From the local to the global, from the environment to the individual

The chapter contrasts two medical paradigms in epidemiology: the pre-bacteriological public hygiene of the late nineteenth century and the contemporary post-Second World War risk-factor epidemiology, and discusses the way they frame environment and public health. As examples serve two significant Finnish epidemiological studies focusing on a specific locality, Konrad Relander’s project to chart the sanitary conditions of his medical district in the 1890s and the North Karelia Project to prevent coronary heart disease in a socioeconomically disadvantaged area in the 1970s. Building on the notion of the performativity of scientific research methods and approaches, the chapter identifies a shift from a holistic approach steeped in localism to a more global, targeted and individualized approach. In the former, the environment signified a generalized milieu relative to the specific site and health problem under consideration. In the latter, the specifics of each locality emerge as the result of abstract calculations, which concern a limited number of clearly demarcated factors that can be foregrounded on demand and are easily transferable from one context to another. The enumerative practices at the heart of the current paradigm support a liberal conception of modern society, configuring it as a global space in which individual agents freely aggregate.