Epidemiologists: Heroes in the War on Disease

Bethany Costello

Mr. Daniel Alburger

English III Honors

22 February 2018

 
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Bethany Costello

Mr. Daniel Alburger

English III Honors

22 February 2018

Epidemiologists: Heroes in the War on Disease

Since the beginning of civilization, disease has constantly evolved becoming faster,

smarter, and more efficient. However, as disease evolves, so do the innovations and means

available to those who fight them. Although new inventions have made the study and tracking of

diseases easier and more advanced, they have also increased the public health threat. Global

travel, faster transportation, expanding trade and commerce, and new methods of communication

have all made the spread of disease easier. A global health threat could now come from

anywhere in the world and spread around the globe at an incredible rate. Luckily, many

dedicated men and women work as epidemiologists in order to gather data, prevent the spread of

disease, and devote their lives to keep the human race safe from biological threats. Since ancient

times, epidemiology has made huge medical advances and saved countless people's lives;

epidemiologists today continue to demonstrate the vital importance of this field in society as they

address new public health emergencies.

Epidemiology originated from a mix of medicine, sociology, demography, and statistics.

However, epidemiology itself didn’t become its own field until the 19th century. In 1546,

Girolamo Fracastoro wrote the first known writing on disease “De Contagione et Contagiosis

Morbis et Eorum Curatione” which translates to “On Contagion, Contagious Diseases and Their

Treatment” in English. In the book, he describes his theory on disease which includes ideas such
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as “seeds of disease”. Fracastoro believed that these multiplying minute contagions each caused

a different disease. According to Fracastoro, disease spread from person to person in three ways:

direct contact, soiled clothing and linen, and through the air (“Institute”). This book became

widely regarded as the first scientific statement on the nature of germs and types of disease

transmission and, though not entirely correct, sparked interest into the workings of disease.

In Medieval and Renaissance Europe, Parish registers kept weekly “Bills of Mortality”, a

list of deaths and their causes. Even with these weekly lists, it took until 1662 for someone to

first find trends within the causes of death. Regarded as the father of demography - the study of

statistics such as births, deaths, and rates of disease - John Graunt wrote “Natural and Political

Observations Made upon the Bills of Mortality” which grouped causes of death into many

categories, including gender, geographical areas, and age groups. He became the first to estimate

the population of London and proved that most population growth came from immigration. He

created time trends for several diseases, explaining how they spread and killed over time, and

took into account population size which could significantly change the statistics. In addition,

Graunt fought against the age old notion that the plague spread at the beginning of the reign of

each new king. He published five versions of his book which the Royal Society published in

1665 (“Epidemiology”). Graunt revolutionized the way people viewed statistics and the plague,

allowing others to use his methods and follow in his footsteps.

During the French Revolution, from 1789 to 1799, interest in public health and

epidemiology spiked and Pierre Charles-Alexandre Louis laid the foundations of statistical

analysis. He created several observational studies showing that bloodletting - the draining of

certain amounts of blood from a patient for medical purposes - proved an ineffective treatment
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for disease, and as a result the prevalent remedy slowly decreased in popularity. Many students

of his went on to contribute more to the field, including William Farr, a British epidemiologist.

William Farr used new statistical methods and came up with many new epidemiological

concepts such as death rate, dose-response, herd immunity, and cohort effect. He, William Budd,

and William Guy created the Statistical Society of London in 1834 (“Institute”).

After 1850, the field of Epidemiology changed rapidly. “Epidemiology” became a word

in the mid 1800’s and the profession advanced with the prominent British physician John Snow

and his work. Born in 1813 in York, England, Snow left his family at the age of fourteen and

pursued several medical apprenticeships throughout Yorkshire, England. Although he primarily

worked as a doctor in London, he also became an early anesthetist and a pioneer epidemiologist.

