Epidemiology

Overview of Course and

Introduction
Jan/19/2015
 Overview
• Introduction and overview of the course
– See teaching schedule for discussion
• [Link]
7oM_6I

• This 20 minute video provides a good

introduction/overview of what
Epidemiology is about. You can view it
as often as you want.
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Topics to be covered -19/Jan
• Definition,
• History of epidemiology &
developments in modern
epidemiology
– Epidemiological era and paradigms - Sanitary
infectious and chronic
• Core epi functions
– surveillance, field investigation, analytic studies,
evaluation and policy development
• Uses and Goals of Epidemiology

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 Objectives
1. Define Epidemiology
2. Summarize the historical
developments of epidemiology
3. Describe some of the key uses
4. Describe some of the key
functions
5. Describe the key goals
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 Definition -Epidemiology
• Greek word
• Epi - on or upon
• Demos - people
• Logos - the study of

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 Definition -Epidemiology
• Greek word
• The study of the distribution and
determinants of health-related
states or events in specified
populations, and the application of
this study to the control of health
problems (Last, 2001)

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 Definition -Epidemiology
• The study –
– a scientific discipline with sound methods of
scientific inquiry
– Data driven
– Relies on systematic and unbiased approach
to the collection, analysis and interpretation of
data
– Described as the basic science of public
health
– A quantitative discipline – statistics, sound
research methods
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 Definition -Epidemiology
• The distribution –
– Concerned with frequency and patterns of
health events
– Frequency
• number of health events
• but also relationship to the size of the population
– Pattern
• The occurrence of health related events by time
(annual, monthly, weekly, hrly etc) Time, Place and
• place (geographic variations) Person are used
• and person (age, sex, marital status, in DESCRIPTIVE
EPIDEMIOLOGY
SES,behaviours, etc)
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 Definition -Epidemiology
• The Determinants–
– A determinant is any factor (an event or
characteristic) that brings about a change in a
health condition
– Epi is used to search for determinants
– Disease occur when the right accumulation of
factors/determinants exist in a individual.
To search for determinants,
Why/How of events are
used in ANALYTIC
EPIDEMIOLOGY

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 Definition -Epidemiology
• The Health related states or events
– Originally, Epidemiology was focused solely
on communicable diseases
– By the mid 20th C, expanded to include non-
communicable diseases

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 Definition -Epidemiology
• The Specified populations
– Epidemiologists are concerned with the health
of the people- community, populations,
school, while clinicians are concerned with
the individual.
– Therefore different responsibilities

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 Definition -Epidemiology
• Application
– Not just the study of… but involves applying
the knowledge through the studies conducted
– Uses the descriptive and analytic
epidemiology to ‘diagnose’ the health of the
community and propose practical and
acceptable public health treatment to prevent
diseases in the community

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 History of Epidemiology
• Hippocrates (460-377 BC),
– who was the first to record human illness as
being affected by external and internal
environmental factors.
• John Graunt – 1662- first major
modern figure in epidemiology
– tabulated births, deaths, and mortality rates in
London during the late 1600s and attempted to
statistically examine the effects of the Plague.
• James Lind (1747 –
– Scurvy related to diet among sailors

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 History of Epidemiology
• William Farr (1807-1883) founded medical
statistics
– and studied cholera. Farr had identified that proximity and
use of contaminated water was responsible for the spread
of cholera amongst various population groups in 1850s
London.

• John Snow (1813-1858), a contemporary of

Farr,
– furthered epidemiology. By also studying the relationship
between cholera and contaminated water in various areas
of London, Snow disproved the miasmic theory of choleric
transmission (Harkness, 1995).

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 History of Epidemiology
• Florence Nightingale (1820-1910) is known as the
founder of modern nursing
– Her contributions to epidemiology include identifying
environmental factors that could lead to the spread of disease
and using statistics to calculate disease rates. Nightingale's
statistical gathering of data during her stay at Scutari, during the
Crimean War, enabled her to have sanitary reforms
implemented. (Harkness, 1995).
• 19th & 20th C
– Application of Epidemiology
– Extended to non-infectious epidemiology
– Increased # of research methods and study of health outcomes
– Doll and Hill – link lung cancer to smoking
– The Framingham heart study – (longitudinal)
– 1980s – injuries and violence
– 1990s – molecular and genetic epidemiology

