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The Impact of Epidemiology in Public Health

The Impact of Epidemiology in Public Health. Robert Hirokawa, DrPH Epidemiologist, Science and Research Group HHI / TSP, Hawaii Department of Health. 3 Core Functions of Public Health. The Institutes  of Medicine (IOM) defines the three core functions of public health as: Assessment

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The Impact of Epidemiology in Public Health

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  1. The Impact of Epidemiology in Public Health Robert Hirokawa, DrPH Epidemiologist, Science and Research Group HHI / TSP, Hawaii Department of Health

  2. 3 Core Functions of Public Health • The Institutes  of Medicine (IOM) defines the three core functions of public health as: • Assessment • Policy development • Assurance

  3. 10 Essential Public Health Services • Monitor health status to identify community problems. • Diagnose and investigate health problems and health hazards in the community. • Inform, educate, and empower people about health issues. • Evaluate effectiveness, accessibility, and quality of personal and population- based health services. • Research for new insights and innovative solutions to health problems.

  4. 10 Essential Public Health Services • Mobilize community partnerships and action to identify and solve health problems. • Develop policies and plans that support individual and community health efforts. • Enforce laws and regulations that protect health and ensure safety. • Link people to needed personal health services and assure the provision of  health care when otherwise unavailable. • Assure a competent public health and personal health care workforce.

  5. Epidemiology Defined • The study of distribution and determinants of health and disease in human populations

  6. 3 Essential Components of Epidemiology • Disease distribution – person, place, time • Disease determinants – causal relationships • Disease frequency • Expected levels • Endemic • Epidemic • Pandemic

  7. Types of Epidemiologic Studies • Descriptive • Analytic

  8. Descriptive Studies • Frequency of occurrence of a particular condition • Patterns of occurrence • Person • Place • Time

  9. Hawaii crude adult obesity (BMI > 30) prevalence (%) by race/ethnicity, BRFSS, 2005

  10. Hawaii crude adult obesity (BMI > 30) prevalence (%), BRFSS, 2005

  11. Hawaii Obesity and Diabetes Trends 1. Percentage of Hawaii adults that are obese, BRFSS 1990 - 2006 2. Percentage of Hawaii adults who have been diagnosed with diabetes, BRFSS 1995 - 2006

  12. Analytic Studies • Observational Studies (exposure not controlled) • Cross-sectional • Case-control • Cohort • Experimental (exposure controlled)

  13. Cross-sectional Study (Observational) • Tests the association between variables of interest • Example: obesity and asthma • Temporal relationship not taken into account

  14. Case-Control Study (Observational) Exposure Disease ??? Group 1 has disease (Cases) ??? Group 2 disease free (Controls)

  15. Cohort Study (Observational) Exposure Disease Group 1 has exposure ??? Group 2 not exposed ???

  16. Basic Presentation of Results Smoke? Lung CA? Relative Risk = Proportion of disease among those exposed divided by the proportion of disease among those not exposed

  17. Basic Presentation of Results Smoke? Lung CA? RR = 40/100 divided by 10/100 = .4/.1 = 4

  18. Measurement Errors • Bias • Recall • Misclassification • Confounding • Statistical Errors

  19. Cause – Effect Relationship • Strength of association • Consistency • Temporality • Biological plausibility • Gradient (dose – response)

  20. Measures of Disease Frequency • Prevalence = # of existing cases / total population • Incidence = # of new cases / total population at risk

  21. Commonly Used Measures • Crude • Category-specific (age, gender, geography) • Age-adjusted

  22. Experimental Study • Clinical Trial • Exposure is controlled

  23. In Summary: Impact of Epidemiology in Public Health • Improved understanding of the distribution and determinants of health and disease in human populations • Used to drive program planning, resource allocation, interventions, and evaluation

  24. Thank you!

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