Available online at www.sciencedirect.

com

Preventive Veterinary Medicine 86

(2008) 250259

www.elsevier.com/locate/prev
etmed

The influence of veterinary

epidemiology on public health: Past,
present and future
Jan M. Sargeant *
Department of Clinical Epidemiology and Biostatistics, Health Sciences Centre 2C15,
McMaster University, 1200 Main St. West, Hamilton, ON, Canada L8N 3Z5

Abstract
This paper summarizes a presentation given at the Association for
Veterinary Epidemiology
and Preventive Medicine sponsored Calvin W. Schwabe
symposium honouring the lifetime achieve- ments of Dr. S. Wayne Martin. While
the concepts were amalgamated from many sources, the examples were primarily
selected to represent areas where Wayne
Martin
has
been
an
active
researcher and educator. The purpose was to
describe
the
impact
of
veterinary
epidemiology
on public health in the past and present and to
consider the future of veterinary epidemiology in public
health. Veterinary
medicine contributes to public health not only in the area of zoonotic disease
prevention and control, but also through contributions to animal health,
comparative and basic medical research, and population and environmental health.
Veterinary epidemiologists contribute to both research in public health and the
practice of public health through a wide range of methodological approaches and
via the networks of trained epidemiologists working in the area. The
contributions of veterinary epidemiologists have resulted in significant
improvements in human health. There are considerable challenges and opportunities
facing veterinary epidemiologists working in the public health area in the
future. Meeting these needs will require continued integration between veterinary
and human public health research and practice, and enhanced communication of both
content and context expertise.
# 2008 Elsevier B.V. All rights reserved.
Keywords: Veterinary epidemiology; Public health; Zoonoses

* Current address: Centre for Public Health and Zoonses, and Department of Population
Medicine, CLRE 203, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada N1G
2W1. Tel.: +1 519 824 4120x54045;
fax: +1 519 763 3117.
E-mail addresses: sargeaj@mcmaster.ca, sargeanj@uoguelph.ca.
0167-5877/$ see front matter # 2008 Elsevier B.V.
All rights reserved.
doi:10.1016/j.prevetmed.2008.02.011

J.M. Sargeant / Preventive Veterinary Medicine 86 (2008) 250259

25
1

1. Veterinary medicine, veterinary epidemiology, and public health

Public health has been defined as what we, as a society, do

collectively to assure the conditions in which people can be healthy
(National Academy of Science, 1988). While many definitions of health
have been proposed, the World Health Organization broadly defines health
as a state of complete physical, mental, and spiritual well being, and
not just the absence of disease or infirmity (WHO, 1946). Protecting and
promoting public health is a research/practice complex involving both
discovery and application of knowledge to improve the health of
populations. Thus, public health is a wide-ranging and multi-faceted
domain, with potential inputs from a wide range of disciplines.
Veterinary medicine has an essential role in protecting and promoting
public health. An important role for veterinary medicine within the
public health field is the prevention and control of zoonotic diseases.
Zoonotic disease agents account for over half of known human pathogens
and approximately 75% of emerging human pathogens (FAO, WHO, OIE, 2004;
Taylor et al., 2001). Many zoonotic disease agents are associated with
outbreaks of disease, increasing public awareness and concern. These
include foodborne and waterborne pathogens such as Escherichia coli O157. In
the US, consumption of contaminated hamburgers led to a four state
outbreak of E. coli O157:H7 in 19921993 (Davis et al., 1993), alfalfa
sprouts from a common lot contaminated with E. coli O157:H7 resulted in
illness in multiple US states (Breuer et al., 2001), and contamination
of the municipal water supply with E. coli O157 in Walkerton, Ontario in
2000 led to over 2000 illnesses and 6 deaths (Anon., 2000). Some
zoonotic disease agents, such as SARS and avian influenza, have the
potential to cause catastrophic disease epidemics that, in addition to
having extensive health repercussions, could also disrupt the social and
economic structure of societies. There is concern for the potential of
some zoonotic diseases to be used maliciously. All of the CDC category A
bioterrorism diseases, and many of the category B diseases, are zoonotic
(CDC, 2007). Thus, the prevention and control of zoonotic diseases is of
enormous importance to public health, and veterinarians have a pivotal
role in these
endeavors.
Not withstanding the importance of zoonotic disease, veterinary
medicines relationship to public
health
is
much
broader.
Dr.
Calvin Schwabe, in his seminal book titled Veterinary Medicine
and
Human
Health
argued that
all
of veterinary
medicine
contributes directly
or indirectly to public health (Schwabe, 1984).
Veterinarians are involved in protecting and promoting the health of
animals, which not only has direct effects via the prevention and control
of zoonotic diseases, but also an enormous indirect impact on public health.
Veterinarians who
work in the area of livestock health are involved in the
production of an abundant, affordable, safe and sustainable food supply. The
food animal veterinarian also is involved in preventing disease outbreaks in
livestock. Some of these outbreaks are zoonotic diseases but, even for
diseases that
are not zoonotic, outbreaks in animals can have enormous
social and economically disruptive effects. This was evidenced by the
outbreak of foot and mouth disease (FMD) in the United Kingdom in 2001,
which had profound economic effects on both
agricultural
and
nonagricultural industries, and psychosocial effects on both farmers and nonfarmers (Mort et al.,
2005; Anderson, 2002). Many veterinarians are
involved in ensuring the health of pet animals and this also has public
health impacts. There is empirical evidence of the mental, physical, and
social health benefits of owning pets (Wood et al., 2005; Raina et al.,
1999; Beck and Meyers, 1996), although exposure to pets may pose zoonotic
disease risks (Weese et al., 2002; Lynch, 1987). The health of non-food
animals or pets also indirectly benefits the public in that humans have both
cultural and aesthetic ties to a wide range of different animal species.
Veterinarians
and
veterinary medicine also have an impact on public
health through comparative and basic medical

