COURSE TITLE: MICROBIAL ECOLOGY

COURSE CODE: MCB 422

TOPIC: INTRODUCTION TO EPIDEMIOLOGY AND PUBLIC HEALTH

LECTURER: MRS. J.O. OKECHIM

INTRODUCTION
A number of infective diseases are emerging that are important public health problems, even in
developed countries. In developing countries, which include about 75% of the world’s
population, infectious diseases are still a major problem. Worldwide, infectious diseases account
for nearly one-third of total of 52 million annual estimated deaths. For many of these diseases (for
example, measles, whooping cough and even tuberculosis), effective vaccines are manufactured
but are sometimes not available in developing countries. The infectious diseases remain an
important, but approachable, public health problem throughout the world. The current Corona
virus Disease 2019 (COVID 19) pandemic, which has spread worldwide in 2 years or less, is only
one example of the devastating consequences of a new infectious disease in a global theater.
Eradication or even effective control of infectious diseases must involve scientific, economic,
political and educational solutions and ultimately, global cooperation.
Definition of Epidemiology
Epidemiology is the study of the occurrence, distribution and control of disease in populations.
Or
Epidemiology 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.” This definition of epidemiology includes several terms which reflect some
of the important principles of the discipline. As you study this definition, refer to the description
of these terms below.
Study: Epidemiology is a scientific discipline, sometimes called “the basic science of public
health.” It has, at its foundation, sound methods of scientific inquiry.
Distribution: Epidemiology is concerned with the frequency and pattern of health events in a
population. Frequency includes not only the number of such events in a population, but also the
rate or risk of disease in the population. The rate (number of events divided by size of the
population) is critical to epidemiologists because it allows valid comparisons across different
populations.
 Pattern refers to the occurrence of health-related events by time, place, and personal
characteristics.
 Time characteristics include annual occurrence, seasonal occurrence, and daily or even hourly
occurrence during an epidemic. It also includes such temporal factors about disease occurrence
like the natural history of the disease, time-incidence curve (epicurve) duration of disease, etc.
 Place characteristics include environment context, geographic variation, urban-rural
differences, and location of worksites or schools.
 Personal characteristics include demographic factors such as age, race, sex, marital status, and
socioeconomic status, as well as behaviors and environmental exposures.
The modern definition of epidemiology accommodates three important elements namely:
inclusion of all diseases, populations, and ecological approach. Please note the three components
(3Ds) common to the definition of epidemiology: disease frequency, distribution and
determinants.
The major questions that are usually asked in epidemiology are: who are the group of person (s)
affected by the disease, where has the incidence occurred? And when (time) did it occur?
The epidemiologist traces the spread of a disease to identify its origin, mode of transmission and
how to control the spread of the disease.
Historically, the impact of epidemiology on the health of nations has been long- standing and far-
reaching. Its origin can loosely be traced to the time of Hippocrates (460-377 BC) who, as a
physician, attempted to investigate the occurrence of disease on a rational basis.
John Snow (referred to as the father of epidemiology) around the 1850s, observed patterns of
incidence of a cholera outbreak in central London. As a result of his recording of the incidence of
cholera and mortality in the area, Snow was able to isolate the cause of the cholera epidemic
which was attributed to a communal water-pump in Broad Street, Soho. After removing the pump
handle, Snow observed that new cases of cholera in the area ceased and the epidemic declined.
Significance of Epidemiology
Why Do We Study the 3 Components in Epidemiology?
The following reasons have been adduced for studying these three ‘Ds’: disease frequency,
distribution and determinants of diseases in human population:
i. for planning and evaluation of health care
ii. for identification of the determinants of diseases for evaluation of method of
controlling disease
iii. for observation of the natural history of a disease-making up of diagnosis and
prognosis
iv. For classification of a disease.
Uses of Epidemiology
Epidemiology is used for the following:
 a. to understand the causation of the disease and the development of hypothesis and their
b. testing
c. to analyse the respective role of agent, host and the environment in the development and
d. the natural history of disease
e. to analyse the occurrence and distribution of disease according to characteristics such as
age, sex, race, occupation and heredity
f. to understand the geographical or local patterns of the diseases.
g. to study, outline and define problems of health and disease by the analysis of incidence,
prevalence and mortality
h. to help complete the clinical feature and natural history of disease by group analysis
i. to estimate an individual‟s risk of developing a disease and his survival chances
j. to search for factors related to health and disease through the observation of group custom
and habits
k. for the planning of health activities and direction of programme to relevant sub-group
identified to be at risk and allocation of resources.
Public Health
Definition of Public Health
Public health is "the science and art of preventing disease, prolonging life and promoting health
through the organized efforts and informed choices of society, organizations, public and private,
communities and individuals.
Health according to WHO, is a state of complete physical, mental and social well-being and not
merely the absence of disease or infirmity.
Public health is concerned with the health of the entire population, rather than the health of
individuals. The population in question can be as small as a handful of people or as large as all
the inhabitants of several continents (for instance, in the case of a pandemic).
The focus of public health intervention is to improve health and quality of life through the
prevention and treatment of disease and other physical and mental health conditions, through
surveillance of cases and the promotion of healthy behaviors.
History of Public Health
In some ways, public health is a modern concept of human development in science, although it
has roots in antiquity. From the beginnings of human civilization, it was recognized that polluted
water and lack of proper waste disposal spread communicable diseases (theory of miasma). Early
religions attempted to regulate behavior that specifically related to health, from types of food
eaten, to regulating certain indulgent behaviors, such as drinking alcohol or sexual relations. The
history of public health is even traced back to the bible as found in Leviticus.
 The establishment of governments placed responsibility on leaders to develop public health
policies and programs in order to gain some understanding of the causes of disease and thus
ensure social stability prosperity, and maintain order.

