Friday, 5 August 2011

What is the future of epidemiology?

The Lancet 6 August 2011

Raj Bhopal a, Gary J Macfarlane b, William Cairns Smith cEmail Address, Robert West d, on behalf of the Management Executive Committee for the XIX World Congress of Epidemiology

Epidemiology is thriving. The striking features of contemporary epidemiology are diversity, change, and global reach: from society to the molecule, responding to technical advances and changing patterns of disease. The two main challenges are: translating epidemiology into evidence, practice, and ultimately better health; and strengthening epidemiology research capacity, particularly in low-income and middle-income countries.
Epidemiology is confronting old and new threats to human health and wellbeing. Established threats, such as tobacco, alcohol, and tuberculosis, that are controlled in some places are affecting new populations, particularly in low-income and middle-income countries. Further evidence on alcohol consumption and related harms is informing the development of public health policy on alcohol. New threats, such as volcanic ash and Shiga toxin-producing Escherichia coli, are posing new challenges. Re-emerging threats of poliovirus and measles along with neglected tropical diseases1 that affect about a billion people all need to be tackled with epidemiological concepts and methods used in tobacco control. Furthermore, understanding of population change through urbanisation, migration, and ageing, and inequalities arising in modern societies, is critical to epidemiology as a population-based discipline.
Epidemiological methods are evolving through multidisciplinary collaboration with other areas of expertise, including basic sciences, computing, and social sciences. New and improved methods of assessment of exposures, analysis of gene—environment interactions, informatics, biobanking, spatial analysis and graphic presentation, and approaches to mixed qualitative—quantitative methods are emerging from cross-disciplinary working.
Epidemiology is a discipline with a broad international reach where robust evidence can be generated by the application of sound epidemiological methods in a range of different settings using modest resources. Increasing global connectivity has facilitated the development of epidemiology through open access to electronic publication databases, sharing of research tools, and knowledge exchange through interactive websites and discussion lists. Supercourse,2 a dynamic repository of lectures on epidemiology and global health, is an excellent example of this global connectivity.
The International Epidemiology Association's XIX World Congress of Epidemiology3 to be held in Edinburgh on Aug 7—11, hosted by the academic departments of public health in Scotland, has adopted five overarching strategic themes: global problems; chronic diseases; cutting edge methodology; epidemiology and policy; and neglected conditions. Epidemiology and policy is the one theme generating most interest among those attending.
The generation of increasing volumes of evidence by epidemiology is of little consequence unless that knowledge influences policy and practice, in addition to improving our understanding of aetiology and causal pathways. Given that epidemiology needs to be relevant for policy, it needs to be presented in a meaningful way for policy makers. This requires recognition of the different language used by epidemiologists and policy makers, as well as their very different timescales—epidemiologists operate over years if not decades, whereas policy makers make shorter term decisions. Policy makers need to learn more about epidemiological strengths and limitations while epidemiologists need to understand the timescales and cycles in policy making and political processes. Epidemiology also needs to be applied to individual patient care in the assessment of risk at an individual level, tailoring preventive and therapeutic interventions as is increasingly the case in cardiovascular disease.
The second challenge for the future is capacity strengthening. Masters level courses in epidemiology are widely available in all regions through medical schools and universities, often with North—South collaboration. These courses provide an understanding and an appreciation of epidemiological research methods, but it requires doctoral and post-doctoral level programmes to develop advanced and practical research skills in epidemiology. An important challenge for the International Epidemiology Association at both regional and international level is the facilitation of advanced epidemiology training to develop research capacity, particularly in low-income and middle-income countries. The forthcoming XIX World Congress of Epidemiology will be preceded by an advanced course in epidemiological methods. The 1500 Congress delegates will debate the challenges of relevance to policy and practice, and capacity building at a global level.


1 WHO. First WHO report on neglected tropical diseases 2010: working to overcome the global impact of neglected tropical diseases. Geneva: WHO, 2010.
2 WHO Collaborating Center University of Pittsburgh. Supercourse: epidemiology, the internet, and global health.∼super1. (accessed July 18, 2011).
3 International Epidemiology Association XIX World Congress of Epidemiology. (accessed July 18, 2011).

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