In both 1853 and 1857, John Snow administered chloroform to Queen Victoria at the birth of two

of her children. In 1854, Dr. Snow became even more famous when he ended an outbreak of

Cholera in Soho, London. Dr. Snow theorized that contaminated water of a pipe on Broad Street

caused the outbreak. He used unpopular new methods and tracked down information and records

to create a geographical chart to record deaths, tracing each case back to the water pump. On

September 7th, 1854, Dr. Snow convinced town officials to take the handle off the pump in order

to prevent anyone from ingesting the water and slowly the cases decreased. Recognized for his

work long after his death, John Snow became known as the “Father of Epidemiology” (Frerichs).

Sara Josephine Baker became another notable figure in 19th century and early 20th

century epidemiology. Born on November 15, 1873 in Poughkeepsie, New York, Dr. Baker

would change the field of epidemiology forever. At just sixteen years old, Baker faced an

unthinkable tragedy- her father and brother both died from the typhoid fever epidemic. Stricken
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with grief, her mother began to work in order to support her family. Baker wanted to become a

doctor- even though everyone told her women could not work as a doctor- and her mother finally

allowed Baker to attend the Women’s Medical College of New York in 1894. After she

qualified, Baker opened a private practice. In her first year, Baker only made around 185 dollars

because no one would trust a female doctor. In need of more money, she applied for a position as

a city medical inspector under the name “Dr. S. J. Baker”. The masculine sounding name

accidentally led those who hired her to believe she was a man. Fortunately, governmental

workers had some form of protection under the law and the city found no real reason to fire her.

Frustrated, they assigned her to “Hell’s Kitchen”, an incredibly poor ghetto filled with recently

arrived immigrants from Europe escaping famine and political persecution, which had one of the

highest infant mortality rates in the world. In 1908, Dr. Baker and thirty other nurses decided to

try out preventative medicine and during her first summer the infant mortality rate dropped

drastically (Vare).

Sara had left a dramatic impression on the city, so much so that they opened the world’s

first public health agency and appointed her as its chief executive. Six male doctors on her staff

threatened to resign rather than work for a woman but Dr. Baker struck a bargain with them: if

after working for her for thirty days they still wanted to resign, she would personally help them

find other high paying positions. At the end of the month, the men decided they did not mind

working for Dr. Baker after all and remained on her staff. Dr. Baker realized that baby clothes of

the time sometimes accidentally suffocated babies and so she created the first baby clothing that

opened from the front. Additionally, she realized the silver nitrate eye drops given to all newborn

babies to prevent neonatal conjunctivitis actually caused blindness, as the bottles holding the
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mixture allowed evaporation which led to dangerously high levels of certain active ingredients.

To prevent this, Dr. Baker created beeswax capsules which still exist in countries around the

world today. In WWI she famously stated “It's six times safer to be a soldier in the trenches of

France than to be born a baby in the United States" forcing Americans to pay attention children’s

issue. Also during this time, Dr. Baker created a wartime program, that many regard as a

blueprint to the school lunch program today. In 1918 she visited Woodrow Wilson in the White

House to discuss suffrage. At the end of the meeting Wilson endorsed the idea of women’s

suffrage and in 1920, thirty-six states ratified the 19th Amendment. In 1923 Baker retired and

she died on February 22, 1945 (Vare).

In 1926, Charles-Edward Amory Winslow became the President of the American Public

Health Association and in the 1950s, he became a consultant for the World Health Organization.

Raised in Boston, he received a Master of Science from MIT- an institution he would later teach

at. Amory Winslow’s definition of public health remains one of his most well known

contributions to epidemiology. Written in 1920, this definition drastically shaped the discipline

and still remains the official definition ninety-eight years later. Throughout his life he wrote

many books, promoted public health and preventive medicine, and advocated strongly for

national health insurance ("Charles-Edward”).

In 1915, Amory Winslow founded Yale’s School of Public Health. Likewise, many other

higher education institutions specializing in public health came about during this time, notably

the Department of Epidemiology at Johns Hopkins in September of 1919. Another huge early

20th century innovation included the use of math in order to explain the spread of disease.

