MEASURMENT OF HEALTH AND DISEASE

Wondwosen Teshager(MPH)

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Contents of Measurement of Health and Disease
1. Introduction to public health and Epidemiology
2. Natural history of disease and levels of prevention
3. Infectious diseases epidemiology
4. Sources of epidemiologic data
5. Epidemiological Measures
6. Epidemiologic study designs
7. Measure of associations and Evaluation of Evidence
8. Public Health Surveillance
9. Epidemic Investigation and Management
10. Screening
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Unit one: Introduction to public health
Learning Objectives: After completing this unit, the student
will be able to:
• Define Public health
• Identify the important features of Public health
• Discuss the core functions of Public health
• Describe scopes of Epidemiology
• Explain Uses of Epidemiology
• Discuss basic assumptions in Epidemiology
• List fields of Epidemiology
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 Brainstorming

• Health

• Public health

• Medicine

• Epidemiology

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 Health: terms
Layman Point of view
• Persons are healthy when they are doing their activities with no
apparent symptoms of disease in them.
• The New oxford Dictionary of English describes health as ‘the state of
being free from illness or injury’.
Professional points of view
• A measure of the state of the physical bodily Organs, and the ability
of the body as a whole to function.
• It refers to freedom from medically defined diseases.

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 Introduction to public health
• Health : WHO Definition
• A state of complete physical, mental and social well being and not
merely the absence of disease or infirmity (WHO, 1948)
• This definition is also expanded to “ The ability to lead a socially
and economically productive life”

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Introduction …
• Physical health- is concerned with Anatomical integrity and
physiological functioning of the body.

• Mental Health- is the ability to learn and think clearly and coherently.

• Social health- is the ability to make and maintain acceptable

interaction with other people.

• Emotional health - is the ability of expressing emotions in the

appropriate way in case of stressful situation such as tension,
depression and anxiety.
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 Introduction…

• Disease - It is a physiological / psychological dysfunction.

• Illness: is a subjective state of the person who feels aware of not

being well

• Sickness: is state of social dysfunction, i.e., a role that the individual

assumes when sick.

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Introduction to Public health
• Public is about what of belonging to the people; relating to, or
affecting, a nation, state, or community; opposed to private.

• Public health is defined as “the science and art of preventing

diseases, prolonging life, promoting health and efficiencies through
organized community efforts and informed choices of society,
organizations, public and private, communities and individuals”.
(Winslow,1923)
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Why invest in public health?
• An effective approach is to prevent than to cure
• Public health contributes a great deal more to the health of a
population than medicine does.
• better nutrition and housing, sanitation and occupational
safety, vaccination
• Public health is usually publicly funded as market does not have
incentive to fund this

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Why invest in public health?
• Public health facilitates economic growth and contributes for poverty
reduction
• For example: In east Asia countries public health efforts
raised labor productivity and life expectancies which lead
to rapid economic growth in these countries
• Poor public health takes economic tolls in various ways
• reduced attraction for investors, tourists,
• continued expenditure in combating diseases
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Examples: Results of PH research
• PH affects the way that individuals make personal decisions about
their lives
• and the way that the government, public health agencies, and
medical organizations make policy decisions that affect how we
live.
• Cellular telephone users who talk or text on the phone while
driving cause one in four car accidents.
• Fire retardants in consumer products may pose health risks.
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 Scientific basis of public health

• The scientific basis of public health activities mainly comes from a

large number of disciplines
• Basic Sciences- pathology, toxicology
• Clinical Sciences/Medicine- internal medicine ,pediatrics
• Public health sciences- such as epidemiology, environmental
health science, health education, and behavioral science.

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 Community Vs Population
• Community: Refers a group of people, often living in a defined
geographical area who share a common: Culture ,Values, Norms and
Arranged in a social structure according to relationships they have
developed over a period of time”.

• Communities may also be based on shared interests or characteristics,

such as race/ethnicity, language, sexual orientation, age, or
occupation.

