Epidemiology is a poorly understood subject. It's related to public health, but it's not like that makes things any clearer. Each time I tell someone what I do and they ask me, “Skin doctor?” To helpfully correct the confusion, I try to qualify the subject with a whitewashed “it’s the study of disease.” While my correction isn’t wrong by any means, I’m taking the proverbial paint-bucket function from MS Word and splashing it around like a drunk Jackson Pollock. Case in point: no one ends up feeling the slightest more satisfied than when we started the conversation.
I’ve talked to some of my other peers (colleagues? fellow epidemiologists? What do I say?) and they all can share similar if not identical situations. Some of the stories even provoke a laugh, but the confident chuckle rests on a strong foundation that we, as insiders, the epidemiologists themselves, could aptly explain epidemiology in detail and application if needed.
So, what makes epidemiology so loopy and downright weird? What is an epidemiologist? What do they do (really) and where the hell can I find one? Most people can’t put a face to a name, let alone understand that just some of the Winslet’s job duties in Contagion are performed by epidemiologists in the field. Thus, the fog must lift. The smoke must clear.
First, an understanding of epidemiology requires an understanding of public health and the best way to know public health is through analogy. Essentially, both a public health professional and a physician deal with health issues, but on different levels and using different tools. A physician treats people individually while a public health official treats whole populations of people. Likewise, a physician is reactive and public health is proactive. As clinicians manage and cure persons one at a time, public health officials are hell bent on preventing those patients from even arriving at the clinic in the first place. They concern themselves with understanding patterns, distributions, determinants and etiologies of disease. They want to know the why, where, how and not just the what of a particular disease.
Under this umbrella of public health, there rests species of public health professionals all working to better understand disease morbidity and mortality. Of these professionals, epidemiologists are a common breed most likely to be found performing some variation of statistical analysis, surveillance or variable assessment. Those terms are obscure buzzwords so it’s best to conceptualize epidemiology by reducing it to a relationship of exposure and outcome. Classic epidemiology investigates how an exposure is associated with an outcome. Parkinson’s disease, for example, is a chronic and progressive neurodegenerative movement disorder shrouded in etiologic mystery. PD has no single clear cause and is, most likely, the result of complex interactions from genetic inheritance and environmental exposures. Thus, while diagnosing PD has become clearer pathologically, medical professionals are still no more helpful in curbing disease incidence. Epidemiologists fill that void by researching the relationship PD has with exposures purported to increase one’s risk through different types of study designs.
In truth, epidemiology is a product of the ages, which is largely responsible for its emergence in the past 50 years. Advances in biomedical innovation, globalization and “historicalization” have all contributed to a surge of methods that can survey, store and analyze large amounts of data. With technology and computers, software has been developed to perform complex statistical analysis that would be time-consuming otherwise. With globalization, researchers are better able to understand the distribution of a certain diseases across a width of cultures. With “historicalization” or the development of an accurate understanding of history, researchers are better able to understand the determinants (vertical distribution) of diseases. In gathering all of these parameters, epidemiologists can begin to connect the dots of exposure to disease and, with some more math, predict future outcomes with a certain degree of confidence.
Of course, those last paragraphs will never fit eloquently into a quick response at a dinner conversation (and may have not even fit eloquently here). Nevertheless, public health and epidemiology is a fast-evolving field likely to garner the attention of more individuals as the field becomes increasingly relevant. The purpose of this blog then is to provide its readers with current applications and editorials of public health from around the world.