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 Epidemiological Eras - Three
Eras
• Sanitary Era – (miasmic paradigm) -early to
middle 19th C
– promoted the "miasmic" theory that disease was
transmitted through the air, soil, and other elements. This
era commenced during the 17th century and reached its
apex by the middle of the 18th century. Its distant origins
were the reaction to the various plagues that had scarred
Europe, such as the Black Death. Miasmic epidemiology
believed that disease was transmitted via the environment,
and carried by the air, dust, or odors. Disease prevention
and treatment included the use of strong sanitary
measures, such as the advocacy of clean water supplies,
fresh ventilation, and drainage, as well as the limitation of
waste and contaminated water supply

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 Epidemiological Eras
• Infectious Era (germ paradigm) - mid 1900s
to 1945
– advocated a theory of "germs," suggesting that one given
agent was related to one specific disease. This was a
change in direction; not so much from the advancements
achieved through the sanitary movement, but it was a
realization, through laboratory science, that many diseases
were caused through infection. It was during this era, that
public health nursing was born. MacDonald (2004) states
that, although nursing still maintained the strong social
conscience of the miasmic movement, gradually both
nursing and medicine put a strict emphasis on single
causative agents. From this, the disease prevention
approach was born, which excluded social policy and
health promotion.

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 Epidemiological Eras
• Chronic Era (risk factor paradigm)
– The chronic disease era suggested a theory of
influencing factors on the pathogenesis of a
disease, including the risk and protective factors,
and developed the new theory of a "web of
causation." A web of causation is a complex
interconnection of various proximate and remote
factors that both promote and protect against
disease (Brownson & Petitti, 2006; MacDonald,
2004). With infectious disease declining after
World War II (WWII), much emphasis shifted to
the study of chronic disease, which was
becoming more prevalent.

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 Epidemiology -
Common Uses
1. Assessing the community’s
health
2. Making individual decisions
3. Completing the clinical picture
4. Searching for cause

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 Epidemiology -
Common Uses
1. Assessing the community’s health
– PH officials responsible for policy development
use epidemiologic info for making decisions.
– Descriptive epidemiology is done during
assessment – data on person place & time
– Questions
• Actual and potential problems
• Where they occur
• Which populations are at risks
• E.g. Used data to identify baseline and set health
goals

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 Epidemiology -
Common Uses
1. Assessing the community’s health
2. Making individual decisions
– Exercise, eating fruits and vegetables,
smoking, etc
– Decisions often based on risk assessments
carried out by epidemiologists
– Eg Epid. Identified risks associated with
HIV

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 Epidemiology -
Common Uses
1. Assessing the community’s health
2. Making individual decisions

3. Completing the clinical picture

– While Epid. rely on other health care prof
when investigating an outbreak, so the
physician rely on the Epid. to search for the
missing links in order to understand the
natural hx of a disease or to describe the
illness

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 Epidemiology -
Common Uses
1. Assessing the community’s health
2. Making individual decisions
3. Completing the clinical picture

4. Searching for cause

– Epid. are devoted to search for disease
causality. May to prove causality, but
provide enough information for effective
treatment and prevention

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 Core Functions
• 1. Public health surveillance
– The ongoing, systematic collection, analysis,
interpretation and dissemination of health
data to assist with PH decision making.

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 Core Functions
• 2. Field Investigation
– Often part of the surveillance activity is to
investigate – may just be a phone call or a
field investigation with many persons
coordinating their efforts to identify the cause
or describe an epidemic outbreak.

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 Core Functions
• 3. Analytic studies
– Analytic studies may use more rigorous
methods to identify causes, modes of
transmission
– Often used in combination with surveillance
and field investigations to meet the goals of
PH

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 Core Functions
• 4. Evaluation
– It is the process of determining, in a
systematic and objective way the relevance,
effectiveness, efficiency and impact of
activities with respect to established goals

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 Core Functions
• Policy Development
– …. and the application of this study to the
control of health problems
– Epid. who understand the problem are in a
unique position to make recommendations
and interventions

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 References
Gordis, L. (2009). Epidemiology. Philadelphia:
Saunders Elsevier.
US Department of Health & Human Services, Centers
for Disease Control and Prevention. (2012).
Principles of Epidemiology in Public Health
Practice: An introduction to applied epidemiology
and biostatistics. CDC, Atlanta Georgia.
[Link]/osels/scientific_edu/ss1978/SS1978.
pdf
Valanis, Barbara (1999). Epidemiology in nursing and
health care. Stamford, Connecticut: Appleton &
Lange.

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