research, through their expertise in population health approaches, and

through involvement in environmental health.
Within veterinary medicine, epidemiology is a core discipline for
contributions to public health. The field of veterinary epidemiology
encompasses
not
only a
set of
methodologies, but also a way of
thinking about broad issues and a scientific approach that is focused on
the health of populations. Veterinary epidemiology is relevant not only
to research that improves
or informs public health but also to the
practice of public health. From a research perspective, veterinary
epidemiology provides a vast array of methods and approaches related to
sampling methods and study design. These have evolved over time as our
knowledge and computing capacity have improved. For instance, there are
available a wide array of
multivariable
methods for understanding
disease sources and transmission and for identifying potential risk
factors for disease, and methods to allow control for clustering of
animals or human populations. There are multilevel models that allow a
consideration of concurrent effects at different levels, such as
individual, herd or community, and societal levels, and potential
interactions between these effects. Additional methodologies include
quantitative risk assessment, spatial and temporal models, computer
simulations and so on. From the standpoint of the practice of public
health, the field of veterinary epidemiology
also
contributes to a
number
of
approaches.
These
include
approaches
for
outbreak
investigations,
policy
development
and
evaluation,
program
implementation and evaluation, and disease surveillance.
2. Past influence of veterinary epidemiology on public

health

Within the veterinary public health literature, there are a plethora

of examples of these methodologies and their uses. However, one disease
that illustrates the breadth of both research and practice applications
of veterinary epidemiology and public health is bovine (zoonotic)
tuberculosis. Mycobacterium bovis is the causative agent of tuberculosis in
cattle. This agent has a wide host range that includes humans (OReilly
and Daborn, 1995; Morris et al., 1994). Prior to the implementation of
control programs, approximately 510% of human tuberculosis cases were
caused by M. bovis, although estimates vary between regions and by
clinical presentation (OReilly and Daborn, 1995). The remaining human
cases primarily result from infection with the human pathogen M.
tuberculosis. Milk is the primary source of M. bovis and the disease in
humans generally presents clinically as non-pulmonary tuberculosis in
children, although pulmonary tuberculosis may result from close contact
with infected cattle (Grange and Yates, 1994).
In the developed world, human tuberculosis caused by M. bovis has been
dramatically reduced by eradication or reduction of M. bovis in cattle
populations and by pasteurization of milk. However, it is still an
important zoonotic issue in many developing countries that lack the
infrastructure or resources to implement control measures or do not
implement control measures due to other competing disease issues (Cosivi
et al., 1998). The M. bovis status of a country also may have implications
for international trade of cattle and cattle products (Cousins and
Roberts, 2001; Caffrey, 1994; Tweddle and Livingstone, 1994). Efforts to
eradicate M. bovis from cattle populations in some countries have been
hindered by the presence of self-maintaining infections in non-bovine
species (OReilly and Daborn, 1995; Morris et al., 1994; Tweddle and
Livingstone, 1994). These include badgers in the UK and Ireland, possums
in New Zealand, and deer in several countries, including the recent
emergence of M. bovis in deer populations in the US (OBrien et al.,
2002; Griffin and Buchan, 1994; Morris et al., 1994; Nolan and
Wilesmith, 1994).

