What Is Epidemiology

WHAT IS EPIDEMIOLOGY?
Epidemiology was originally defined as the

scientific study of epidemics.
The word epidemiology” derives from

,,epidemic”, which translated from the Greek
means “upon the people”.
This word reminds us that the first concern of

the epidemiologists was to investigate,
control and prevent epidemics.
Epidemiology - what is it?
•epi - upon
•demos - people or population
•logos – science
•‘That which befalls the population’
•The study of the distribution and determinants of
disease frequency in human populations
(MacMahon and Pugh, 1970)
Epidemiology - what is it?
•Core science of public health

•Branch of medicine dealing with transmission and
control of disease
•The study of:
•epidemics (somewhat dated!)
•the occurrence of illness
•factors controlling the presence or absence of a
disease or pathogen (bug)
•Epidemiology addresses health at the population
level
JOHN SNOW (1813‐1858)
History of epidemiology
¾Snow had previously hypothesized cholera
was transmitted via water.
¾ Two water companies in London
¾ One pulled water down stream from
sewage, one from up stream
¾ Deaths occurred around water pumps from
the downstream company
Snow on Cholera
Water Deaths From Death Rate
Supplier Population Cholera
Southwark 167,654 844 5.0
& Vauxhall
Lambeth 19,133 18 0.9
Both 300,149 652 2.2
DEFINITION OF EPIDEMIOLOGY
Epidemiology is 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.
(from Last, Dictionary of Epidemiology)
•Study: surveillance, observation, hypothesis testing or
analytic research, experiment
•Distribution: analysis by time, place and class of persons
affected
•Determinants: all the physical, biological, social, cultural,
and behavioural factors that influence health
•Health‐related states and events: diseases, causes of
death, behaviour, and provision and use of health
services
•Specified populations: those with identifiable
characteristics such as precisely defined numbers
•Application to control: to promote, protect and restore
health
Epidemiologist’s checklist
•Define (verify) disease – what?
-Accuracy of diagnosis
•Describe historical trend of disease – when?
•Define extent of the problem – how much?
•Identify determinants of disease distribution – why?
•Formulate hypotheses about causation
– how?
•Determine modes of transmission
•Develop and evaluate interventions for control and
prevention
Epidemiology is a Population Science
•“Traditional” epidemiology starts at the population

level and the first step is to ascertain variations in
the occurrence of disease within and between
populations
•“Populations” include not only countries, but

geographical regions, demographic groups,
communities, extended families, etc
THE RELATIONSHIP BETWEEN
EPIDEMIOLOGY & CLINICAL MEDICINE
Populations lndividuals
Studies/ Assessments Diagnosis
Prevention Treatment
Evaluation Curing
Planning Caring
Basis of epidemiology
Disease, illness and ill-health are
not randomly distributed in a
population.
Determinants of disease
Health and
Disease
well-being
Determ inants
Host
Etiologic Agent
person,com m unity
Tim e
Environment
(setting)
Agent
•A necessary ingredient in the
production of disease
•May be infectious (virus, bacteria) or
noninfectious (chemical, radiation)
•May be a single agent or a complex of
agents
Host
•The biological and behavioral qualities

of an individual
•Factors can influence the exposure to

disease causing agents and the
occurrence of disease after exposure
Environment
•External factors that affect the

likelihood of disease occurrence
• Examples: weather, population density,

geography
Epidemiology – Aims
discover which are the key determinants and to define the
natural history of diseases (the analytic study);
assess the efficacy, effectiveness and efficiency of

methods to prevent, cure and alleviate disease (the
intervention or experimental study);
describe the distribution of health-related states and

determinants in the population (descriptive study);
evaluate the process and outcome of services provided for

these purposes (health services research)
Applications of epidemiology
1. Describe the health of a population

