PHA201 | Principles of Epidemiology

I. DIFFERENT DEFINITIONS OF EPIDEMIOLOGY OVERTIME epidemiologic studies to provide the “Why” and “How”
• In Greek terms: of such events.
EPI-upon
DEMOS-People ➔ HEALTH-RELATED STATES OR EVENTS
LOGOS-Study of ▪ anything that affects the well-being of a population.
• Not a pure science but applied one and related to ▪ Exclusively on “epidemics of communicable diseases”,
development of other disciplines and vice-versa expanded to address endemic communicable and non-
▪ Pure Science- is the exact science of applying knowledge. communicable infectious disease
E.g. Physics, Chemistry, Biology ▪ By the middle of the 20th Century, additional
▪ Applied Science- also known as basic science, is the exact epidemiologic methods had been developed and
science of the development of scientific theories. E.g. applied to chronic diseases, injuries, birth defects,
Psychology, Sociology maternal-child health, occupational health, and
• Is the study of the distribution and dynamics of a disease in environmental health. Then epidemiologists began to
human population (as such, it is considered a science, art, look at behaviors related to health and well-being, such
philosophy, and methods) as amount of exercise and seat belt use. Now, with the
• is problem solving by looking to explanation of disease recent explosion in molecular methods,
behavior we can exploit the explanation for developing epidemiologists can make important strides in
preventive measures examining genetic markers of disease risk. Indeed, the
term health-related states or events may be seen as
anything that affects the well- being of a population.
Nonetheless, many epidemiologists still use the term
“disease” as shorthand for the wide range of health-
related states and events that are studied.

➔ SPECIFIED POPULATIONS
▪ The clinician is concerned about the health of an
individual; the epidemiologist is concerned about the
collective health of the people in a community or
population. In other words, the clinician’s “patient” is
• Basic Preventive Medicine the individual; the epidemiologist’s “patient” is the
community.
➢ Epidemiology is the study of the distribution ▪ Therefore, the clinician and the epidemiologist have
and determinants of health-related states or events (not just different responsibilities when faced with a person with
diseases) in specified populations, and the application of this illness. For example, when a patient with diarrheal
study to the control of health problems. (Principles of disease presents, both are interested in establishing
Epidemiology, 3rd edition) the correct diagnosis. However, while the clinician
➔ STUDY- Data-driven and relies on a systematic and usually focuses on treating and caring for the
unbiased approach to the collection, analysis, and individual, the epidemiologist focuses on identifying
interpretation of data. the exposure or source that caused the illness; the
▪ Basic epidemiologic methods tend to rely on careful number of other persons who may have been similarly
observation and use of valid comparison groups to exposed; the potential for further spread in the
assess whether what was observed, such as the number community; and interventions to prevent additional
of cases of disease in a particular area during a cases or recurrences.
particular time period or the frequency of an exposure
among persons with disease, differs from what might be CLINICAL MEDICINE VS EPIDEMOLOGY
Doctors & Other Health
expected. Care Practitioners BOTH Epidemiologists
▪ 5Ws (What/ Where/ When/Who/Why) Who: Individual Patients Collecting Who: Entire Populations
Data (Small or Large)
➔ DISTRIBUTION How: Taking Medical How: Surveillance
History & Conducting a Systems or Descriptive
▪ Frequency - refers not only to the number of health
Physical Exam Epidemiological Studies
events such as the number of cases of meningitis or Data used to make a Using Data Data used to generate
diabetes in a population, but also to the relationship of diagnosis hypotheses about the
that number to the size of the population. relationships between
▪ Patterns - refers to the occurrence of health-related exposure and disease
events by time, place, and person. Time patterns may be Test diagnosis by Testing Test hypothesis by
conducting additional Hypothesis analytical studies such
annual, seasonal, weekly, daily, hourly, weekday versus diagnostic studies or as cohort or case-control
weekend, or any other breakdown of time that may tests (ex: biopsy or MRI) studies
influence disease or injury occurrence. Place patterns Prescribes medical Taking Creates a community
include geographic variation, urban/rural differences, treatment to patient Action intervention to end the
and location of work sites or schools. Personal health problem and
prevent its recurrence
characteristics include demographic factors which may
be related to risk of illness, injury, or disability such as
➔ APPLICATION
age, sex, marital status, and socioeconomic status, as
▪ Like the practice of medicine, the practice of
well as behaviors and environmental exposures.
epidemiology is both a science and an art. To make the
proper diagnosis and prescribe appropriate treatment
➔ DETERMINANTS (Causes, Risk Factors, Mode of
for a patient, the clinician combines medical (scientific)
Transmission)
knowledge with experience, clinical judgment, and
▪ causes and other factors that influence the occurrence
understanding of the patient. Similarly, the
of disease and other health-related events.
epidemiologist uses the scientific methods of
▪ Epidemiologists assume that illness does not occur
descriptive and analytic epidemiology as well as
randomly in a population, but happens only when the
experience, epidemiologic judgment, and
right accumulation of risk factors or determinants exists
understanding of local conditions in “diagnosing” the
in an individual. To search for these determinants,
health of a community and proposing appropriate,
epidemiologists use analytic epidemiology or

