EPIDEMIOLOGY

1. 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 prevention and control of health problems 2. In general, epidemiology has three principal uses in the field of preventive medicine. a. First, it may provide the key to discovering the etiology, or causative origin, of a disease hose e!act cause is not yet kno n. For e!ample, during the "ondon

cholera epidemic of 1#$%-&$, 'ohn (no , an )nglish physician, established that cholera as caused by polluted ater and not by *bad air* as most people at that time believed to be the cause. +is hypothesis disease drinking as based upon a study of the occurrence of the hich each affected family obtained its

ithin the city and the source from ater.

b. (econd, epidemiology is used to investigate epidemics of diseases in

hich

the causative agents are kno n, but the means of transmission are unkno n. ,n epidemic of infectious hepatitis at +oly -ross .niversity in 1%/# a polluted ater supply by means of the tools of epidemiology. c. 0hird, epidemiology is a useful administrative tool in the implementation of a preventive medicine program. It in planning the type of health care facilities assists us as traced to

needed, planning education programs, identifying high risk groups, identifying areas in hich to locate health care facilities, and in many other facets of preventive medicine. Continue with Exercises )pidemiology is the only ay of asking some 1uestions in medicine, one ay of asking others 2and no ay at all to ask many3. (even 4uses5 of epidemiology have been described6 1. In historical study of the health of the community and of the rise and fall of diseases in the population7 useful 4pro8ections5 into the future may also be possible.

2. For community diagnosis of the presence, nature and distribution of health and disease among the population, and the dimensions of these in incidence, prevalence, and mortality7 taking into account that society is changing and health problems are changing. 9. 0o study the workings of health services. 0his begins ith the determination of needs and resources, proceeds to analysis of services in action and, finally, attempts to appraise. (uch studies can be comparative bet een various populations. $. 0o estimate, from the common e!perience, the individual's chances and risks of disease. &. 0o help complete the clinical picture by including all types of cases in proportion7 by relating clinical disease to the subclinical7 by observing secular changes in the character of disease, and its picture in other countries. /. In identifying syndromes from the distribution of clinical phenomena among sections of the population. :. In the search for causes of health and disease, starting ith the discovery of groups ith high and lo rates, studying these differences in relation to differences in ays of living7 and, here possible, testing these notions in the actual practice among populations. 0hese various uses, it may be said, all stem from the fact that in epidemiology the group is studied and not merely particular individuals or cases in the group. 0he definition of groups involves accounting for all members7 and this has immediate uses in the study of the natural history of disease. ;escribing group e!perience of health, disease and their circumstances is useful in itself, and it permits manifold comparisons in time, place and society. )pidemiology is today the cinderella of the medical sciences. <evertheless, there have been advances during recent years in the study of lung and other cancers, dental caries, pneumoconiosis, of atherosclerosis, ischaemic heart disease, hypertension, of rheumatism, schi=ophrenia, the congenital malformations>to mention some e!amples. <e ground is being broken in the investigation of health, in the determination of physiological norms, in studies of morbidity, in family studies, in application to genetics, in the study of psychological aspects. 0here have been improvements in techni1ues of sampling and surveys, diagnostic and screening devices, methods of prediction, in the estimation of observer validity and reliability, the treatment of 1ualitative data. 0he prospective study of cohorts, the combination of survey ith case studies, international comparisons and field e!periments are being increasingly used. 0he proposition might be advanced that ?ublic +ealth needs more epidemiology7 so does medicine in general7 and, it may be said, society at large. Public Health needs more epidemiology>this cannot be doubted since epidemiology is the most likely basis for its further intellectual gro th. Medicine as a hole needs more epidemiology because it is a social science as ell as human biology and the epidemiological is the main method of studying the social aspects of health and disease. @oreover, epidemiology is rich ith suggestions for clinical and laboratory research and it offers many possibilities for testing hypotheses emerging from these. 0he main relations of epidemiology ith clinical medicine may be restated thus6 )pidemiology is the study of populations and all cases that can be defined in them. 0hese cases ill often include, and in their due proportion, cases differing in type from those presenting to particular clinical attention 2early disease, minor, the symptom-less cases, the someho peculiar3. 0he epidemiological method can also be used to identify subclinical manifestations and again in proper proportion to the clinical. )pidemiology thus helps to complete the clinical picture and natural history of disease.

)pidemiology supplements the clinical picture by asking 1uestions that cannot be asked in clinical medicine about the health of the community and of sections of it, present and past6 it provides a different vie of the orld of medicine. -linical problems are set in community perspective7 health problems are revealed and indication may be given here among the population they might best be studied. @easurements can be made of the need for clinical services and ho the needs are being met, thus providing an indicator of the 1uality of medical care. Finally, epidemiology by identifying harmful ays of living, and by pointing the road to healthier ays,helps to abolish the clinical picture. Ane of the most urgent social needs of the day is to identify rules of healthy living that might reduce the burden of the metabolic, malignant and 4degenerative5 diseases hich are so characteristic a feature of our society. 0his is the main field today for the use of epidemiology.