Therefore, although great strides have been made in the control of

zoonotic tuberculosis, it remains an important public health and trade
issue.
The successes in control of zoonotic tuberculosis in cattle, wildlife,
and humans are the result of multidisciplinary research and practice
efforts by both the animal health and public health communities. On the
research side, there is an enormous array of questions that need to be
addressed in order to understand and combat bovine tuberculosis. One
area where extensive research has been conducted is related to
eradication efforts in cattle. Even within
this
relatively narrow
research area, there are numerous issues that need to be addressed. For
example, extensive research using a wide variety of methodologies has
been conducted to understand the epidemiology of M. bovis in non-bovine
species and the potential role of wildlife in the transmission and
maintenance of M. bovis in cattle populations. A
brief overview of
methods will illustrate the breadth of epidemiological approaches that
have been used to research this area. The specific studies referenced
are meant to be illustrative, rather than an exhaustive list.
Evidence for the possible involvement of wildlife species originated
from case reports, case series, or prevalence studies describing illness
and/or tubercular lesions from which M. bovis could be isolated (Schmitt
et al., 1997; Nolan and Wilesmith, 1994; Muirhead et al., 1974).
Molecular epidemiology has been used to compare strains of M. bovis
between wildlife and cattle (Costello et al., 1999; Whipple et al.,
1997; Collins et al., 1994). Methodologies such as observational
studies, spatial and temporal analysis, and social network analysis have
been used to understand the dynamics of M. bovis within wildlife species
and to investigate the potential for these species to be involved in
transmission to cattle populations (Olea-Popelka et al., 2003, 2005;
Corner et al., 2003; Martin et al., 1997; Griffin et al., 1996). Field
trials have been used to compare the incidence of bovine tuberculosis in
areas where the wildlife host has been removed or controlled to areas
where no wildlife control effects have been implemented (Griffin et al.,
2005; Donnelly et al., 2003; OMairtin et al., 1998). Thus, a diverse
range of epidemiological methodologies and approaches have been used to
address a single area of research within the complex issue of bovine
tuberculosis.
Veterinary epidemiologists also provide important inputs to public
health practice. This is illustrated by the efforts to eradicate M. bovis
from cattle populations using a test-and-slaughter approach. The
experience in North America serves as an example. A wide range of
epidemiological methods and principles were applied, and the approaches
and methods evolved as eradication efforts succeeded. Initially, when M.
bovis was relatively common in cattle, testing efforts involved the
identification of infected animals within herds (Essey and Koller,
1994). Effective testing programs therefore required an understanding of
the sensitivity and specificity of available tests for detecting the
presence of disease in individual animals and, in the case of M. bovis, in
different species of animals. As eradication efforts began to succeed,
and the prevalence of M. bovis declined, testing efforts shifted to the
identification of infected herds, often by tracing back from positive
animals identified during surveillance at slaughter (Essey and Koller,
1994). Here, veterinary epidemiologists contributed through the
application of methodologies for determining herd sensitivity and
specificity, and the design and maintenance of surveillance systems in
cattle herds and in abattoirs, testing strategies for decision-making
with regard to animal movement, and systems for identifying and tracing
reactor animals. Finally, as eradication efforts succeeded, the
situation developed where disease was essentially absent. Testing and
surveillance systems under this scenario needed to address the issue of
false positive reactors (Martin et al., 1987) and the identification and
traceability of sporadic cases of M. bovis (Radunz, 2006).

There was, and remains, a need for coordination between veterinary and
medical surveillance systems in continuing efforts to control M. bovis.
Notifiable disease registries, case studies, and molecular epidemiology
have been used to identify sporadic cases of human disease and to
determine whether they are related to exposure to cattle, occupational
exposures, reactivation of earlier disease, or whether they were
acquired in another country (Cousins and Dawson, 1999; Cousins et al.,
1999).
3. Present influences of veterinary epidemiology on public

