Rejoinder

In this issue of EPIDEMIOLOGY, we propose the term “Accountable Health Advocate” (AHA) as “a model for the epidemiologist who specializes in knowledge synthesis, translation, and dissemination, in addition to knowledge generation.”1 The AHA model, like any other model, cannot provide a perfect representation of reality. At best, a model is a useful representation—in this case, one that may help to distill complex phenomena into measures that we can use to improve health. McKeown2 and Ness3 point out that our model of the AHA is far from perfect. We do not disagree. As McKeown describes, the practice of epidemiology is dynamic and multidimensional, and many epidemiologists do indeed practice both knowledge generation and knowledge translation to varying degrees. By highlighting the importance of accountable health advocacy, we wish to neither downplay the importance of the many initiatives cited by McKeown and Ness—from the Plain Writing Act to the Joint Policy Committee of the Societies of Epidemiology—nor suggest that these initiatives lack impact. Rather, as Ness argues, we hope that epidemiologists will expand these and other initiatives that allow us to “move from observation to intervention.” The question is not whether the model of epidemiologist as AHA is “right,” but whether reformulating the epidemiologist as AHA is useful to achieve the ultimate goal identified by Ness as the “attainment of better population health.” In defining population health, we believe the focus should be on human well being,4 not merely the advancement of knowledge. McKeown2 and Ness3 argue that our formulation of the AHA may paradoxically detract from the goal of improved human well being, by allowing “the rest of us”2 to “eschew [our] responsibility”3 to be accountable to society, to prioritize population health, and to actively engage with policymakers and opinion leaders. McKeown and Ness worry that, if we brand some epidemiologists with expertise in knowledge translation as AHAs, others with expertise in knowledge generation may brand themselves as “non-AHAs.” The concern is that such people would, as a result of the AHA model, become less accountable to society, less concerned with population health, and less engaged with decision makers. We do not believe this will happen. Rather, we see the AHA as analogous to the voluntary credentialing of public health graduates, initiated in 2008 as a method of “encouraging recognition of new public health graduates prepared with [a] broad vision of public health.”5,6 Some persons who decline to participate in the credentialing process do so not because they reject the importance of broad expertise in public health, but because the credentialing “square peg” does not fit their “round” professional vision. The success or failure of that initiative can only be measured over time as epidemiologists and society either recognize its value and adopt it more widely or allow it to fall by the wayside. Similarly, we propose the AHA model as a means to encourage epidemiologists who might wish to shift their professional focus more toward knowledge translation but lack the professional support (funding, publication, professional advancement) to do so. Over time, the AHA model will either be further developed and more widely adopted or (if there is no need for a new type of epidemiology) forgotten. We see the AHA model as particularly relevant to students and other trainees of epidemiology, whose professional paths are most malleable. We cannot expect students to fully grasp the nuances of the spectrum of epidemiologic practice before they enter the workforce; a simple conceptual framework can be useful as trainees consider the professional options available to them. For students who plan to pursue methodologically oriented academic training (eg, PhD rather than DrPH) but do not wish to fashion themselves primarily as knowledge generators, the AHA model may provide a roadmap. As Ness3 points out, complacency is the one thing we cannot afford in pursuit of a brand of epidemiology that more universally approaches the AHA ideal. The desire to improve health is an urgent one, and we need alternatives to the status quo. The AHA model does not capture the full scope of epidemiologic work, nor will it fit every epidemiologist’s professional vision. However, we hope that there will be epidemiologists (including trainees) to whom this model speaks, and who will find incentives to shape their practice in the direction of more knowledge translation and ultimately improved human health. Despite being imperfect, we hope the AHA model might ultimately prove useful.

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