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PHA201 | Principles of Epidemiology

practical, and acceptable public health interventions to epidemiology has evolved to cover more public health
control and prevent disease in the community. issues beyond diseases, agents can also be
represented as physical or chemical factors.
II. FUNCTIONS OF EPIDEMIOLOGISTS
✓ Epidemiologists are public health workers who investigate *Epidemiologic triangle agents include:
patterns and causes of disease and injury. They seek to a. Bacteria: Bacteria are single celled organisms
reduce the risk and occurrence of negative health that are able to reproduce on their own.
outcomes through research, community education and Commonly-known bacteria are streptococcus
health policy. (which causes strep throat), lyme disease,
✓ Duties: syphilis and anthrax.
▪ Plan and direct studies of public health problems to find b. Viruses: Viruses are made up of genetic
ways to prevent them or to treat them if they arise. material but cannot reproduce on their own and
▪ Collect and analyze information-including data from instead infect cells with their DNA to be
observations, interviews, surveys, and samples of blood reproduced. The flu, the common cold, HIV and
or other bodily fluids-to find the causes of diseases or herpes are all types of viruses.
other health problems. c. Fungi: Fungi are not plants because they
▪ Communicate findings to health practitioners, policy cannot produce their own food and instead live
makers, and the public. off other organisms including plants, animals
▪ Manage programs through planning, monitoring and people. Fungal infections are often found
progress and seeking ways to improve in fingernails and toenails, on the skin as
▪ Supervise professional, technical and clerical ringworm, and in the vagina as yeast infections.
personnel. d. Protozoa: Protozoa are tiny parasites that live
▪ Write grant proposals to fund research. off other organisms and are commonly found in
✓ Epidemiologists typically specialize in one or more public water. Malaria is an example of a parasitic
health areas, including the following: protozoan.
▪ Chronic diseases e. Chemical Contaminants: Contaminants like
▪ Environmental health poisonous metals such as lead or mercury,
▪ Genetics and molecular epidemiology gases like chlorine and carbon dioxide,
▪ Infectious diseases radiation and organic compounds like
▪ Maternal and child health pesticides are all considered potential agents
▪ Mental health of health events or issues.
▪ Public health preparedness and emergency response f. Physical Forces: In the scientific sense physical
▪ Veterinary epidemiology forces that could be responsible for public
✓ Are epidemiologists considered medical doctors? health events include environmental forces like
▪ No. While epidemiologists study and investigate the extreme temperatures, vibration or noise. Other
causes and sources of diseases in much the same way physical forces are more minute like carpal
as medical doctors, they’re not considered actual tunnel from repetitive movements.
physicians.
✓ Do epidemiologists go to medical school? 2. HOST
▪ Epidemiologists need at least a master’s degree from an ✓ The host is the organism which is exposed to and
accredited college or university. Most epidemiologists harbors a disease. In epidemiology the host is usually
have a master’s degree in public health (MPH) or a a human who gets sick but can also be an animal that
related field, and some have completed a doctoral acts as a carrier of disease but may or may not present
degree in epidemiology or medicine. illness. The host also presents symptoms of a disease
or health issue. As the CDC explains, a variety of
III. PUBLIC HEALTH CORE SCIENCES factors intrinsic to the host, sometimes called risk
a. Surveillance factors, can influence an individual’s exposure,
b. Epidemiology susceptibility, or response to a causative agent.
c. Informatics
d. Laboratory *Risk factors include:
e. Prevention Effectiveness ▪ Opportunities for exposure: Exposure factors
often fall into the category of lifestyle choices
➢ Epidemiology Purposes In Public Health Practice including sexual practices, hygiene, and other
➔ Discover the agent, host, and environmental factors that personal choices as well as by age and sex.
affect health ▪ Susceptibility and response: How likely you’ll be
➔ Determine the relative importance of causes of illness, impacted and how a disease or health event will
disability, and death affect someone include factors like genetics,
➔ Identify those segments of the population that have the nutritional and immunologic status, anatomic
greatest risk from specific causes of ill health structure, presence of disease or medications,
➔ Evaluate the effectiveness of health programs and and psychological makeup.
services in improving population health
➔ It is the cornerstone of public health 3. ENVIRONMENT
✓ Represents the favorable conditions for an agent to
➢ Epidemiologic Triangle cause a health event. Environmental factors include
➔ The epidemiologic triangle is made up of three physical features like geology or climate, biologic
components that contribute to the spread of disease: an factors like the presence of disease transmitting
external agent, a host and an environment in which the insects and socioeconomic factors like crowding,
agent and host meet. Between the vertices, scientists will sanitation and access to health services.
often describe the center of the triangle as representing ✓ For water-dwelling protozoa, that could mean a body
time. (Kent State University, 2021) of dirty water, E. Coli need warm temperatures to
➔ Composed of: survive, and the flu and colds thrive in environments
1. AGENT with people in close proximity like college
✓ The agent is the cause of the health event. When it dormitories in the winter months of North America.
comes to infectious disease the agent is a microbe or
what people typically think of as germs. As
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 PHA201 | Principles of Epidemiology