health

As
the
bovine
tuberculosis
example
illustrates,
veterinary
epidemiologists have had an enormous impact on public health, both from
a research standpoint and in the practice of public health. Another
significant impact of veterinary epidemiology on public health has been
the contribution of trained professionals. There are a large number of
veterinarians working in the field of public health, both as researchers
and as public health practitioners. In the United States, veterinarians
work in a wide range of public health organizations at the federal,
state, and local- levels in animal and human-health agencies, including
the Food and Drug Administration, Centers for Disease Control, and Food
Safety Inspection Service (King et al., 2004; Held and Gregory, 1992).
The majority of states in the US have state public health veterinarians
(King and Khabbaz, 2003). The involvement of veterinarians in public
health is not unique to the United States; most countries have
veterinarians embedded in their food protection and public health
systems (Adroit, 1992; Held and Gregory, 1992; Papadopoulos, 1992).
International animal and health agencies, such as World Health
Organization (WHO), Food and Agricultural Organization (FAO), and Office
International Epizooties (OIE), employ veterinarians in a variety of
public
health
capacities
(Pappaioanou,
2003).
However,
while
representing an impressive achievement, these citations reference
veterinarians
in
general,
rather
than
specifically
veterinary
epidemiologists.
To more specifically address the issue of veterinary epidemiologists
in public health roles, I first considered academia. Within academia,
all of the veterinary medical colleges in North America have at least
one epidemiologist on faculty and, based on a key word search of
veterinary college websites, all but a few of the North American
veterinary colleges have at least one veterinary epidemiologist involved
in zoonotic disease research, food safety research, or research
involving some other facet of public health. Many US veterinary colleges
offer either a Masters degree in public health or in veterinary public
health (Riddle et al., 2004). Clearly, veterinary academia represents an
impressive source of veterinary epidemiologists with expertise in public
health. Veterinary epidemiologists are not as well ensconced in human
medical universities. An informal web search of the 14 English-speaking
medical universities in Canada identified many veterinarians in basic
science departments and in laboratory animal medicine, but only a
minority of medical schools had veterinarians on faculty in their
epidemiology, community medicine, or public health departments. Thus,
there is an opportunity to better integrate veterinary epidemiologists
into human medical
academia.
While a consideration of academia provides insight into the role of
veterinary epidemiologists in public health, it represented primarily a
research role and does not address the duality of research and public
health practice. There does not exist a comprehensive list of the jobs
and responsibilities of individuals trained in veterinary epidemiology.
However, a sense of the broad roles of veterinary epidemiologists, both
in research and applied settings, can be envisioned by considering
graduate students, who represent the past, present and future of our
profession. To address this, I conducted an informal survey of the
current occupations of epidemiology graduate

students from the Department of Population Medicine at the Ontario

Veterinary College, University of Guelph (Guelph, Canada). This
department was chosen because Wayne Martin was the founding chair of the
department, taught all of the graduate students, was on the graduate
committees of many, and supervised quite a few. Over 160 students have
completed an MSc, PhD, or both in epidemiology in this department since
its inception. Of these, over 70% are involved at some level in public
health research or practice. These individuals are involved in a wide
range of public health activities, including zoonotic disease control,
food and water safety, surveillance, and other activities. They are
employed in government agencies, academia, private industry, research
institutes, and hospitals. In addition to the diversity of expertise and
employers, the former graduate students from this department are
employed in numerous countries throughout the world. While this example
was provided to illustrate the breadth of application of veterinary
epidemiological expertise in public health, it also speaks to the
remarkable teaching accomplishments of Wayne Martin and the Department of
Population Medicine that he founded.
4. Future influences of veterinary epidemiology on public

health

There are very real challenges to public health that will need to be
addressed in the coming years (Institute of Medicine, 2003). There are
increasing economic and other inequities between nations and this will
increase inequalities in public health between countries. Globally,
continued population growth and urbanization will challenge public
health systems. The increasing occurrence of diseases like obesity in
the developed world and HIV-AIDS in developing countries will have
profound implications to public health. New diseases continue to emerge,
and some have the potential for catastrophic consequences to the public
and to public health and medical infrastructure. The speed of
international travel means that infectious disease agents can move
around the world in a very short period of time. Our food supply is
increasingly global and the food safety implications of this are
enormous. Habitat encroachment leads to human contact with new species,
with the potential for exposure to new zoonotic diseases. Other
challenges to public health include environmental degradation, natural
and man-made disasters, climate change, and microbial adaptation. These
existing and future challenges to public health are going to have to be
met, and veterinary epidemiologists have an important role to play.
Veterinary epidemiologists can clearly help in meeting these challenges
by continuing to engage in research and public health practice. However,
there also is the opportunity for increased integration of people,
research methods, and public health practice across the animal to human
spectrum. Coupled with this is a need for increased communication
between these communities and with the public.
Despite the existing interactions between the animal health and human
health communities, there is still a need to better integrate public
health efforts and initiatives. For instance, physicians treating the
first cases of West Nile Virus in the eastern United States might have
benefited from knowing that veterinarians in the area had been seeing
birds with similar symptoms (Kahn, 2006). There are numerous
surveillance systems for zoonotic emerging diseases. However, they
generally lack standardized protocols and do not share data (King et
al., 2004). Thus, there is a need to develop surveillance systems that
include human and animal disease and also incorporate sampling of food,
vectors, and environmental samples, as appropriate. Examples of
integrated systems designed to meet this need include the Global SalmSurv project, a surveillance system for Salmonella and antimicrobial
resistance in Salmonella, which involves human samples, animal samples,
and food samples and currently has membership from 142 countries (WHO,
2006). Another example is ArboNet, a national West Nile Virus
surveillance system in the
US,

