On December 2022, I had the pleasure and honour to be invited to the presentation of the book Epidemiología cercana. La salud pública, la carne y el oxidado cuchillo del miedo (“Close Epidemiology. Public Health, Flesh and the Rusty Knife of Fear”), by Miquel Porta (1), held at the Ateneo de Madrid. I want to devote this editorial to this book for its relevant implications upon the turbulent times we are living, and for the importance of Epidemiology, which necessarily must be “close”, and of public health in its contribution to a better world.

The complexity inherent to the events we are facing (particularly present since the COVID-19 pandemic appeared), keeps challenging us permanently to incorporate a systemic view (referring to the interdependences and interactions of all the components, functions and effects of a system; these interactions will usually cause effects that go beyond the sum or multiplication of components or processes (2)). Therefore, analyses must go beyond the traditional epidemiological approach (more focused on addressing risk factors, and from a healthcare perspective), and this book gets us closer to an essential systemic approach. On the other hand, and no less important for the crucial scientific dissemination at the time of achieving impacts, a wide reading public will not remain indifferent to its ingenious, creative and metaphorical twenty-seven chapters. See when within the chapter “The Stowaways of Obesity” (“Los polizones de la obesidad”), the author connects masterfully the social determinants of health (3) with the risk to develop Type 2 diabetes through PCB 153, a contaminant polychlorinated biphenyl frequently found in fatty foods, which at high concentrations can increase up to six, eight, or more times the risk of this disease in people. Because this is not only about individual or family decisions at the time of eating some specific foods; and as Porta points out: “Which rate of diabetes induced by environmental contaminants seems acceptable to us?”.

Continuing with this systemic idea, in the chapter “Between football and glyphosate, there is a match” (“Entre el futbol y el glifosato, hay partido”), and regarding glyphosate (an herbicide still widely used) as carcinogen, the author states that “the decisions by international organizations are critical in order to regulate or not those products and processes which are almost completely outside the power of local authorities” and, of course, from the behaviour of citizens. And this is because solutions are not individual but collective: you cannot ask the fishmonger, “How is salmon today in terms of mercury?” (in the chapter “What doesn’t kill you makes you fat” (“Lo que no mata, engorda”)).

And in order to solve the challenging problems in the current world, the highest burden should not be upon citizens, but on the development of policies which will control better these problems, and even more, that will allow to prevent them. A close, understandable and accessible epidemiology should play a role here, to provide the keys for change from an approach of “Health in all policies” (4), or what has recently been called One Health (5), Planetary Health (6) or Planetary Wellbeing (7). Public health, nurtured by epidemiological knowledge, as Porta points out, should be present in industry, livestock, agriculture, and of course in economic authorities, “so often short-sighted towards the consequences of their policies on health, animals and the environment” (in the chapter “Epidemiology, pleasure, flesh, and the rusty knife of fear” (“La epidemiología, el placer, la carne y el oxidado cuchillo del miedo”)).

I would also like to highlight the reference to fear throughout the book, which in my opinion is another of the significant elements to reflect upon. The reason is that “frightening people” should not be a strategy for a healthier society, even though this has been systematically used during the still hot pandemic experience, even emphasizing some assumed benefits, and without noticing the damage and negative consequences which soon became evident and are still increasing, mostly in terms of mental health. As the author says, “Not causing fear, but informing, communicating, explaining, discussing, creating awareness, warning…” In my humble opinion, we still have plenty of work to do regarding this. And we should use the world of advertising, which is extraordinarily “creative, dynamic, and skilled to convince us” (in the chapter “Looking, seeing and appreciating what pays off” (“Mirar, ver y apreciar lo que nos sale más a cuenta”)); moreover, I would say in order to seduce us, not giving up the pleasure, the enjoyment of doing things to achieve better health. And here we also have the world of social networks, influencers who sometimes achieve more in one minute than many hours of teaching methodologies in a classroom, and I do not mean to belittle them in any way.

I would like to end up with some notes and considerations in the chapter “Conversation and dialogue on scientific knowledge” (“La conversación y el diálogo sobre el conocimiento científico”). As Porta says, those who order and decide are stakeholders and, therefore, it is inescapable and essential to take them into account, by asking “which knowledge we must transfer to those who hold power over structures and processes (economic, political, legal, industrial, cultural, environmental, educational, social)”. And I would highlight that they should be taken into account from the most germinal moment of knowledge generation, in connection with “A close epidemiology for an active citizenship” (the title of the presentation event for the book), which is the essence of Citizen Science (8), and which is closely linked to the recent proposal by the PAHO in its report “Just Societies: Health Equity and Dignified Lives” (9), where the natural environment, the earth and climatic change, as well as persistent colonialism and structural racism are incorporated as structural factors or drivers, alongside the governance models and human rights, in an intersectionality context (social and economic inequities, gender, sexual orientation, ethnicity, disability and migration).

This editorial must end here, due to the characteristics inherent to this document type, and it is completely insufficient to reflect everything that has impressed me regarding this magnificent book, and which can be discovered by the thoroughly enjoyable reading of its over three hundred pages. But I would like to end up with this lesson: that we need scientific knowledge, always temporary but also always valuable, to be used to undertake political actions which are really transformative, and which must be undoubtedly brave, originating from Politics with capital letters.