V. HISTORY OF EPIDEMIOLOGY
❖ Time
✓ In the center of the triangle is time. This factor is less ➢ Hippocrates (460-377BC)
consistently used to represent one thing. Time can - Father of medicine
represent the incubation period of a disease duration - The first epidemiologist
of the illness or amount of time a person can be sick - He is the first person known to have examined the
before the disease has run its course and results in relationships between the occurrence of disease and
death or recovery. It also can be used to describe the environmental influences.
period from an infection to the threshold of an - Believed that sickness of human body to be caused by
epidemic for a population. an imbalance of 4 humours (air, water, fire, and earth
“atoms”
➢ Captain James Vaunt (1662)
- “Nature and Political Observations made upon the Bills
of Mortality”-First to employ quantitative methods in
describing population vital statistics.
- Number of births and deaths of males exceeded those
of female (by the ratio 14 to 13)
➢ Joaquin de Villalba
- Spanish physician
- word “epidemiology” appears to have first been used
to describe the study of epidemics in 1802.
- Villalba used it to compose a historical chronology of
the epidemics in Spain, noting the type of disease and
the place and year in which it had occurred; this was an
initial approach to the concept of epidemiology, which
coincided with the development of medical
topographies and statistics applied to infectious
diseases.
➢ Plato & Rosseau
- Origin of disease was primary the fault of human luxury.
➢ Girolamo Fracastoro
- De contagione et contagiosis morbis= “On Contagion
and Contagious Diseases”
- was the first to propose a theory that these very small,
unseeable, particles that cause disease were alive.
They were considered to be able to spread by air,
multiply by themselves and to be destroyable by fire.
IV. SOLVING HEALTH PROBLEMS - The first to promote personal and environmental
hygiene to prevent disease.
• STEP 1: The Department of Health (DOH) noted the clustering ➢ John Snow
of Cholera cases in the Municipality of Medina, a fourth-class - is famous for his investigations into the causes of the
municipality with a 2017 projected population of 34,790, in 19th century cholera epidemics
the province of Misamis Oriental. - is also known as the father of (modern) epidemiology.
• STEP 2: Water was supplied by Medina Rural Waterworks and ➢ Ronald Ross, Anderson Gray McKendrick et al.
Sanitation Cooperative (MERWASCO). Complaints from - Mathematical methods were introduced into
consumers were received by MERWASCO of reports on epidemiology
drinking water turning salty. Rehabilitation of pipelines were ➢ Richard Doll and Austin Bradford Hill
proposed due to intrusion of sea water in the grounds leading - Published results by 1954
to fast rust build-up in the pipelines. The result of ocular - very strong statistical support to the suspicion that
investigation of health authorities showed water pipelines tobacco smoking was linked to lung cancer.
were almost 30 years old and are submerged in drainage
water. VI. EPIDEMIOLOGY APPROACH AND METHODS
• STEP 3: There is an association between drinking tap water
supplied by MERWASCO and increasing cases of cholera in
Medina.
• STEP 4: Augmentation and treatment of the affected
individuals (IV hydration, antibiotics). Provision of clean water
for the community.

