My field epi training was the best professional experience of my life; however, towards the end of it I found myself often getting frustrated. Why? Because when presenting results of our research/projects we were continually asked "So what is your public health recommendation?"1/

Which seems a fair thing to say, but I always thought "How can I know what the public health recommendation is? All I've found is that doing X raises the risk of Y by a factor of Z. I don't know why people do X,how important it is to them, how hard it would be to stop doing it.2/

I don't know how people would weigh up the risk of Y versus the risk of any number of other things in their life, and how that would vary between different population groups. Would we even want to reduce the Z increase in risk if doing so causes other unintentional harms? 3/

These questions all interested me, so I continued to do a mixed methods PhD looking at emerging disease risks that integrated epi with social sciences/economics approaches, and then spent a while working in general public health looking at the wider determinants of health. 4/

But that's not the typical experience of many epidemiologists; many of whom are more interested in digging down deeper into the disciplinary specifics of epidemiology - and that's a really good thing, because we need those people. 5/

However, it does mean that when epidemiologists are asked the question "What is your public health recommendation?", many may not be thinking much wider than "If X raises the risk of Y by a factor of Z, the recommendation is to stop doing X." 6/

That's no criticism - we're all a product of our training and experiences.But I guess it's a plea to those people who have had wider public health training to speak out if they see potential pitfalls in a proposed approach.They won't necessarily have been fully thought through.7/

Every control measure has trade offs, and groups who will be worse affected. As we move from the emergency phase to a new phase where severe Covid can essentially be considered a vaccine preventable disease, 8/

now more than ever we need interdiscplinary, particpatory, honest and nuanced discussions about where we go from here. There have been enough inequities embedded in the response already. We should not forget that health is so much wider than the absence of infectious disease./end