which collates data from humans, mosquitoes, birds, and other animals
(Lemmings et al., 2006; King et al., 2004).
There also is an opportunity to better integrate our research
methodologies between disciplines and across the animal and human public
health communities. Although veterinary epidemiologists are primarily
trained in the biological field, the problems we face are imbedded in
complex social, environmental, and economic systems (King, 2004). The
population health approach embraced by veterinary epidemiologists
involves a consideration of health and disease both in individuals and
in groups, and often incorporates a consideration of health determinants
at multiple levels. The levels of organization inherent in agricultural
research, the animal, herd, region, and country, have obvious
counterparts in human public health research: the individual, family,
community, and society. For this reason, and because of the broad range
of possible disease determinants, veterinary epidemiology often involves
collaborative research and the disciple is well positioned to provide a
leadership role in multi- and inter-disciplinary efforts. Within
epidemiology, there are many common research approaches used by both the
veterinary and human health communities, although often independently
and sometimes with different objectives. There is an opportunity to
integrate these methodologies to strengthen our ability to improve
public health. For instance, the food safety research community spends
considerable effort developing risk assessment models to describe
transmission chains and to identify areas for effective intervention.
The human health community has developed a variety of methods for
evidence-based synthesis of public health research. Combining these
methodologies has the potential to improve our ability to produce safe
food in a powerful and innovative way.
Meeting current and future public health challenges will require
enhanced communication as well as communication to a broader audience.
This should include methods to improve the timely dissemination of our
research findings, and their implications, to policy-makers to better
inform the policy process. It also is important to be able to
communicate risk to the public, as they will need to be a part of
meeting future public health
challenges.
Communication of research findings, although not always the broader
implications of those findings, is common through a wide range of peerreviewed publications and scientific meetings. Veterinarians also have
been effective at communicating their content knowledge, for example the
pathogenesis, transmission, and epidemiology of zoonotic diseases.
However, enhanced sharing of contextual knowledge could further enhance
communication. Contextual knowledge comprises our understanding of the
settings in which problems occur. These include, for veterinary
epidemiologists involved in livestock industries, an appreciation for
the economics of the farm, the trade implications of many zoonotic and
non-zoonotic diseases, and the economic and social inter-relationships
within rural communities. The implications of this complexity have been
evidenced during recent disease outbreaks. The outbreak of FMD in the
United Kingdom not only resulted in economic devastation to the
agricultural industry, but also to other industries such as tourism
(Anderson, 2002). The economic hardship and loss of social structure
within the rural community had public health consequences related to
stress and mental anxiety. A similar situation was seen following the
May 2003 finding of a cow positive for Bovine Spongioform Encephalopathy
(BSE) in Canada. Although BSE has limited zoonotic potential, the
finding of a positive animal led to enormous economic and social
disruption due to the dependence of the Canadian beef industry on its
export market (ONeill, 2005; Mitura and DiPietro, 2004). The public
health consequences of this disruption remain to be elucidated. However,
with their training in population-health approaches and knowledge of the
context of BSE in a country such as Canada, veterinary epidemiologists
were in a position to understand and communicate the consequences of a
single case of BSE. While communication of this context may not
have

mitigated the effects, it might have led to better preparedness for the
crisis. In the future, as new and potentially zoonotic diseases emerge,
veterinary epidemiologists have an obligation to communicate the full
range of their considerable content and context knowledge, not only to
researchers, but also to policy decision-makers and the broader public
health community.
5. Conclusion
Veterinary epidemiology is a core discipline of public health because
of the methodological approaches it embraces, but also because of its
focus on population health. Veterinary epidemiologists have contributed
to both research and the practice of public health. Continued excellence
in research and practice, increased integration between veterinary and
human health communities, and enhanced communication will be necessary
to meet future challenges in public health. As a profession, we can take
inspiration from Dr. Calvin Schwabe, who said that Improved human
health is the sole among veterinary medicines several benefits to
society that arises from virtually all of veterinarians diverse
activities... There is now and always has been only one medicine
(Schwabe, 1984).
Conflict of interest statement
Dr. Sargeant does not have a financial or personal relationship with
other people or organizations that could inappropriately influence or
bias the paper entitled The influence of veterinary epidemiology on
public health: Past, present and future.
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