Ronald Ross created a mathematical model of malaria and used this type of model to plan and
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conduct the control of contagious diseases (“Institute”). During the Second World War,

outbreaks of malaria near military training bases in the United States led to the creation of the

Office of Malaria Control in War Areas (WCMA). Since the South had the largest and most

frequent malaria outbreaks, Atlanta became the WCMA headquarters. After the war ended, Dr.

Joseph Walter Mountin built upon the existing WCMA and created the Communicable Disease

Center (CDC) on July 1st, 1946 which focused on fighting diseases including malaria, typhus,

and other infectious diseases. Its headquarters remained in Atlanta, Georgia, and the CDC simply

took over the old WCMA offices. Many changes to the name have occurred since the creation of

the Communicable Diseases Center, including The National Communicable Disease Center,

Center for Disease Control, Centers for Disease Control, Centers for Disease Control and

Prevention. However, the initials “CDC” have stayed the same. Today, the CDC works not only

with infectious diseases but also with noncommunicable diseases, injury and environmental

health, and health statistics and occupational health. CDC staff work tirelessly to keep the United

States safe from Public Health threats (“Our History”).

In the late 20th Century, computers quickly enhanced the methods of data collection and

analysis. One useful method that came about during this time, known as meta analysis, included

collecting data from several studies carried out under the same conditions and analyzing the data

with computers. Throughout this time, epidemiology went through a process of specialization.

Today, new epidemiologists have the option to specialize from anything as broad as

environmental threats to something as specific as traffic related injury and death. The invention

of the internet has made it possible for the whole world to receive notifications about a public

health risk immediately and gives them the ability to receive live updates (“Epidemiology”). In
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addition, the internet has introduced a wide range of students to the world of public health and

epidemiology leading to a large increase in those interested in this field.

Today, becoming an epidemiologist requires a minimum of a master's degree. A

prospective epidemiologist should receive one of three types of master’s degrees: Master of

Science (Ms, ScM), Master of Health Science (MHS), or a Master of Public Health (MPH). To

gain a master’s degree, one has to gain entry into a graduate program. Requirements include:

scores from the GRE, MCAT, or GMAT, college transcript, letters of recommendation, essay,

and a curriculum vitae (CV). Some epidemiological jobs require a doctoral degree, such as:

Doctor of Science (ScD), Doctor of Public Health (DrPH), or a Doctor of Philosophy (PhD)

(“Institute”). Both a master’s and doctoral degree require some form of specialization within the

field of epidemiology.

While gaining a master’s or doctoral degree, students can choose to specialize in a range

of subjects. For example, choosing a specialization in environmental epidemiology includes the

studying of environmental exposures that contribute to injuries, illnesses, developmental

conditions, disabilities or death. With rising sea levels and global temperatures, environmental

epidemiology has become even more relevant today. Hospital and molecular epidemiology

combines laboratory methods with the analytic methods of epidemiology and biostatistics.

Generally, hospital and molecular epidemiology leans closer to microbiology and molecular

biology. Infectious or microbial disease epidemiologists study the spread of infectious disease in

the human population. While monitoring a multitude of factors, epidemiologists can identify the

progress of the disease and work on preventive measures to help end the spread of the disease.

Women’s health epidemiology, on the other hand, promotes the health of women, children, and
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families and use epidemiologic methods to create policies and programs to improve maternal and

child health. Global epidemiologists focus on health around the world, particularly in developing

nations, including research into causes and prevention of disease. Many global epidemiologists

work under governmental organizations (“Areas”). These descriptions only include a few of the

hundreds of types of specializations within epidemiology.

