What is

epidemiology?

Dr AA Abubakar
Department of Community Medicine
ABU Zaria
adapted from
Raj Bhopal,
Public Health Sciences Section,
University of Edinburgh, UK
 What is epidemiology? Objectives
1/2
You should understand:
 The focus of epidemiology is on the
pattern of disease and ill-health in
the population
 Epidemiology combines elements of
clinical, biological, social and ecological
sciences.
 Epidemiology is dependent on clinical
practice and sciences to make a diagnosis,
the starting point of our work.
What is epidemiology?
Objectives 2/2
 The goal of epidemiology as a science
is to understand the causes of disease
variation and use this to improve the
health of populations and individuals.
 The goal of epidemiology as a practice
is preventing and controlling disease,
guiding health and health care policy
and planning, and improving health
care in individuals.
 Epidemiological variables should meet
the purposes of epidemiology.
 Epidemiology is based on theories
 Overview of Epidemiology 1/2
 Epidemiology is the science and practice
which describes and explains disease
patterns in populations, and puts this
knowledge to use to improve health

 The central paradigm of epidemiology is

that patterns of disease in populations
may be analysed systematically to
provide understanding of the causes and
control of disease
Overview of Epidemiology 2/2
 Epidemiology seeks out the differences
and similarities ('compare and
contrast') in the disease patterns of
populations to gain new knowledge
 Valid measurement of the frequency of
disease and factors which may
influence disease, and are therefore
potential explanations for the observed
patterns, is crucial to the
epidemiological goal
Epidemiology: definition and strategy
 The origin of the word epidemiology is
unknown but it is derived from the Greek
words meaning study upon populations
(epi = upon, demos = people, ology = study)
 Epidemiopathology (pathos is the Greek word
for suffering and disease) would be more
accurate but clumsy
 Epidemic was used by Hippocrates
 Last’s dictionary gives a detailed definition of
epidemiology that includes these words “The
study of the distribution and determinants of
health-related states or events in specified
populations, and the application of this study
to control of health problems”.
 Uses of Epidemiology
Currently epidemiology is seen as useful in:
 yielding understanding of what causes or
sustains disease in populations
 preventing and controlling disease in
populations
 guiding health and health care policy and
planning
 assisting in the management and care of
health and disease in individuals
 Epidemiology as a science

 What are the characteristics of a science?

 Name and differentiate between some
disciplines which are and are not sciences?
 Is public health a science?
 Is epidemiology a science?
 Is there some aspect of a science which
epidemiology does not fulfill?
 The scope of Epidemiology as a science
 Epidemiology is particularly relevant to medicine rather
than laboratory science, but the increasing
collaboration between geneticists and epidemiologists
is changing the balance
 Epidemiology is concerned with disease in populations.
Humans live in societies, where behaviour and attitudes
are shaped by interaction among people, which in turn
are governed by the conventions and laws.
Epidemiology is, therefore not only a bio-science but
also a social science.
 Populations exist in a physical environment which is a
dominant force in determining health. The study of life
in relation to the environment is ecology, so
epidemiology is, in addition, the science of the ecology
of disease.
 The science of epidemiology, therefore, combines
elements of biology, social sciences and ecology - a bio-
social-environmental science focusing on disease in
populations.
 The epidemiological
exposure variable

 What qualities should an exposure

variable have to make it worth pursuing in
epidemiology?

 How do the purposes and uses of

epidemiology help to assess the potential
value of a variable?
 Criteria for a good
epidemiological variable: age
 Impact on health in individuals and population
 Be measurable accurately
 Differentiate populations in their experience of
disease or health
 Differentiate populations in some underlying
characteristic relevant to health e.g. income,
childhood circumstance, hormonal status, genetic
inheritance, or behaviour relevant to health.
 Generate testable aetiological hypotheses,
and/or
help in developing health policy,
and/or
help plan and deliver health care
and/or
help prevent and control disease
Category of underlying
difference: example of sex
 Biological

 Co-existing diseases

 Behavioural

 Social

 Occupational

 Economic

 Health care
 Types of disease and reasoning
on sickness/disease X
 Genetic  Infections

 Congenital  Toxins

 Degenerative  Nutritional Deficiency

 Cancers  Immune disorders

 Injuries
 Epidemiological theory

 Can you discern any theories which have

guided this chapter so far?

 What general principles follow from these

theories?
 Epidemiological theories
 disease in populations is more than the sum
of the disease in individuals
 populations differ in their disease experience
 disease experiences within populations differ in
subgroups of the population
 disease variations can be described and their causes
explored by assessing whether exposure variables
are associated with disease patterns.
 knowledge about health and disease in human
populations can be applied to individuals and vice
versa.
 health policies and plans, and clinical care can be
enriched by understanding of disease patterns in
populations.
 Summary
 Populations, as with individuals, have unique patterns
of disease. Populations’ disease patterns derive from
differences in the type of individuals they comprise of,
in the mode of interaction of individuals, and in the
environment in which the population lives.
 The science of epidemiology, which straddles biology,
clinical medicine, social sciences and ecology, seeks
to describe, understand and utilise these patterns to
improve health.
 Epidemiology is useful in other ways too, including
preventing and controlling disease in populations and
guiding health and health care policy and planning.
 Epidemiology is both founded on, and contributes to,
theories of health and disease, though these are
seldom made explicit
 Modern epidemiology is becoming more than a
science; it is becoming a craft, vocation and
profession; a partner of public health, not just a
science of public health
Sickness X: examine the handout
(see last slide)
 What thoughts come into your mind about
the nature of the sickness?
 What kind of sickness/disease is it?
 What kind of sickness/disease is it not?
 What sort of factors could cause a sickness
such as this?
 Can you form a definition of this sickness X?
 If not, how would physicians make a
diagnosis? How could the number of cases of
the sickness be counted?
 If you can define it how would you do it?
 What would be the components of your
definition?
 Sickness X
A sickness of unknown type, which appears as
outbreaks, sometimes affecting whole communities,
is spreading across a large part of continental
Europe. Years later it will emerge in the USA. It will
be shown to be present in many countries, though it
may remain unrecognised in normal medical
practice, for it may occur as solitary cases or in
small numbers and not outbreaks. Sick people have
a wide range of symptoms and signs on
examination. Their many symptoms include simply
feeling unwell, with loss of appetite and abdominal
pain, disturbances of the gastrointestinal tract
including diarrhoea, a skin rash on parts of the body
exposed to the sun, and mental disturbances. It
leads to progressive physical and mental
deterioration. People who contract the sickness are
likely to die, with the mortality rate as high as 60
percent in some outbreaks. If a sufferer recovers
the sickness can recur.