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TRANSCRIPT
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This presentation is made available through a Creative Commons Attribution-Noncommercial license. Details of the license and permitted uses are
available at http://creativecommons.org/licenses/by-nc/3.0/
© 2010 Dr. James C. Scott and the Clinic on the Meaningful Modeling of Epidemiological Data
Title: Public Health, Epidemiology, and ModelsAttribution: Dr. Jim Scott, Clinic on the Meaningful Modeling of Epidemiological Data
Source URL: http://lalashan.mcmaster.ca/theobio/mmed/index.php/Public_Health%2C_Epidemiology%2C_and_Models
For further information please contact Dr. Jim Scott ([email protected]).
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MMEDAfrican Institute for the Mathematical SciencesMuizenberg, South AfricaMay, 2010
Jim Scott, Ph.D, M.A., M.P.H.
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Published analysis of London mortality data in 1662
Recognized patterns and trends such as male-female disparities and high infant mortality
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In 1632Plague: 8
Buried:9535
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“The science of preventing disease, prolonging life, and promoting physical health and efficiency through organized community efforts… ” - Winslow
Prevention is job #1 Works at the population level
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“I believe the history of public health might be written as a record of successive redefinings of the unacceptable.” - George Vicker
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400 BCE Hippocrates presents causal relation between environment and disease
1st Century Romans introduce public sanitation and organized water supply system
14th Century Black Death leads to quarantine
Middle Ages Colonial expansion spreads infectious disease aroung the world
1750-1850 Industrial Revolution results in health and social improvements
1850-1910 Expansion of knowledge about infectious disease agents and transmission
1910-1945 Reductions in child mortality; Development of schools of public health; International foundations
1945-1990 Creation of World Bank; WHO; Eradication of smallpox; Beginning of HIV pandemic
1990-Present Priority given to health sector reform, equity, health and development
A Summarized History of International Public Health (Merson, Black, Mills, 2nd ed.)
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Public Health Improvements
Cleaner Water
Vaccinations Family
Planning
Cleaner Food
SmallpoxEradicatio
n
Education
ImprovedSanitation
ImprovedHygiene
Cleaner Air
Tobacco Control
Better Nutrition
Vector Control
Google: Life expectancy
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Key concepts
Prevention is job #1 Interdisciplinary Everyone has a right to health Linked to government Works at the population level Different than medicine
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Assess health of populations (surveillance)
Policy development
Assure that services are available
Prevent disease
Assess health of individuals (diagnosis)
Develop treatment plan (regimen)
Administer treatment
Cure the patient
Public Health Medicine
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Assessment : Epidemiology and Statistics
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Policy Development Government and International
Organizations
▪ e.g. The World Health Organzation17
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Assurance Implementation and maintenance Governments and Public Health
Infrastructure
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Five Steps Define the problem Determine risk factors Develop interventions Implementation Assessment
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The problem: 1966: 10 – 15 million cases of smallpox
in 50+ countries 1-2 million deaths annually ~ 30% case-fatality ratio Higher in children Survivors scarred for life
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Source: Millions Saved: Proven Successes in Global Health, Center for Global Development, 2004
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Natural History/Risk Factors Variola virus Airborne / contact with an infected
person Non-infectious for up to 17 days Flu-like symptoms – high fever Rash
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Intervention: vaccination In existence since 18th century – Edward
Jenner Improved vaccine in 1920s 1959: Global eradication program
endorsed by the WHO
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Implementation 1959: 1 fulltime WHO medical officer, 1
assistant National vaccination campaigns 1965: World Health Assembly – “eradication
of smallpox is a main objective of the WHO” 1967: Smallpox Eradication Program 1970’s: focused ‘containment’ teams 1973: 5 countries remaining 1977: last endemic case
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24Source: Vaccines, 3rd ed. ,W.B. Saunders Co. 1999
The Decline of Smallpox
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Assessment 2 years of surveillance and searching May 1980: Smallpox declared
“eradicated”
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Barriers to public health Economic Moral/religious Individual freedom Political
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Public HealthPreventionPopulationsChallenging
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Policy Developme
nt
Assessment
Assurance
Epidemiology
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“The study of the distribution and determinants of health-related states or events in specified populations, and the
application of this study to control health problems”
- J. Last, Dictionary of Epidemiology
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The… Who What When Where Why and How ……of Disease
Descriptive Epidemiology
Analytic Epidemiology
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Slide courtesy of Warren Winkelstein 32
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Describe Disease in the Population Surveillance,
observation, research, experiments
Person, place, and time
Determinants Physical, biological,
social and behavioral factors that influence health
Natural History of Disease Symptoms,
pathogenisis, incubation
Design/Implement interventions Control disease
Inform Policy Use findings to
promote, protect, and restore health – “Big Picture”
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Describe Disease in the Population
- Surveillance
- Distribution of disease
Determinants of Disease
- Outbreak investigations
- Observational studies
- Experimental studies (RCTs) Interventions
- Mathematical modeling
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Centers for Disease Control and Prevention
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Susceptible Host
Subclinical Disease
(Incubation period)
Clinical Disease
Recovery, Disability or
Death
Time
Exposure
Pathological Changes Usual Time of Diagnosis
Onset of Symptoms
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Agent – Hepatitis A virus
Reservoir – Humans, and rarely captive chimpanzees
Mode of Transmission – Person-to-person by fecal-oral route
Incubation period – 15 to 50 days, depending on dose
Period of communicability – Greatest during latter half of incubation period, continues for a few days after onset of jaundice
Symptoms – Fever, nausea, abdominal discomfort, jaundice
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0.85 vs 2.11, a reduction in HIV incidence of approximately 60%
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Universal voluntary HIV testing with immediate antiretroviral therapy as a strategy for elimination of HIV transmission: a mathematical model
Reuben M Granich, Charles F Gilks, Christopher Dye, Kevin M De Cock, Brian G Williams
Lancet 2009; 373
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Population or community health assessment Surveillance
Individual decision making Should I smoke?
Completing the clinical picture Natural History of Disease
Search for causes HPV and Cervical Cancer
Public health action Circumcision
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Models allow us to gain insight into public health questions (e.g. Universal testing) Differences between:
▪ What factors increase the risk of HIV transmission? (Analytic Epidemiology)
▪ In what populations is HIV incidence/prevalence the highest? (Descriptive Epidemiology)
▪ By how much could we expect the incidence of HIV to decrease in South Africa if 80% of all sexually active people used condoms 80% of the time? (Public Health Impact)
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1) Simple as possible Avoid unnecessary complexity Only add complexity when the research
question demands it2) Based on what is known
Biological systems DATA
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Implies we must know relevant:- biology- statistics (how to make sense of data)
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Slide courtesy of Warren Winkelstein 51