BGY4305

Principles and Methods of

Epidemiology

Lecture 1: Introduction to Epidemiology

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 Learning Outcomes
At the end of this lecture, you should be able to

 define epidemiology
 explain components of the definition
 explain the basic assumptions of epidemiology
 list the purpose of epidemiology
 describe the history of epidemiology
 differentiate between descriptive and analytic epidemiology
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 What is Epidemiology?

Originates from the Greek words

epi upon, on, befall +

demos people, population, human +
logy study of

Literal translation: “That which befalls human” (epidemics)

Epidemiology is fundamentally concerned with populations

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 Definitions

Health
A state of complete physical, mental and social well-being
and not merely the absence of disease or infirmity
(WHO,1948)

Disease
A physiological or psychological dysfunction

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 Definitions

Epidemiology

A 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.

John Last, Dictionary of Epidemiology (1988).

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 Components of the definition

Study Systematic collection, analysis and

interpretation of data

Epidemiology involves collection, analysis and

interpretation of health-related data

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 Components of the definition

Distribution Distribution of an event by person,

place and time (PPT)

Epidemiology studies distribution of diseases

It answers the question who, where and when?

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 Components of the definition

Determinants Factors the presence/ absence of which

affect the occurrence and level of an event

Epidemiology studies what determines health events- risk

factors, environmental factors and preventive factors

It answers the question how and why?

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 Components of the definition

Diseases & other health-related events

Epidemiology is not only the study of diseases

The focus of epidemiology is not only patients

It studies all health-related conditions (injuries, birth

defects, amount of exercise, use of seat belt etc.)

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 Components of the definition

Human population

Epidemiology diagnoses and treats communities/

populations

Clinical medicine diagnoses and treats patients

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 Components of the definition

Application

Epidemiological studies have direct and practical

applications for prevention of diseases and promotion
of health

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 In general…

Basic assumptions of epidemiology

1. Death and disability do not occur at random.

2. There are causal factors that can be identified through

the systematic investigation of human populations.

3. Identifying these causal factors can lead to preventive

intervention.

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 Basic features of Epidemiology

1. Studies are conducted on human population

2. It examines patterns of events in people

3. Can establish cause-effect relationship without the

knowledge of biological mechanism

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 What is the purpose of epidemiology?

1. Provide the scientific basis to prevent disease & injury

and promote health.

2. Determine relative importance to establish priorities

for research & action.

3. Identify sections of the population at greatest risk to

target interventions.

4. Evaluate effectiveness of programs in improving the

health of the population.

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 What is the purpose of epidemiology?

5. Study natural history of disease from precursor states

through clinical course.

6. Conduct surveillance of disease and injury occurrence

in populations.

7. Investigate disease outbreaks.

Milton Terris, The Society for Epidemiologic Research (SER) and the future of
epidemiology. Am J Epidemiol 1992; 136(8):909-915, p 912
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History of Epidemiology

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 History of Epidemiology
Whoever wishes to investigate medicine properly should proceed
thus: in the first place to consider the seasons of the year, and what
effects each of them produces... when one comes into a city in which
he is a stranger, he should consider its situation, how it lies as to the
winds and the rising of the sun... One should consider most
attentively the waters which the inhabitants use...and the ground...
and the mode in which the inhabitants live, and what are their
pursuits, whether they are fond of drinking and eating to excess, and
given to indolence, or are fond of exercise and labor and not given to
excess in eating and drinking.

Hippocrates (“On Airs, Waters and Places” 400 BCE)

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 Types of Epidemiology

1. Descriptive Epidemiology

Defines frequency and distribution of diseases and other

health related events

Answers the four major questions: how many, who,

where, and when?

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 Types of Epidemiology

2. Analytic Epidemiology

Analyses determinants of health problems

Answers two other major questions: how? and why?

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History of Epidemiology

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 Father of Field Epidemiology

John Snow’s work illustrates the classic sequence from

descriptive epidemiology to hypothesis generation to
hypothesis testing (analytic epidemiology) to application.

With no knowledge of the existence of microorganisms,

Snow demonstrated through epidemiologic studies that
water could serve as a vehicle for transmitting cholera and
that epidemiologic information could be used to direct
prompt and appropriate public health action.

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 History of Epidemiology

During the first half of the twentieth century, the study of

epidemiology was largely concerned with infectious
diseases.

In the second half of the twentieth century, epidemiology

was concerned with chronic diseases (e.g. lung cancer and
smoking).

In the late 1980s, HIV/AIDS was a combination of both.

Recent focus- rediscovery of the “social” determinants of

health.
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Principal Causes of Death in Malaysia, 2018

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Causes of death in Malaysia, 2018 by gender

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Causes of death in Malaysia, 2018 by gender

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Causes of death in Malaysia, 2018 by stratum

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Causes of death in Malaysia, 2018 by ethnic group

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Causes of death in Malaysia, 2018 by age group

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