An introduction

Epidemiology matters: a new introduction to methodological foundations

Chapter 1
Epidemiology is the science of understanding the
causes and distribution of population health so that we
may intervene to prevent disease and promote health.

Epidemiology Matters – Chapter 1 2

Examples of questions epidemiologists ask

 What is the incidence of myocardial infarctions between

2010-2020 among women born in 1950 in the United
States?
 What are the causes of myocardial infarctions in this
population?
 If we were to change population dietary habits, what
improvement in myocardial infarction incidence could we
affect?
Epidemiology Matters – Chapter 1 3
1. Evolution of epidemiology

2. Our approach to teaching epidemiology

3. Seven steps to conduct an epidemiologic study

4. Farrlandia

5. Summary

Epidemiology Matters – Chapter 1 4

1. Evolution of epidemiology

2. Our approach to teaching epidemiology

3. Seven steps to conduct an epidemiologic study

4. Farrlandia

5. Summary

Epidemiology Matters – Chapter 1 5

 Evolution of epidemiology
 Epidemiology is a relatively new as a formal scientific
discipline
 Practice of conducting epidemiologic studies is not new;
‘counting’ health and disease goes back centuries
 Many of design and analytic techniques that we use
today arose in response to health concerns during 19 th
and 20th century

Epidemiology Matters – Chapter 1 6

 Epidemiology, a beginning
 John Graunt – 17th century - pioneered approaches to tabulating
population health and mortality in rates, ratios, and proportions
 William Farr – 18th and 19th century - developed more
sophisticated life table approaches to understanding the force
and burden of mortality
 John Snow – 19th century - used epidemiologic approaches to
understand London cholera epidemic; developed and applied
basic measures of disease frequency and occurrence

Epidemiology Matters – Chapter 1 7

 Epidemiology history, continued
 19th century – focus on infectious disease

 20th century – high-income countries shifted toward

non-communicable diseases
 Mid 20th century – methods formalized (1970s)

 Late 20th century – Miettinen, Rothman, and

Greenland - modern epidemiology (1980s)
formalized central disciplinary principles
Epidemiology Matters – Chapter 1 8
 Current conceptual movements
1. Ecosocial perspective on population health – suggests policies,
institutions, and characteristics of context contribute to the
shaping of health
2. Life course perspective – determinants of health are distributed
across the life course and even before conception  

Therefore, epidemiology understands causes of population health

across levels of influence - from cells to society - and across life
course.

Epidemiology Matters – Chapter 1 9

 An ecosocial framework
Social and Economic Policies

Institutions

Neighborhoods and Communities

Living Conditions

Social Relationships

Individual Risk Factors

``
Genetic/Constitutional Factors
``
Pathophysiologic pathways

Individual/Population
Health

Kaplan, G. What’s wrong with social epidemiology, and how can we make it better? Epid Rev 2004; 26: 124-135
 A lifecourse approach to health production

Uauy, R. et al. Diet, nutrition, and the life-course approach to cancer prevention. J Nutr 2005; 135: 2934S-2945S
1. Evolution of epidemiology
2. Our approach to teaching epidemiology

3. Seven steps to conduct an epidemiologic

study

4. Farrlandia

5. Summary
Epidemiology Matters – Chapter 1 12
Our approach to teaching epidemiology

 We are interested in an epidemiology of consequence, an epidemiology

that can guide the improvement of the health of population
 Therefore, we focus here on teaching underlying concepts that start
from understanding populations, and lead the learner through the key
steps to designing an epidemiologic study
 We will mention and adopt the labels that are used in many other
epidemiology textbooks (e.g., confounding) but only after we have
introduced the reader to the underlying concepts

Epidemiology Matters – Chapter 1 13

1. Evolution of epidemiology
2. Our approach to teaching epidemiology

3. Seven steps to conduct an epidemiologic study

4. Farrlandia

5. Summary

Epidemiology Matters – Chapter 1 14

Epidemiology of consequence, seven steps
1. Define the population of interest
2. Conceptualize and create measures of exposures and health
indicators
3. Take a sample of the population
4. Estimate measures of association between exposures and health
indicators of interest
5. Rigorously evaluate whether the association observed suggests a
causal association
6. Assess the evidence for causes working together
7. Assess the extent to which the result matters, is externally valid, to
other populations

Epidemiology Matters – Chapter 1 15

Epidemiology of consequence, seven steps

Descriptive epidemiology
 Step 1. Define the population of interest
 Step 2. Conceptualize and create measures of exposures and health indicators
 Step 3. Take a sample of the population
 Step 4. Estimate measures of association between exposures and health indicators of interest

Assessing for causal effect

 Step 5. Rigorously evaluate whether the association observed suggests a causal association

Conceptualizing and testing for interactions

 Step 6. Assess the evidence for causes working together
 Step 7. Assess the extent to which the result matters (is externally valid) to other populations

Epidemiology Matters – Chapter 1 16

1. Evolution of epidemiology
2. Our approach to teaching epidemiology

3. Seven steps to conduct an epidemiologic study

4. Farrlandia

5. Summary

Epidemiology Matters – Chapter 1 17

 Farrlandia

 Examples often based on hypothetical geographic area,

Farrlandia
 Inspired by William Farr, pioneering epidemiologist and
statistician
 Through use of Farrlandia examples, students will focus
on applying foundational concepts to populations

Epidemiology Matters – Chapter 1 18

1. Evolution of epidemiology
2. Our approach to teaching epidemiology

3. Seven steps to conduct an epidemiologic study

4. Farrlandia

5. Summary

Epidemiology Matters – Chapter 1 19

 Summary
 This book aims to provide learners with a systematic
grounding in the theoretical underpinnings of epidemiology
with an awareness of the practical considerations that are
essential for public health professionals
 This text establishes a foundation by building on
methodological innovation and teaching of the previous
century, while adopting a novel approach to teaching
epidemiologic foundations

Epidemiology Matters – Chapter 1 20

epidemiologymatters.org

Epidemiology Matters – Chapter 1 21