Hills Criteria of Causation


Hills Criteria of Causation outlines the minimal conditions needed to establish a causal relationship between two items.  These criteria were originally presented by Austin Bradford Hill (1897-1991), a British medical statistician, as a way of determining the causal link between a specific factor (e.g., cigarette smoking) and a disease (such as emphysema or lung cancer).  Hill's Criteria form the basis of modern epidemiological research, which attempts to establish scientifically valid causal connections between potential disease agents and the many diseases that afflict humankind.  While the criteria established by Hill (and elaborated by others) were developed as a research tool in the medical sciences, they are equally applicable to sociology, anthropology and other social sciences, which attempt to establish causal relationships among social phenomena.  Indeed, the principles set forth by Hill form the basis of evaluation used in all modern scientific research.  While it is quite easy to claim that agent "A" (e.g., smoking) causes disease "B" (lung cancer), it is quite another matter to establish a meaningful, statistically valid connection between the two phenomena.  It is just as necessary to ask if the claims made within the social and behavioral sciences live up to Hill's Criteria as it is to ask the question in epidemiology (which is also a social and behavioral science).  While it is quite easy to claim that population growth causes poverty or that globalization causes underdevelopment in Third World countries, it is quite another thing to demonstrate scientifically that such causal relationships, in fact, exist.  Hill's Criteria simply provides an additional valuable measure by which to evaluate the many theories and explanations proposed within the social sciences.


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Hill's Criteria



Hills Criteria* are presented here as they have been applied in epidemiological research, followed by examples which illustrate how they would be applied to research in the social and behavioral sciences.





1.     Temporal Relationship:                 

Exposure always precedes the outcome.  If factor "A" is believed to cause a disease,  then it is clear that factor "A" must necessarily always precede the occurrence of the disease. This is the only absolutely essential criterion.  This criterion negates the validity of all functional explanations used in the social sciences, including the functionalist explanations that dominated British social anthropology for so many years and the ecological functionalism that pervades much American cultural ecology.


2.     Strength:

This is defined by the size of the association as measured by appropriate statistical tests.  The stronger the association, the more likely it is that the relation of "A" to "B" is causal.  For example, the more highly correlated hypertension is with a high sodium diet, the stronger is the relation between sodium and hypertension.  Similarly, the higher the correlation between patrilocal residence and the practice of male circumcision, the stronger is the relation between the two social practices.


3.       Dose-Response Relationship:

An increasing amount of exposure increases the risk.  If a dose-response relationship is present, it is strong evidence for a causal relationship.  However, as with specificity (see below), the absence of a dose-response relationship does not rule out a causal relationship.  A threshold may exist above which a relationship may develop.  At the same time, if a specific factor is the cause of a disease, the incidence of the disease should decline when exposure to the factor is reduced or eliminated.  An anthropological example of this would be the relationship between population growth and agricultural intensification.  If population growth is a cause of agricultural intensification, then an increase in the size of a population within a given area should result in a commensurate increase in the amount of energy and resources invested in agricultural production.  Conversely, when a population decrease occurs, we should see a commensurate reduction in the investment of energy and resources per acre.  This is precisely what happened in Europe before and after the Black Plague.  The same analogy can be applied to global temperatures.  If increasing levels of CO2 in the atmosphere causes increasing global temperatures, then "other things being equal", we should see both a commensurate increase and a commensurate decrease in global temperatures following an increase or decrease respectively in CO2 levels in the atmosphere.


4.      Consistency:

The association is consistent when results are replicated in studies in different settings using different methods.  That is, if a relationship is causal, we would expect to find it consistently in different studies and among different populations.  This is why numerous experiments have to be done before meaningful statements can be made about the causal relationship between two or more factors.  For example, it required thousands of highly technical studies of the relationship between cigarette smoking and cancer before a definitive conclusion could be made that cigarette smoking increases the risk of (but does not cause) cancer.  Similarly, it would require numerous studies of the difference between male and female performance of specific behaviors by a number of different researchers and under a variety of different circumstances before a conclusion could be made regarding whether a gender difference exists in the performance of such behaviors.


5.       Plausibility:

The association agrees with currently accepted understanding of pathological processes.  In other words, there needs to be some theoretical basis for positing an association between a vector and disease, or one social phenomenon and another.  One may, by chance, discover a correlation between the price of bananas and the election of dog catchers in a particular community, but there is not likely to be any logical connection between the two phenomena.  On the other hand, the discovery of a correlation between population growth and the incidence of warfare among Yanomamo villages would fit well with ecological theories of conflict under conditions of increasing competition over resources.  At the same time, research that disagrees with established theory is not necessarily false; it may, in fact, force a reconsideration of accepted beliefs and principles.


6.       Consideration of Alternate Explanations:

In judging whether a reported association is causal, it is necessary to determine the extent to which researchers have taken other possible explanations into account and have effectively ruled out such alternate explanations.  In other words, it is always necessary to consider multiple hypotheses before making conclusions about the causal relationship between any two items under investigation. 


7.      Experiment:     

The condition can be altered (prevented or ameliorated) by an appropriate experimental regimen. 


8.      Specificity:       

This is established when a single putative cause produces a specific effect.  This is considered by some to be the weakest of all the criteria.  The diseases attributed to cigarette smoking, for example, do not meet this criteria.  When specificity of an association is found, it provides additional support for a causal relationship.  However, absence of specificity in no way negates a causal relationship.  Because outcomes (be they the spread of a disease, the incidence of a specific human social behavior or changes in global temperature) are likely to have multiple factors influencing them, it is highly unlikely that we will find a one-to-one cause-effect relationship between two phenomena.  Causality is most often multiple.  Therefore, it is necessary to examine specific causal relationships within a larger systemic perspective.


9.      Coherence:

The association should be compatible with existing theory and knowledge.  In other words, it is necessary to evaluate claims of causality within the context of the current state of knowledge within a given field and in related fields.  What do we have to sacrifice about what we currently know in order to accept a particular claim of causality.  What, for example, do we have to reject regarding our current knowledge in geography, physics, biology  and anthropology in order to accept the Creationist claim that the world was created as described in the Bible a few thousand years ago? Similarly, how consistent are racist and sexist theories of intelligence with our current understanding of how genes work and how they are inherited from one generation to the next?  However, as with the issue of plausibility, research that disagrees with established theory and knowledge are not automatically false.  They may, in fact, force a reconsideration of accepted beliefs and principles.  All currently accepted theories, including Evolution, Relativity and non-Malthusian population ecology, were at one time new ideas that challenged orthodoxy.  Thomas Kuhn has referred to such changes in accepted theories as "Paradigm Shifts"


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                    *Austin Bradford Hill, “The Environment and Disease: Association or Causation?,”
Proceedings of the Royal Society of Medicine, 58 (1965): 295-300.



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Of Related Interest:





Science and Anthropology







Aristotelian vs. Galilean Forms of Explanation:

Implications for Explaining Human Behavior






Why Cultural Anthropology Students Should Learn

Quantitative Research Methods







A Temporary Convenience

A Critical Review of the Species Concept







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