3 - Disease Patterns and Assumptions: Unpacking Variables

Summary

Dr. Donald M. Berwick, a Boston pediatrician, said recently, “Tell me someone's race. Tell me their income. And tell me whether they smoke. The answers to those three questions will tell me more about their longevity and health status than any other questions I could possibly ask.”

(Kilborn 1998:A16)

Dime cómo mueres y te diré quién eres.

(Tell me how you die and I will tell you who you are.)

(Paz 1993:59)

A pediatrician predicts health status and lifespan from aspects of North American social status and identity; a writer divines identity from manner of death. These opposite positions are actually based on the same premise: that selfhood and mortality are intertwined. Both claims rest on the assumption that there are systematic connections between how people live and how they die.

Of course, any pattern of relationships between causes and outcomes is based on an underlying set of assumptions, because assumptions drive the choice of measures that allow the pattern to become visible. The choice of what variables to measure both directs and confines attention. As one researcher put it, “We will consistently fail to observe what we do not seek to find” (Burrage 1987). This chapter explores how different health-related disciplines define and employ a few key concepts: person, place, and time.