• Population refers to people who have no identity as a group or

locality. For instance: Men under
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fifty, Adolescents, Prisoners
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Clinical versus community medicine
• Clinical medicine focuses largely on the medical care of
individuals,
• i.e., sick people who seek medical help/care.
• It is concerned with diagnosing and treating diseases in
individual patients.

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Clinical versus community medicine
• Community Medicine: Concerned with the study of health and
Disease in human population.
• It is also concerned with diagnosing the health problems of a
community.

• The community replaces the individual patient by population as

a primary focus of concern

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 Community medicine
• All attempts are meant to evaluate the health of a defined
community including those members who would benefit from but
do not seek medical care.

• Comprehensive approach
• Curative
• Preventive
• Health promotion
• Rehabilitation
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 Clinical versus community medicine
• Clinical Medicine Techniques:
History + Physical Examination + tests ® Clinical diagnosis ®
Treatment ® Follow-up

• Community Medicine Techniques:

Discussion with the community + Health record survey + Field

Survey ® Community Diagnosis ® Intervention ® Monitoring
and Evaluation

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Clinical versus community medicine

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 Community Diagnosis:
• It is the process of identification and detailed description of the
most important health problems of a given community

• It provides basic decision on:

• The need for intervention
• Type of intervention needed
• Target group for intervention
• Base-line data for later evaluation

• This task requires Statistical and epidemiological knowledge

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 Methods of community diagnosis
1. Discussion with community leaders/health workers

2. Survey of records/secondary data sources

3. Filed survey
• Interview , physical examination and collection of specimen

4. Data collection, compilation and analysis

5. Intervention in priority problems

Why we act on priority health problem??
Problems --- huge

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Resources ----limitedIntroduction to public health 21
 Criteria for priority settings
1. Magnitude- the frequency, percentages/ coverage of the
health problem in the community.

2. Severity- seriousness
• To what extent does it cripples /disables/ cause death?

3. Feasibility-
• Do we have a mechanism to overcome ?
• Resources (trained man power, time and money)

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 Criteria for priority…

4. Community concern- It refers to the health felt need of the community.

• Dose the community perceives as a problem?

5. Government concern- It is the need of the government to be solved for

that community first.

• does it in line with the government policies and strategies

• Finally we use rating scale out of five. The disease or health problem
with the highest scores will be given priority in that community.
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 Example

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Sciences of public health
• Often five basic science of public health are identified:
• Epidemiology and Biostatics,
• Environmental Health,
• Management sciences and behavioral sciences.
• Nutrition and
• Maternal and Child Health
•Epidemiology and Biostatics are essential tools of public health.

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History of Public Health
• In 400 BC Hippocrates presents causal relation between environment
and disease

• In first Century AD: the introduction of public sanitation and an

organized water supply system by the Romans contributed to public
health

• In fourteenth century: Quarantine started to control bubonic plague or

Black Death epidemic

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History of Public Health
1750-1830 : Age of enlightenment
• Industrial revolution results in extensive health and social improvement in
cities in Europe and the United states.
• improvements in urban water supply
• Introduction of sewage system
• Municipal hospital
• Laws enacted
• Data on deaths and births began to systematically collected
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History of Public Health
Nineteenth Century

• Progress towards understanding the causes of communicable diseases was

made towards the last quarter of the century
• 1862 – Luis Pasteur’s proof of the Germ Theory of diseases
• 1876 – Robert Koch’s discovery of tubercle bacilli
• Walter Reeds demonstrated the role of mosquito in transmitting yellow
fever.
•1880-1910: the etiological cause and means of transmission for most
communicable disease were discovered
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History of Public Health
First half of the 20th century (1900-1945)

• Three formal inter governmental public health bodies established

• International sanitary bureau (1904)
• L’ office International d’Hygiene(1909)
• The League of Nations Health Office in Geneva (1920)

