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Zena Stein, Mervyn Susser and epidemiology: observation, causation and action.

highlight the contributions of two pioneering self-taught epidemiologists, Zena Stein and Mervyn Susser. Their joint paper ‘Civilization and Peptic Ulcer‘, originally published in the Lancet in 1962, appears as one of our series of reprints of important epidemiological papers, along with several commentaries. These include a reflection, 40 years on, by the original authors. A companion series of papers originated in an international symposium held by the Mailman School of Public Health of Columbia University, New York, to mark the 80th years of both Zena and Mervyn. The event ended in a manner perhaps unusual for such an occasion: it was closed by Ahmed Kathrada, a friend of Zena and Mervyn, who was incarcerated with Nelson Mandela on Robben Island during the struggle against apartheid in South Africa. He read out a letter from Nelson Mandela to mark the occasion (Box 1). The interlocked careers of Zena and Mervyn have been described elsewhere,1 as well as in the present collection.2 The range of their work in epidemiology and public health can be appreciated from the bibliographies which we have made available on the web (http://www.ije.oupjournals.org). Therefore here we will just give a brief account of their continuing contributions to epidemiology and public health. For both Zena and Mervyn their work in epidemiology and public health started in South Africa and has continued to have a strong attachment to that country. Their initial driving motivation was to contribute to the health and medical care of ‘non-whites’ in apartheid South Africa in the early 1950s. This majority population was virtually ignored in medical curricula at the time, so the task meant striking out with a small group of colleagues to direct a ‘township’ clinic, in Alexandra, Johannesburg. Although they began with no knowledge of epidemiology, the effort naturally led them to carry out one of the first studies of community health in the developing world, published in the Lancet in 1955 as ‘Medical Care in an African Township’.3 It was during this period that they developed ties with Ahmed Kathrada, Walter Sisulu, Joe Slovo and Nelson Mandela, among many others, in the anti-apartheid movement. The efforts made by them and others such as Sidney Kark4 (a mentor) to address the health of the community as a whole is of more than historic importance; if anything, it may be even more germane today than it was then. Even as the AIDS epidemic brings catastrophe to South Africa—as outlined in the present collection5—medical training in that country still fails to give any centrality to the care and prevention of HIV/AIDS. Zena and Mervyn are once again in the centre of the melee, supporting those in South Africa who want to bring about change. Due to political difficulties in South Africa in 1955, they settled in England for the next decade. Taking positions at Manchester University, they took up research on what are now called developmental disabilities. Their many early contributions to this field are exemplified by studies showing the influence © International Epidemiological Association 2002 Printed in Great Britain