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Health and Society 2012 Dr Elizabeth Denney-Wilson

Definition of epidemiology Common terms used in epidemiology How epidemiological data is used in public health Examples of epidemiology-infectious disease Examples of epidemiology-non infectious (non-communicable) disease

Epidemiology is the study of the distribution and determinants of disease in human populations
Distribution-person, places, time Determinants-agent, host, environment Disease-traditional definition but also health, injury, behaviours

The epidemiological triangle

Host factors-behaviours, genes, body mass index Agent-eg microorganisms, chemicals, psychological factors, radiation Environment-physical, social or biological circumstances, occupation

Epidemiological investigation aims to:

provide information that results in breaking one side of the triangle-thereby disrupting disease transmission or controlling health problems in the community Epidemiology is concerned with disease prevention and control

Broad Street pump: investigation of a cholera outbreak in London in

Epidemiological terms
Prevalence Incidence Vector Morbidity Mortality Epidemic
How many people have it? How many new cases are there? How is it spread? How many people who have it are sick? How many people who have it will die? How widespread is it?

Relative risk

Is it here all the time?

What are my chances of getting it?

Back to broad street

Snow figured out the prevalence (number of cases in total) in the local area by calculating: number of cases of cholera number of residents And compared it with other similar neighbourhoods

Epidemiology in public health

Screening Disease surveillance Disease investigation Community health assessment Targeting intervention programs Evaluation of intervention programs

Used to detect disease (or risk factors) in people who dont have signs or symptoms of the disease Disease must be a common and important public health problem Disease has an asymptomatic stage and benefits from early treatment A suitable screening test is available


Disease surveillance

Active and passive surveillance

Routine, ongoing data collections
Laboratories, doctors, hospitals Notifiable diseases include

Identifying outbreaks or clusters Mounting a public health response

NSW Ministry of Health data

Disease investigation

Occurs in response to a short-term outbreak

Food or environmental contamination Identify the source Develop intervention to control outbreak Develop prevention policies

Investigation of a cryptosporidosis outbreak in Sydney

Community health assessment

Routine collections of health-related data

Telephone Paper

Environmental data
Pollution Parks, playgrounds Beaches and water quality

Chief Health Officers Report

Targeted interventions
Descriptive and analytic epidemiology identifies unequally distributed disease or risk factors in a population What are the determinants in the high risk group? What interventions can influence the determinants in this population?

Low levels of physical activity in girls from Middle-Eastern backgrounds

NSW Health funded targeted, schoolbased intervention to increase participation in physical activity

Evaluating intervention programs

Systematic collection of characteristics, activities and results of a program

Used to make decisions about the process, implementation and outcomes of a program

Has the program worked and is it good value?

Evaluation of measure up

Focus groups
Recall Understanding of messages Intention to change behaviours What would help make changes?

Infectious disease-chicken pox Non-immune individuals-not

previously exposed/infected Immunocompromised individuals

Herpes Zoster Virus Direct transmission, airborne through coughing/sneezing

Young children in close contact eg day care

Non-infectious diseaseobesity Genetic succesptibility

Food habits Physical activity

Energy density Portion size Car usage

Policy Advertising Economic factors


Epidemiology definitions
Study of distribution and determinants of disease, health and health events in a population

Uses of epidemiological data

Surveillance, assessment, Planning and evaluation