Introduction to Public Health &

Epidemiology
Dr. Tauseef Ismail
Associate Professor
Department of C Med KGMC
 Learning Objectives
• Define & discuss the goals of PH
• Define epidemiology and explain its objectives
& Uses
• Discuss important figures in the history of
epidemiology
• Discuss modern experimental studies.

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 Definition & Goals
PH is a multidisciplinary field whose goal is to promote the
health of the population through organized community efforts.
Public Health activities include
• Assessing the health status of the population
• Diagnosing its problems
• Searching for the causes for those problems
• Designing solutions for them.
Solutions usually involve community-level interventions that
control or prevent the cause of the problem. For example,
educational programs to discourage teenagers from smoking,
screening programs for cancer, laws requiring seat belt use.

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 Public health achievements include,

25 years of the increase in life expectancy can be attributed to

improvements in public health and only 5 years can be attributed to
improvements in the medical care system.
• Routine use of vaccinations for infectious diseases
• Improvements in motor vehicle and workplace safety
• Control of infectious diseases through improved sanitation and
clean water
• Smoking cessation and blood pressure control
• Safer foods from decreased microbial contamination
• Access to family planning and contraception services
• Acknowledgement of tobacco as a health hazard and the ensuing
anti-smoking campaigns.

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 Epidemiology
Epi: “on or upon” demos: “the common people”
& logy: “study”
Putting these pieces together yields the following
definition of epidemiology: “the study of that
which falls upon the common people.”
The study of the distribution and determinants of
disease frequency in human populations and
the application of this study to control health
problems.
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 Objectives of Epidemiology
1. Study the natural course of disease from onset
to resolution
2. Determine the extent of disease in a
population
3. Identify patterns & trends in disease
occurrence
4. Identify the causes of disease, &
5. Evaluate the effectiveness of measures that
prevent & treat disease.
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The definition of Epidemiology has 5 key words
1.Population
2.Disease frequency
3.Disease distribution
4.Disease determinants &
5.Disease control

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 1-Population
• A group of people with a common
characteristic such as place of residence,
gender, age or use of certain medical services.
• Size of the population in which the disease
occurs is as important as counting the cases of
the disease, because it is only when the
number of cases is related to the size of the
population that we know the true frequency
of the disease.
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 2-Disease Frequency
Counting, a key activity of epidemiologists, includes 3 steps
1. Developing a definition of disease
2. Instituting a mechanism for counting cases of disease
within a specified population, &
3. Determining the size of that population.
Disease definitions are usually based on a combination of
physical & pathological examinations, diagnostic test
results, & signs and symptoms. e.g. a case definition of
breast cancer might include findings of a palpable lump
during a physical exam & mammographic & pathological
evidence of malignant disease.
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 3-Disease Distribution
Analysis of disease patterns according to the characteristics of
person, place, & time.
Who is getting the disease
Where is it occurring
How is it changing over time?
Variations in disease frequency by these 3 characteristics provide
useful info that helps epidemiologists
understand the health status of a population;
Formulate hypotheses about the determinants of a disease;
&
Plan, implement, & evaluate PH programs to control &
prevent adverse health events.
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 Characteristics of disease distribution
1. Time characteristics include annual occurrence, seasonal
occurrence (flu, malaria), and daily or even hourly
occurrence during an epidemic.
2. Place characteristics include geographic variation (recent
Covid pandemic & Dengue epidemics), urban-rural
differences, and location of worksites or schools.
3. Personal characteristics include demographic factors such as
age, race, sex (Ca breast & Prostate), marital status, and
socioeconomic status, as well as behaviors and
environmental exposures.
 4-Disease Determinants
• Factors that either cause a healthy individual
to become sick or a sick person to recover.
• Thus, determinants include both causal &
preventive factors
• Determinants also include individual,
environmental, & societal characteristics.
Cont’d

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 Individual Determinants
• Include a person’s genetic makeup, gender,
age, immunity level, diet, behaviors, & existing
diseases. E.g. the risk of breast cancer is ed
among women who carry genetic alterations
such as BRCA1 & BRCA2, are elderly, give birth
at a late age, have a history of benign breast
disease, or have a history of radiation
exposure to the chest.
Cont’d
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Environmental, & Societal Determinants

Are external to the individual, & encompass a

wide range of natural, social, & economic
events & conditions. E.g. the presence of
infectious agents, reservoirs in which the
organism multiplies, vectors that transport the
agent, poor and crowded housing conditions,
& political instability are environmental &
social factors that cause many communicable
diseases around the world.
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 5-Disease Control
Epidemiologists accomplish disease control through
epidemiologic research & through surveillance. The
purpose of surveillance is to monitor aspects of disease
occurrence that are pertinent to effective control. E.g.
since 1985 the CDC has collected info on the occurrence
of AIDS across the US. For every case of AIDS & HIV
infection, the surveillance system gathers data on the
individual’s demographic characteristics, exposure
category (such as IDUs or homosexual men), & Dx date.
These data are essential for formulating & evaluating
programs to the spread of AIDS.
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 Seven Uses of Epidemiology
1. To study the history of the health of populations, and of the
rise and fall of diseases and changes in their character.
Useful projections into the future may be possible.
2. To diagnose the health of the community and the condition
of the people, to measure the true dimensions and
distribution of ill health in terms of incidence, prevalence,
disability, and mortality; to set health problems in
perspective and define their relative importance; to identify
groups needing special attention. Ways of life change, and
with them the community’s health; new measurements for
monitoring them must therefore constantly be sought.
Cont’d

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3. To study the working of health services with a view to their
improvement. Such knowledge may be applied in action research
pioneering better services, and in drawing up plans for the future.
Timely information on health and health services is itself a key
service requiring much study and experiment.