•There was reduction in child mortality; establishment of schools of public

health and international foundations

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 History of Public Health
In 1945-1990:
• The first decade after the end of the 2nd world war is considered as the
beginning of the current era of international public health.
• Creation of World Bank, WHO and other UN agencies; early 1940s.
• The Alma Ata declaration of PHC: 1978
• Small pox Eradication, last case reported 1977 (Somalia), eradication
declared in 1980
• 1981: the first case of HIV/AIDS, pandemic begins, efforts for universal
immunization; great attention to chronic diseases.
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History of Public Health

In 1990-2005:

• Priority given to health sector reform, equity, health and development,

the MDGs, impact of and responses to globalization, cost effectiveness,
public private partnership in health and use of information
communication technologies

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History of Public Health
• Public Health achievements in the 20th century
The dramatic achievements of Public Health in the 20th century:
• world wide reduction in infant, child and mortality, Maternal mortality
• the elimination or reduction of many communicable diseases
• increase in life expectancy,
• Control of Infectious Diseases
• Clean water and improved sanitation, and discovery of antimicrobial
therapy, led to successful control of infectious diseases.

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History of Public Health
• Safer & Healthier Foods
• Decreases in microbial contamination and increases in nutritional content
• Have almost eliminated major nutritional deficiency diseases in the
developed world.
• Reduced Maternal, infant and child mortality rates due to.
• Child hood immunization
• Family panning, antenatal & post natal services
• Interventions on childhood diarrhea diseases
• ARI program
• Infant feeding programs

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Important features of public Health
1. Social justice - Is the central pillar of public health

2. Inherently Political nature

3. Expanding agenda

4. Link with government

5. Grounded in science

6. It focuses on prevention

7. Uncommon culture
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Features of public Health
1. Social justice philosophy

•Justice -there is fairness in the distribution of benefits and burdens;

•Injustice -when persons are denied some benefit or when some burden is
imposed unduly.

•Factors that impede the fair distribution of benefits and burdens

•Social class, racism, disability, etc..

•Public health works to overcome those impediments.

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Features of public Health
2. Inherently political nature

• Public Health is both public and political in nature.

• The social justice component of public health stimulates political conflict

• Public health advocates at times appear as antigovernment

• Governmental public health agencies seeking to serve the interest of

both government and public health are frequently caught in the middle

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Features of public Health
3. Expanding Agenda
• Prior to 1900, the primary problems were infectious diseases and related
environmental risks.
• After 1900, the focus expanded to include problems and needs of children and
mothers
• Middle of the century: chronic disease prevention and medical care fell into public
health
• Later -substance abuse, violence, injuries
• Recently: Bioterrorism, other disaster preparedness are also added to the public
health agenda
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Features of public Health
• Bioterrorism-deliberate release of viruses, bacteria, or other germs
(agents) used to cause illness or death in people, animals, or plants.

• These agents are typically found in nature, but it is possible that they
could be changed to:
• increase their ability to cause disease,
• make them resistant to current medicines, or
• increase their ability to be spread into the environment

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 Features of public Health
• Smallpox and anthrax are examples of biological agents that could be used
for bioterrorism.
• A biological attack may not be recognized immediately and may take local
health care workers time to discover that a disease is spreading in a
particular area.
4. Link with Government
• Public health is linked with government in Two ways:
1. Issuing policies that govern the health of the population
2. Directly provide programs and services that are designed to meet the
health needs of the population
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Features of public Health
5. Grounded in Science

• Often five basic science of public health are identified:

• Epidemiology, Biostatics, Environmental science, Management sciences

and Behavioral sciences.

•Other sciences of public health:

•Maternal and Child Health

•Nutrition

•Occupational Health
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Features of public Health
6. Focus on prevention
• Prevention is the main purpose of public health
• It is aimed at preventing disease;
7. Uncommon culture
• Public health is unique in that many different sciences, art and methods
can contribute towards the same outcome.
• Vast majority of public health workers are not formally trained in
public health.
• Public health professionals include professionals from different
disciplines, like anthropologist, sociologist, psychologist, physicians,
nurses , nutritionist, lawyers , mangers etc..
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Public health functions

§ The core functions of public health include:

• Assessment
• Policy Development
• Assurance

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Core functions of public health
Assessment
• Every public health agency regularly and systematically collect, assemble, analyze,
and make available information on the health of the community, including statistics on
health status, community health needs, and epidemiological and other studies of health
problems.