Once a new epidemiologist has chosen a specialization, they can choose to work in a

medical, research, academic, or governmental setting. Thirty-four percent of epidemiologists

work in state governments while nineteen percent work in local government, according to the

Bureau of Labor Statistics (“Epidemiologists.”). These epidemiologists working at a

governmental level focus primarily on keeping the American people safe from health related

threats and can work at county, city, state, and federal departments of health. Health departments

on a federal scale include the Department of Health and Human Services which encompasses

more than 300 programs and many different agencies such as the Centers for Disease Control

and Prevention. Throughout the US and the world, epidemiologists work for the CDC to ensure

the safety of the American people. Also within the Department of Health and Human Services,

the National Institute of Health has twenty-seven institutes and centers and works mainly to

advance medical research. Other opportunities for epidemiologists could include working in a

state, local, or private hospital. These clinical epidemiologists generally work in a more patient

oriented setting, mostly as consultants for hospitals. Around ten percent of epidemiologists work

in scientific research and development services. Research epidemiologists mostly work at

colleges, pharmaceutical companies, research laboratories and large medical corporations

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(“Institute”). Epidemiology offers unique and exciting job opportunities in a multitude of work

environments.

At an international level, epidemiologists can work for the World Health Organization,

which coordinates health programs within the United Nations (“Institute”). Applied

epidemiologists can also work at the CDC internationally. Global travel and expanding

commerce and trade has made global health more important in the world today. The CDC

stations people in more than sixty countries to control outbreaks and create relationships with

other countries in order to end any health threat to the United States. They also work closely with

the WHO to coordinate strategies with other countries to prevent the spread of disease (“What”).

Working internationally gives epidemiologists the opportunity to travel and work with other

cultures and populations.

Many great options exist for epidemiologists to receive hands on training in order to work

throughout the US and around the world. The CDC has its own program called the Epidemic

Intelligence Service, or EIS. Each year the EIS chooses seventy to eighty new EIS officers to

enter the two year training program for applied epidemiology. The EIS began in 1951 with just

twenty-three students - all male - but now includes around eighty trainees with females

comprising around seventy percent of each class. In the EIS, the officers learn to develop

questionnaires, conduct surveys, analyze data, trace contacts, identify causes of outbreaks, and

recommend methods of control. (“Epidemic”).

The Peace Corps provides another avenue to receive training and experience in order to

travel internationally as an epidemiologist. The Peace Corps began informally in 1960, after

Senator John F. Kennedy asked students to serve their country in the cause of peace by working
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in developing nations. A year later, on March 1, 1961, Kennedy signed the executive order to

officially establish the Peace Corps. Overall, around 187,000 volunteers and trainees have

worked in the 139 countries served by the Peace Corps and the numbers continue to grow. Many

of those who work for public health agencies began their public health journey in the Peace

Corps- so much so that many regard CDC staffers as having the “Peace Corps Gene”. Applying

for the Peace Corps generally requires a large amount work experience or a college degree,

depending on what kind of program one applies to. In addition, certain programs require

volunteers to know a language, or enough of a language to understand most conversations

(“Peace Corps”). Joining this volunteer organization serves as yet another path to work as a

epidemiologist around the globe.

A real life example of an epidemiologist, Elizabeth Jackson, works as a research scientist

in population and family health. She works for Columbia University and splits her time between

Ghana and North Carolina. For almost twenty years, Jackson has worked in partnership with the

Ghana Health Service and multiple universities in Ghana. She works mostly to measure the

impact of strengthening primary health care services in rural areas of Ghana. Jackson received

her undergraduate degree in biological anthropology and participated in a semester abroad at the

University of Ghana in her junior year. While she did not study public health there, she fell in

love with the country and received her first job working on a project based in Ghana. Jackson

went on to receive a PhD in Epidemiology after a recommendation to pursue public health by a

trusted former professor. Jackson’s story proves that receiving an undergraduate degree in public

health does not guarantee one’s success, and shows that focusing on experience and an eventual

public health graduate degree- whether just a master’s or PhD- allows one to prevail in this field.
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Through a rich history, epidemiology has grown and matured into a hugely important

career in today’s interconnected world. As that modern world quickly changes and new diseases

and public health situations arise, epidemiology must rise to the challenge and adapt in order to

make the world a safer place. For those wishing to become an epidemiologist, a lot of hard work

and difficult decisions lie ahead but undoubtedly the rewards vastly outweigh the efforts

involved.
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