4. To estimate from the group experience what are the individual

risks on average of disease, accident and defect, and the chances
of avoiding them.

5. To identify syndromes by describing the distribution and

association of clinical phenomena in the population.
Cont’d

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6. To complete the clinical picture of chronic diseases and describe
their natural history. Follow-up of cohorts is necessary to detect
early subclinical and perhaps reversible disease and to discover
precursor abnormalities during the pathogenesis, which may offer
opportunities for prevention.

7. To search for causes of health and disease by computing the

experience of groups defined by their composition, inheritance
and experience, their behavior and environments. To confirm
particular causes of chronic diseases and the patterns of multiple
causes, describing their mode of operation singly and together,
and to assess their importance in terms of the relative risks of
those exposed.

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 Hypothesis
• Epidemiologic research involves generating & testing
specific hypotheses about disease determinants.
• A hypothesis is defined as “ a tentative explanation for
an observation, phenomenon, or scientific problem that
can be tested by further investigation”. E.g. “children
who take vitamin C are less likely to become ill during flu
season than those who do not.”
• Generating hypotheses is a process that involves
creativity & imagination & usually includes observations
on the frequency & distribution of disease in a
population.
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 Testing Hypotheses
• Epidemiologists test hypotheses by making
comparisons, usually within the context of a
formal epidemiologic study.
• The goal of a study is to harvest valid &
precise info about the determinants of disease
in a particular population.

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Historical Development of
Epidemiology
Historical Figures
 John Graunt
• Born in London, on April 24, 1620.
• Despite his lack of formal education, Graunt became the 1 st
Epidemiologist, statistician & demographer when he wrote
a book about the Bills of Mortality (lists of the dead) in the
late sixteenth century. The Bills of Mortality were the vital
statistics about the citizens of London collected over a 70-
year period. Graunt explained that the accounts were kept
as the number of deaths rose from the plague, a
catastrophic illness whose germs were carried by fleas that
lived as parasites on rats. In the year 1625 alone, one-fourth
of England's population died, many from the plague.

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 James Lind
Lind was influenced by Hippocrates and focused his
research on observing the effect of time, place,
weather and diet on the prevalence of scurvy. He
documented the months when there appeared to be
higher rates of occurrence, along with the weather at
the time when the initial symptoms of scurvy, began
to show . He noted that after sailors had been sent
off to sea, the symptoms of scurvy would typically
occur around 4-6 weeks into their voyage, despite
adequate water, and untainted provisions .

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Lind set up several experiments by changing the sailors diet. In
doing so, he noted a lack of scurvy symptoms among the sailors
that had been allotted a daily orange to eat. Because of this, he
identified the importance of citrus in a sailors diet, and that the
lack thereof ,was the cause of scurvy. In 1895 the British navy
made it a requirement to include limes or lime juice in the diet of
a seaman.
http://www.encyclopedia.com/topic/James_Lind.aspx

James Lind assisting a sailor

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stricken by illness
 William Farr (1807 -83)
The father of modern vital records, was another
important figure in the development of
epidemiology.
His contributions include:
• Establishing the first registry of births and
deaths in the 1830s
• Advancing population-based surveillance
• Distributing reports that led to public health
interventions
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 John Snow (1813-58)
An English physician & anesthetist. He is
considered one of the fathers of modern
epidemiology, because of his work in tracing the
source of a cholera outbreak in Soho
, London, in 1854. His findings inspired
fundamental changes in the water and waste
systems of London, which led to similar changes
in other cities, and a significant improvement in
general public health around the world.

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Analysis of the addresses of the cholera
deaths and interviews of residents of the area
led him to suspect that water from a pump on
Broad Street was responsible – and he
prevailed upon the local council to remove
the handle of the pump on 8th September
1854.

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Original map by John Snow showing the clusters of cholera
cases in the London epidemic of 1854

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 Modern Experimental Studies
• Streptomycin Tuberculosis Trial
• Doll & Hill’s Studies on Smoking & Lung Cancer
• The Framingham Study
Assignment: Make a ppt presentation (maximum 12
minutes duration) highlighting salient features of
these 3 research studies (with special emphasis on
study design) of historical importance; to be
presented in next class.
Email: tauseefism@gmail.com
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Below is a list of activities that an epidemiologist
might perform. Match the term to the activity that
best describes it.
A. Distribution
B. Determinants
C. Application
1. Compare food histories between persons with Staphylococcus food
poisoning and those without

2. Compare frequency of brain cancer among anatomists with frequency

in general population

3. Mark on a map the residences of all children born with birth defects
within 2 miles of a hazardous waste site

4. Graph the number of cases of congenital syphilis by year for the

country

5. Recommend that close contacts of a child recently reported with

meningococcal meningitis receive Rifampicin

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1. Compare food histories between persons with
Staphylococcus food poisoning and those without
Determinants
2. Compare frequency of brain cancer among anatomists with
frequency in general population
Determinants
3. Mark on a map the residences of all children born with birth
defects within 2 miles of a hazardous waste site
Distribution
4. Graph the number of cases of congenital syphilis by year for
the country
Distribution
5. Recommend that close contacts of a child recently reported
with meningococcal meningitis receive Rifampin
Application

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 References
• Gordis L. Epidemiology. 5th Edition. Canada:
Elsevier Saunders; 2014. Chapter 1:
Introduction; p.2-18
• Aschengrau A, George R, Seage III. Essentials
of Epidemiology in Public Health. 2nd Edition.
USA: Jones and Bartlett Publishers; 2008. The
Approach and Evolution of Epidemiology:
chapter 1; p.1-32

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