• measure the burden of disease
•detect trends in incidence and prevalence
•track changes in the character of a disease
•define groups at special risk
•describe functional ability or impairment
Descriptive Study: “… to describe the existing

distribution of variables, without regard to causal
hypotheses” Last.JM 1995
eg. community health surveys, records from disease
registries
2. Describe the natural history of

disease
•define normal range of expected values
•complete the clinical picture; predisposing
conditions, syndromes
•describe frequency and course of pre-symptomatic
disease
•permit prediction (prognosis) of clinical progress
3. Discover the determinants of disease
•may be obvious or obscure
•multiple determinants - genetic, environmental,
infectious
•distinguish between associations and determinants
Analytic Study: “to examine associations,
commonly putative or hypothesized causal
relationships…. identifying or measuring effects of
risk factors…” Last.JM 1995
4. Control / prevent disease (primary prevention)
•remove the primary agent or determinant
•protect people from the agent - environmental control
(hygiene)
•enhance host resistance (protective mechanisms,
immunity)
•modify human behaviour to avoid risks or promote
healthy actions
secondary and tertiary prevention
•efficacy of treatments and other interventions
Intervention study: “involving intentional change in
some aspect of the status of subjects, eg. introduction
of a preventive or therapeutic regimen; … usually an
experiment” Last.JM 1995
5. Planning and evaluating health services
planning:
•estimate need and demand
•identify major avoidable hazards
•determine supply of resources
evaluating:
•measure delivery and utilisation
•measure output of services provided
•evaluate effectiveness and efficiency of services (outcomes)
Health services research:

“integration of epidemiologic, sociological, economic, and
other analytic sciences in the study of health services….
concerned with the relationship between needs, demand,
supply, use, and outcomes … aim is evaluation.” Last.JM 1995
USES OF EPIDEMIOLOGY(Morris)
•Historical study: Is community health getting better or

worse
•Community diagnosis: What actual and potential
health problems are there
•Working of health services:
Efficacy
Effectiveness
Efficiency
•Individual risks and chances:
Actuarial risks
Health hazards appraisal
USES OF EPIDEMIOLOGY(Morris)
•Completing the clinical picture: Different

presentation of a disease
•Identification of syndromes: “Lumping and
splitting”
•Search for a causes: Case control and cohort
studies
•Evaluation of presenting symptoms and
signs
•Clinical decision analysis
Minamata disease is due to a
typical Industrial pollution incident
caused by pollutant generated in
industrial activities.
The disease was officially recognized on
May 1, 1956. The characteristics of
Minamata disease are summarized as
follows :
Rheumatic Fever
Rheumatic fever used to be a fairly common disease
amongst children in developed countries until about
the middle of the 20th century. It was a major cause
of death in children until 1960 and a common cause
of chronic structural heart disease in developed
countries. In developing countries it still remains a
major cause of death and heart disease.
Smoking and asbestos interact
creating exceedingly high lung cancer
rates for workers who both smoke and
are exposed to asbestos dust
“Iceberg” concept of infectious disease
in populations
DEATH
CLINICAL
DISEASE SEVERE
DISEASE
SUB CLINICAL MILD ILLNESS

DISEASE
INFECTION WITHOUT
CLINICAL ILLNESS
EXPOSURE WITHOUT INFECTION

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WHAT IS EPIDEMIOLOGY?

Epidemiology was originally defined as the

The word epidemiology” derives from

This word reminds us that the first concern of

•Core science of public health

•“Traditional” epidemiology starts at the population

•“Populations” include not only countries, but

Studies/ Assessments Diagnosis

•The biological and behavioral qualities

•Factors can influence the exposure to

•External factors that affect the

• Examples: weather, population density,

assess the efficacy, effectiveness and efficiency of

describe the distribution of health-related states and

evaluate the process and outcome of services provided for

1. Describe the health of a population

Descriptive Study: “… to describe the existing

2. Describe the natural history of

Health services research:

•Historical study: Is community health getting better or

•Completing the clinical picture: Different

SUB CLINICAL MILD ILLNESS

EXPOSURE WITHOUT INFECTION

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assess the efficacy, effectiveness and efficiency of

describe the distribution of health-related states and

evaluate the process and outcome of services provided for