➢ Epidemiology Key Terms

✓ epidemic or outbreak: disease occurrence among a
population that is in excess of what is expected in a given time
and place.
✓ cluster: group of cases in a specific time and place that might
be more than expected.
✓ endemic: disease or condition present among a population at
all times.
✓ pandemic: a disease or condition that spreads across regions.
✓ rate: number of cases occurring during a specific period; Descriptive Epidemiology Analytic Epidemiology
always dependent on the size of the population during that WHEN was the population HOW was the population
period. affected? affected?
WHERE was the population
WHY was the population
affected?
affected?
WHO was affected?

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PHA201 | Principles of Epidemiology

➢ Fatalities Associated with Farm Tractors ✓ The physical environment: This includes which
✓ In 1982, the number of farm tractor-associated deaths germs exist in an area, as well as pollution
was described in terms of time, place, and person by levels.
using records from an existing surveillance system ✓ A person’s characteristics and behaviors: A
person’s genetic makeup and lifestyle choices
can affect their overall health.
✓ According to some studies, the higher a person’s
socioeconomic status (SES), the they are to
enjoy good health, have a good education, get
a well-paid job, and afford good healthcare in
times of illness or injury.
✓ They also maintain that people with low
socioeconomic status are more likely to
experience stress due to daily living, such as
financial difficulties, marital disruption, and
unemployment.
VIII. DISEASE
• Is a physiological/psychological dysfunction.
• suffering from a malfunctioning organism or function
within the body itself.
ILLNESS DISEASE SICKNESS
is basically termed is the pathological A state of social
as an unwell or process, deviation dysfunction, i.e., a role
unhealthy state of from a biological norm that the individual
mind or body. assumes when ill
VII. HEALTH A person Underlying pathology. Social and cultural
• Health, according to the World Health Organization, is "a experiencing Practitioner’s conceptions of this
state of complete physical, mental and social well-being and symptoms perspective condition: cultural
not merely the absence of disease and infirmity". (1948) beliefs and reactions:
FEAR OR REJECTION
• This means that health is a resource to support an
individual’s function in wider society, rather than an end in
itself. A healthful lifestyle provides the means to lead a full ✓ “Disease is something that needs to be cured. Illness
life with meaning and purpose. is something that needs to be managed”

➢ Types of Health
1. Physical Health
• This is not only due not only to an absence of disease.
Regular exercise, balanced nutrition, and adequate rest
all contribute to good health. People receive medical
treatment to maintain the balance, when necessary.
• Looking after physical health and well-being also
involves reducing the risk of an injury or health issue,
such as:
▪ minimizing hazards in the workplace
▪ using contraception when having sex
▪ practicing effective hygiene
▪ avoiding the use of tobacco, alcohol, or illegal drugs
▪ taking the recommended vaccines for a specific
condition or country when traveling

2. Mental Health
• According to the U.S. Department of Health & Human
Services, Trusted Source mental health refers to a
person’s emotional, social, and psychological well-being.
Mental health is as important as physical health as part
of a full, active lifestyle.
• Good mental health is not only categorized by the
absence of depression, anxiety, or another disorder. It
also depends on a person’s ability to:
▪ enjoy life
▪ bounce back after difficult experiences and adapt to
adversity
▪ balance different elements of life, such as family and
finances
▪ feel safe and secure
▪ achieve their full potential
• PHYSICAL AND MENTAL HEALTH HAVE STRONG
CONNECTIONS.

➢ Factors for Good Health

✓ The social and economic environment: This may
include the financial status of a family or
community, as well as the social culture and
quality of relationships.

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