscribers and readers in general.

Keeping to the principle of peer review imposes problems that have been exhaustively discussed in international meetings of scientific editors. Even at the national level, at the periodic meetings of ABEC (Brazilian Association of Scientific Editors), the issue of authorship ethics in peer reviewed journals has also been addressed. A type of collective production with responsibility shared between authors, reviewers and editors has been established.

And to make matters worse, the emergence of the Internet has raised the idea of "virtual journals". Rejected by many, the idea enjoys prestige in many circles. In spite of all the controversy, the National Institutes of Health (NIH) have decided to regard articles published both in printed and virtual journals almost on an equal footing. Obviously that is so only as long as they follow the minimum essential criteria in selecting the published matter. French scientists see this issue with the expectation that the process of virtual publishing may restore the importance of languages that have lost space in modern science to English, the língua franca of the twentieth century. Perhaps the next century will bring news in that respect. In our journal, where we adopt a complex system of publishing an extended summary in English, in addition to the conventional abstract, there is a pressing need to address those issues. What should be done in a journal like ours, where we adopt the língua franca as the main language, but also publish articles in both Portuguese and Spanish?

For the time being, in spite of everything, we have managed to survive. In order to move forward, we must have an extensive debate about what our real prospects are. We hope readers will play an active role in discussing that issue, by sending in their contributions.

This issue's Special Article is the transcript of a lecture delivered in Abrasco's most recent Congress of Epidemiology, EpiRio 98. The author teaches at Santa Casa de São Paulo's College of Medical Sciences. She presents an fascinating discussion about the prospects for Epidemiology in Brazil in the Twenty-first Century. As is understandable, we cannot isolate our trends from those of the rest of the scientific world. She thus builds an impressively current epidemiological picture, adding to the viewpoints presented in the Special Articles of the Journal's two previous issues: one focusing on the hegemonic development of the discipline in first world countries, and the other one, focusing on Latin America's counter-hegemonic approach. She examines the theoretical aspects (the crisis in modern science), ethical aspects (social inequalities, health iniquities and the bridgeable gaps) and aspects of the praxis ('the relation between Epidemiology and Collective Health'). She analyzes the current proposals of the discussion about 'building the object' and new concepts. She is particularly concerned with the concept of risk and individual/collective or individual/society dynamics. She also warns against the fallacies of the uncritical application of "collective truths" to unique individuals who have difficulty in identifying with the collective and taking a "risk sharing" approach. She closes with an emphatic appeal to the imperious need for Epidemiology to restate its commitment to Public Health and "(re)formulate its utopian emancipatory project". It does no harm to dream!

There is a paper written by a Professor from the University of Havana, Cuba, addressing two of the most critical issues in a unique context: a third world country, which, with political will, an organized community, guaranteed funding, and qualified human resources, has succeeded in establishing the principle of universal and equal access. Is the Cuban health system epidemiologically oriented? Is there a 'Cuban School of Epidemiology'? It adopts as a point of reference the Seminar Trends and Prospects in Epidemiology, sponsored by the Pan-American Health Organization, in Buenos Aires, in 1983. It admits that there is, after all, a 'certain emptiness' between the theoretical argumentation and the practice of epidemiology in the Cuban Health System.

Three papers deal with issues associated with social inequality. Two of them analyze the differences in the distribution of deaths in the city of São Paulo. Both take advantage of the existing information systems to approach social-spatial inequalities: among adults in one case, and among adolescents and young adults in the other. They work with violence, particularly homicides, a typical feature of all large cities in the world, but exacerbated in the largest Brazilian city. One of them talks about non-transmissible chronic diseases. Both of them, with different methodologies, reveal the socially and economically determined nature of the causes of death. It is the poor who die in greater number in both studies, as they do everywhere. One of these studies has been authored by teachers from the Faculty of Medicine of the Santa Casa of São Paulo, and the other by a teacher from the Faculty of Medical Sciences of UNICAMP and by an epidemiologist from the Death Recording System of the city of São Paulo, Pro-AIM. The third study in this group has been conducted in São Luís by teachers of the Federal University of Maranhão, and one from the Faculty of Medicine in Ribeirão Preto of the University of São Paulo (USP) . It discusses factors related to out-patient care for children under five years of age, from several social brackets, as defined by variables usually used in epidemiological studies, particularly parents' education. The surprising conclusion that public out-patient care has lessened the differences in access to out-patient care contrasts with the persistence of inequality in inpatient care. As a possible explanation, they suggest the differences in quality and in resolutivity in the facilities that serve different brackets.

Another paper has been written by teachers and professionals from universities and institutions from North America. One of them is a teacher at the University of Montreal in Canada. The other is a teacher at the University of Pittsbourgh, and the third works for a computing company in Florida. They report their experience with a proposal for wide dissemination of epidemiological knowledge as a means to ensure 'public health for all', particularly in developing countries. They have worked with three key processes: disseminating the modern methods and techniques to measure diseases, by building and developing discussion lists; discussing themes related to these advances in virtual seminars; supporting the lists with an internet page.

Last but not least, there are two papers dealing with issues related to support techniques to epidemiological surveys. One, by teachers of the Institute of Social Medicine of the State University of Rio de Janeiro (UERJ) and professionals from the Instituto Fernandes Figueira (part of FIOCRUZ, Rio de Janeiro), talks about a practical method for training anthropologists in measuring skin folds, considering agreement between technicians. It strives to produce reliable information on fat amounts and distribution in the body of individuals who take part in epidemiological surveys. The other one, by a teacher of the Faculty of Public Health, USP, and by a professional from DataSUS, of the Ministry of Health, introduces a microcomputer program as a tool to 'tabulate multiple causes of death'. It is based on the idea that the concept of main cause of death is limited as regards premature death prevention guidelines within the current death rate patterns: chronic degenerative diseases with multiple conditions associated. The new tabulator generates a matrix from which it is possible to extract more information from deaths.

We believe that the breadth and importance of the themes addressed, along with the diversity of institutional affiliation and geographical origin of the authors of the papers here published are proof of the vitality of the Journal. We hope it becomes an important reference in the editorial scenario of epidemiology at this turn of the millennium. It might even become an instrument of our presence in defining a new geography of knowledge in the world, as in the aptly-coined expression of the French authors when they discuss the issue of the dissemination of knowledge through virtual media. To that end, the input from the epidemiologists who have made an effort to contribute with their work, suggestions and criticism is enough.

The Editor

Publication Dates

• Publication in this collection
  07 July 2005
• Date of issue
  Aug 1999