Policy Development
• Every public health agency exercises its responsibility to serve the public interest in the
development of comprehensive public health policies by promoting use of the
scientific knowledge base in decision- making about public health
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Core functions of public health
Assurance
• Public health agencies assure their constituents that services necessary
to achieve agreed upon goals are provided, either by
• encouraging actions by other entities (private or public sector),
• requiring such action through regulation, or by providing service
directly”.

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 The Ten Essential Services of Public Health
1. Monitor health status to identify community health problems
2. Diagnose and investigate health problems and health hazards in the community
3. Inform, educate, and empower people about health issues
4. Mobilize community partnerships to identify and solve health problems
5. Develop policies and plans that support individual and community health efforts
6. Assure a competent public health and personal health care workforce
7. Enforce laws and regulations that protect health and ensure safety
8. Link people to needed personal health services and assure the provision of health care
when otherwise unavailable
9. Evaluate effectiveness, accessibility, and quality of personal and population-based health
services
10. Research for new insights and innovative solutions to health problems
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 Essential Services under Assessment
Essential services
1 Monitor health status to • Morbidity/ mortality reports
identify community health • Surveillance
problems • surveys

2 Diagnose and investigate • Community needs assessment

health problems and health • Surveys
hazards in the community

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 Essential Services under Policy
Essential services
3 Inform, educate, and empower • Mass medias, Brochures,
people about health issues • Leaflets, booklets
• Community gatherings…
4 Mobilize community • Community involvement thorough CBOs,
partnerships to identify and • Community conversation
solve health problems • Clubs

5 Develop policies and plans that • Develop different policies,

support individual and • Guidelines and plans
community health efforts • E.g.: drug policy, HIV/AIDS policy, ART
guideline, TB/Leprosy guideline, etc…
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 Essential Services under Assurance
Essential services
6 Assure a competent public health and • Trainings: Pre- service training (ensure
personal health care workforce quality and quantity), In service training and
Mentoring
• Assignment of health personnel
• Regular technical supervision
7 Enforce laws and regulations that • Quarantine law,
protect health and ensure safety • Sanitation ,
• STDs
8 Evaluate effectiveness, accessibility, and • Monitoring and evaluation
quality health services
9 Link people to needed personal health • Out reach services
services and assure the provision of • Campaigns
health care when otherwise unavailable • Expansion of health posts
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 Essential Services of Public Health…

Essential Service under – Assessment/Policy/ Assurance

10. Research for new insights and innovative solutions to health

problems
• Research serves all functions of public health

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public health core functions with services

50
Public Health Approaches
• Public health interventions dealing with infectious diseases are
defined based on their long term target :
1. Control
2. Elimination
3. Eradication
4. Extinction

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Public Health Approaches
1. Control
• reduction of disease incidence, prevalence, morbidity or mortality to a
locally acceptable level as result of deliberated efforts ; continued
intervention measures are required to maintain the reduction.
• Control programs in Ethiopia
• Malaria
• Tuberculosis
• Blindness
• STI
• HIV
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Public Health Approaches
2. Elimination
• Elimination is reduction to zero of the incidence of a specified disease
in a defined geographic area as a result of deliberate efforts;
continued intervention measures are required.
• Current elimination programs include
• neonatal tetanus
• leprosy
• onchocerciasis
• trachoma and
• lymphatic filariasis
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 Public Health Approaches
3. Eradication
• It is defined as permanent reduction to zero of the worldwide incidence
of infection caused by specific agent as a result of deliberate efforts
intervention measures are no longer needed.
Eradication Requires
• Political commitment must be gained at the highest levels, following informed
discussion at regional and local levels.
• A clear commitment of resources from international sources is essential from the start.
• A resolution by the World Health Assembly is a vital booster to the success of any
eradication programme.
• An advocacy plan must be prepared and ready for full implementation at global,
regional, and national levels.
• Eradication requires an effective alliance with all potential collaborators and
partners.
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Public Health Approaches
• Eradication Example
•Small pox Declared eradicated in 1978

4. Extinction: The specific infectious agent no longer exists in nature

or in the laboratory.
• Example:
• none.

