Introduction to Epidemiology

2021
 What is Public Health?
A multidisciplinary field whose goal is to
promote the health of the population through
organized community efforts
 What is Public Health? Cont…
Public health focuses on:
-Preventing disease
-Prolonging life
-Improving the quality of life
-Eliminating health inequalities
-Organizing community to promote active
participation
 Core functions of Public Health
1) Assessment
Identifying health needs by conducting surveillance
and specific studies
2) Leadership
Designing appropriate interventions and mobilizing
resources and social action…
3) Provision of services
Assuring availability of quality & comprehensive
health services through accessible outlets
 What is Epidemiology?
Epidemiology is the study of the frequency,
distribution and determinants of diseases and
other health related states or events in
specified populations, and the application of
this study to the promotion of health, and to
the prevention and control of health
problems.
 Broad Categories of Epidemiology
1) Descriptive Epidemiology
Defines the amount and distribution of health
problems in relation to place, person, and
time(answer how many, where, who, and when
questions)
2) Analytic Epidemiology
Involves explicit comparison of groups of
individuals to identify determinants of health
and diseases(answer what, why and how
questions)
 Frequency
• Frequency refers to quantifying how often a
disease or other event arises in a population
• This shows that epidemiology is mainly a
quantitative science.
• Frequency of diseases is measured by different
morbidity and mortality rates.
 Distribution
• Distribution refers to:
o the geographical distribution of diseases (Place)
o the distribution in time, and
o distribution by type of persons affected (Person).
• Descriptive Epidemiology is concerned with the
frequency and distribution of diseases by time,
person and place.
• Descriptive Epidemiology asks the questions:
What? how many? Where? When?
 Determinant
• Determinants are factors which determine
whether or not a person will get a disease.
• Analytic Epidemiology deals with the causes/
determinants of diseases.
• Analytic Epidemiology asks the questions:
how? (Mechanism) : Mode of transmission
Why? (Cause):
-Genetic Vs environmental
-Social & cultural condition etc…
 Fundamental Epidemiological
Assumptions
Two basic assumptions:
1) Non random distribution of diseases
the distribution of disease in human
population is not random or by chance
2) Human diseases have causal and
preventive factors that can be identified
through systematic investigations of different
populations.
 Features of Epidemiology
• Studies are conducted on human population
• Examines patterns of events in groups of people
• Can establish cause-effect relationship without
the knowledge of biologic mechanism
• Covers a wide range of conditions
-from infectious to non-infectious
-From simple survey to complex drug trials
 Applications of Epidemiology
• Elucidation of the natural history of disease
• Description of the health status of the population
• Establishing the determinants/causation of disease
• Evaluation of intervention
• Supply information for decision:
-Individual: behavioral changes e.g smoking, sexual
-Public Health: planning interventions, priority setting,
resource allocation, evaluating the effectiveness of
intervention
 Using Epidemiology
for Public Health
Epidemiology and biostatics are essential tools
of public health.
 The iceberg phenomenon-
routine information comes mainly from people who attend the health
services

Proper and unbiased assessment of health conditions is important for good

public health practice!!
What is this?
It is important to see the full
picture!!
Patient diagnosis and community
diagnosis

Established methods must be used in

both!!
Understanding the Population (the denominator):

What is the composition?

What are the health needs?
What are the potential health threats?
 Key focuses for Epidemiological
studies
• Quantitative (rather than qualitative)
• Observational (rather than experimental)
 Key aspects of Epidemiology
“I often say that when you can measure
• Measurement what you are speaking about, and
express it in numbers, you know
something about it; but when you
cannot express it in numbers, your
knowledge is of a meager and
unsatisfactory kind’’
Lord Kelvin (Kenneth Rothman, Modern
Perspectives in Epidemiology, 1 ed.
Boston, Little Brown, 1986, pg 23)
 Trends in Epidemiology

Infectious diseases

Emerging: HIV/AIDS Improved SES

Re-emerging: TB, Malaria Improved control
activities

Non-infectious diseases
 History of Epidemiology
• Although epidemiological thinking has been
traced to the time of Hippocrates, who lived
around 5th century B.C., the discipline did not
flourish until the 1940s.
• Hippocrates displayed an extraordinary
awareness of the impact of environment and
behavior on personal well–being.
• Hippocrates therefore identified forces that
epidemiologists today recognize as major
determinants of human health.
 History of Epidemiology cont…
John Graunt (1620 – 1674).
• He noted that biological phenomena, such as births and
deaths, varied in predictable and regular ways.
• His research laid the groundwork for the disciplines of both
epidemiology and demography.
• He observed that male births consistently outnumbered
female births.
• Graunt also noted a relatively higher urban than rural death
rate and seasonal variation in mortality rates.
• His work is summarized in the “Natural and Political
Observations…. Upon the Bills of Mortality”, which was first
published in England in 1662.
 History of Epidemiology cont…
• In 1747, Lind used an experimental approach
to prove the cause of scurvy by showing it
could be treated effectively with fresh fruit.
• In 1839, William Farr established the tradition
of application of vital statistical data for the
evaluation of health problems.
 History of Epidemiology cont…
• In 1849, John Snow formulated and tested a
hypothesis concerning the origin of an
epidemic of cholera in London.
• Snow postulated that cholera was transmitted
by contaminated water.
 Evolution in Epidemiology

Multi-level causality (21st Century): focus on

risk-factors as well as causal pathways at the societal level and with
pathogenesis at the molecular level.

Chronic disease era (Modern

Epidemiology): focus on risk-factor at individual level

Germ theory: infectious disease era

Miasma theory: focus on environment; the theory

that all disease was due to bad air – contaminations (miasma)
 Epidemiology Fields
• Surveillance
• Descriptive Epidemiology
• Microbial/ Infectious Epidemiology
• “Risk factor” Epidemiology
• Clinical Epidemiology
• Social Epidemiology
 Epidemiology Fields cont…
• Molecular Epidemiology
• Genetic Epidemiology
• Entrepreneurial Epidemiology –
• Global Epidemiology
 Exercise
• Q1. What is Epidemiology?
• Q2. Who are some of the scientists who shaped
epidemiologic thought? Discuss their contribution
• Q3. Discuss How John Snow Assessed cholera
epidemic in London in the mid-19th century(1854)
• Q4. Why do we study Epidemiology?
• Q5. what are the special fields of epidemiology?