Early Public Health Interventions

By Roman times, it was well understood that proper diversion of human waste was a necessary
tenet of public health in urban areas. The Chinese developed the practice of variolation following
a smallpox epidemic around 1000 BC. An individual without the disease could gain some
measure of immunity against it by inhaling the dried crusts that formed around lesions of infected
individuals. Also, children were protected by inoculating a scratch on their forearms with the pus
from a lesion. This practice was not documented in the West until the early-18th century, and was
used on a very limited basis. The practice of vaccination did not become prevalent until the
1820s, following the work of Edward Jenner to treat smallpox.
The Arabs were the first to build hospitals and differentiate between patients i.e out-patients and
in-patients and those that should be isolated from other patients.
Public health started when people started to find out why people die. One of such people is John
Graunt who analyzed the deaths and put up a bill known as bill of mortality.
Other public health interventions include latrinization, the building of sewers, and the regular
collection of garbage followed by incineration or disposal in a landfill, providing clean water and
draining standing water to prevent the breeding of mosquitoes. This contribution was made by
Edwin Chadwick in 1843 who published a report on the sanitation of the working class
population in Great Britain at the time. So began the inception of the modern public health.
Modern Public Health
With the onset of the epidemiological transition and as the prevalence of infectious diseases
decreased through the 20th century, public health began to put more focus on chronic diseases
such as cancer and heart disease.
During the 20th century and early in the next, the dramatic increase in average life span is widely
credited to public health achievements, such as vaccination programs and control of many
infectious diseases including polio, diphtheria, yellow fever and smallpox; effective health and
safety policies such as road traffic safety and occupational safety; improved family planning;
tobacco control measures; and programs designed to decrease non-communicable diseases by
acting on known risk factors such as a person's background, lifestyle and environment.
Why is Public Health Important?
Public health is fundamental to 21st century healthcare and shares the same overall goals as the
rest of the health care system - reducing premature death and minimizing the effects of disease,
disability, and injury. After all, the main intent of public health is to promote a healthier
population. This is quintessential to a sustainable health care system, and also provides economic
and social benefits for the province, due in part to increased productivity.
There are two underlying principles in public health programs, services and institutions that differ
from clinical medicine:
1. The focus of public health is prevention rather than treatment of diseases; and
2. Public health addresses the health needs of populations as a whole instead of individuals.

These principles allow public health to work in a complementary fashion to clinical medicine in
all of its core functions. Core functions in public health include health promotion and protection,
disease prevention, health assessment and disease surveillance.

Assignment
1. Compare and contrast public health and clinical medicine.
2. Discuss the barriers to the development of public health.