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 Definition of Epidemiology
• The word Epidemiology derived from three Greek words:
• Epi, meaning ― on or upon,
• demos, meaning ― the common people, and
• logos, meaning ― the study.

• Putting these pieces together yields the definition of

epidemiology as : “the study of that which falls upon the common
people.”

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Definition of Epidemiology
• Epidemiology is the study of the frequency, distribution and
determinants of diseases and health related events in specified
human populations and

• the application of this study to the promotion of health and to the

prevention and control of major health problems.

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 Major components from the definition
Study:

• It is to mean epidemiology involves collection, analysis and

interpretation of health related data to facilitate health
related decision for action.

• Epidemiology is a scientific discipline, sometimes called

“the basic science of public health”

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Major components from the definition
Frequency:

• Epidemiology is concerned with the quantification of the occurrence of

diseases and other health related conditions.

• How many people are affected?

• Quantities , rates of disease occurrences

• Frequency of diseases is measured by morbidity and mortality rates.

• Because of this reason, epidemiology is considered as mainly a quantitative

science.
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 Definition…
• Distribution: the distribution/patterns of diseases in time, place and person.
• – It asks the questions: When? Where? Who?

i.e. Descriptive epidemiology

• Time characteristics include annual occurrence, seasonal occurrence, and daily or

even hourly occurrence of disease and health related events.

• Place characteristics include geographic variation, urban-rural differences, and

location of worksites or schools

• Personal characteristics include demographic factors such as age, race, sex,

marital status, and socioeconomic status,
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 Definition…
Determinants

• factors which determine whether or not a person will get a disease

• The causes and risk factors for the diseases

• It asks the questions: how? Why?

• How diseases are transmitted and prevented?

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Definition…

•“why diseases occur:

• in certain places?
• In a certain period?
• in a certain population groups?”

• The part of epidemiology dealing with the causes and determinants

of diseases is Analytical Epidemiology.
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 Definition…
Health related conditions
• Since every thing around us and what we do also affects our health.
• Epidemiology is concerned not only with disease but also with other
health related conditions
• This are conditions which directly or indirectly affect or influence
health.
• These may be
• injuries,
• vital events
• health related behaviors like smoking, unemployment,poverty etc.
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 Definition…
Population
• The main focus of epidemiology is on the effect of disease on the
population rather than individuals.
For example
• malaria affects many people in Ethiopia but lung cancer is rare.
• If an individual develops lung cancer, it is more likely that he/she will die.
• Even though lung cancer is more killer, epidemiology gives more emphasis
to malaria since it affects many people.

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Definition…

• Application: Epidemiology Provides the base for directing practical

and appropriate public health action.

“Epidemiology is a practical science”

