Commentary: Culture in epidemiology—the 800 pound gorilla?

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Abstract
The paper by Eckersley1 in this issue of the International Journal of Epidemiology is important in several respects. It represents a rare attempt to deal with a complex subject that has traditionally stood outside what Thomas Kuhn2 would call ‘normal science’ in epidemiology. It surveys a vast body of evidence, concluding, in response to the question posed by the title, that yes, modern Western culture is a health hazard. The author concedes that his core argument is based on evidence that is ‘indirect and circumstantial.’ Rather than comment on the substance of his main aim, my interest is in the more general question of why culture has been so sparsely examined. Eckersley's paper is likely to stimulate discussion and controversy. Any discussion of culture is strikingly unorthodox and hampered by weak evidence. It is especially significant that culture has (Marmot and Wilkinson's idea of a ‘culture of inequality’ notwithstanding) been largely ignored or denuded of its essential meaning in contemporary discourse surrounding determinants of population health. In this commentary, I address two issues: (i) what is culture, and (ii) why is it so consistently off the radar screen. In so doing, I will use several analogies to physics.

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