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 History of epidemiology
• Although epidemiological thinking has been traced to the time of
Hippocrates, who lived around 5th century B.C., the discipline did not
flourish until the 1940s.
1. Hippocrates,(400 BC) the father of clinical medicine,
• He laid the earliest cornerstones of Epidemiology
• He attempted to explain disease occurrence from a rational instead of a
supernatural viewpoint.
• He related disease with the environment (air, water, earth) and host
factors such as behavior for the first time.
• He related disease with the environment for the first time and considered
as the first Epidemiologist.
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 History of epidemiology
2. John Grant -1662 AD
• The most important advances in epidemiology is attributed to the
English man John Grant (1620 –1674).
• He was the first to quantify patterns of birth, death, and disease
occurrence; noting male-female disparities, high infant mortality,
urban rural differences, and seasonal variations
• His research laid the groundwork for the disciplines of both
epidemiology and demography.
• His work is summarized in the “Natural and Political Observations….
Upon the Bills of Mortality”, which was first published in England in
1662.
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 History of epidemiology
3. William Farr- English physician in 1839 AD
• He utilized the medical statistics in England by extending the work
of John Graunt.
• He related mortality and morbidity with occupation, marital
status and altitude.
• He is considered as the father of modern vital statistics and
surveillance,
• He developed many of the basic practices used today in vital
statistics and disease classification like population at risk, and
Choosing appropriate comparison group .
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 History of epidemiology
4. James Lind (1747):
• He was the first person to use experimental study in human
populations to discover the cause and prevention of scurvy.
• He used fresh fruit to treat ―bleeding gums, i.e. scurvy
indicated that the cause of scurvy is deficiency of citrus fruit.
5. John Snow. In1853-54
• Considered as a father of modern epidemiology
• An English physician formulated and tested a hypothesis
concerning the origin of an epidemic of cholera in London.
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History of epidemiology
• On the basis of the available data snow postulated that cholera was
transmitted by contaminated water through a the unknown mechanism

• He used information to map the distribution of cases on what

epidemiologists call a Spot map.

6. Bradford Hill (1937)

• He suggested judgmental criteria currently used to establish cause-

effect relationship among exposure and outcome of interests
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 Scope of epidemiology
• A number of transition have been seen in the history of epidemiology:
• In the past epidemiology was concerned with infectious Disease and
mainly epidemics
• Now Scope of Epidemiology has expanded to include both infectious
and non- infectious Disease, such as:
• Injuries and accidents Nutritional deficiencies
• Maternal and child health occupational health
• congenital anomalies Environmental health
• Cancer, Health behaviors, etc.
• Can be applied to all diseases and health related conditions

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Evolution of modern Epidemiology
• Generally in the evolution of modern epidemiology,
Milestones have been broadly divided into four stages.
• Sanitary statistics
• Infectious disease epidemiology
• Chronic disease epidemiology and
• Multi-level causality
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Evolution of modern Epidemiology
The Era of sanitary statistics

• Focused on the environment

• Common in the first half of the19th century

• The widespread etiologic theory was "miasma” i.e. all diseases were
due to pollutes from soil, air, and water

• Focused on assessing the clustering of morbidity and mortality and on

preventive measures such as drainage, sewage, and sanitation
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Evolution of modern Epidemiology
The Era of infectious disease epidemiology
• Late 19th C - first half of the 20th C
• The germ theory prevailed
• It was the “Period of bacteriology”
• Focused on laboratory isolation and interrupting
transmission of the infectious agent

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Evolution of modern Epidemiology
The Era of chronic disease epidemiology: Since World War II

• Focused on risk factors at individual levels

• The "black box" approach: exposures are related to outcomes without

always understanding the principal factors or pathogenesis.

• Primary analytic methods: Risk ratios were used to relate exposures to

outcomes.

• Preventive measures:- control of risk factors by modifying the environment or

human behavior (e.g. smoking, diet, physical activity)
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Evolution of modern Epidemiology

Multi-level causality

• Multiple risk factors interacting to cause disease including molecular

pathogenesis of diseases

• The focus was on risk factors as well as causal pathways at the

community level and the pathogenesis at the individual level

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Evolution of modern Epidemiology

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 Factors leading to progressive development of
Epidemiology
• The need for quantitative reasoning in public health
• Possibility of conducting comparative studies – comparison of
groups or populations
• Increasing availability of vital statistics system
• Hygienic and public health movement
• Improvements in diagnosis and classification
• Advances in computer applications
• Increasing availability of personal computers
• Biotechnology revolution
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 Fields of Epidemiology
• In recent years, the field of epidemiology has expanded tremendously in size,
scope, and influence
• epidemiologists examine health determinants at the molecular(molecular markers)
and genetic level as molecular epidemiology and genetic epidemiology
respectively.
• Other field of epidemiology includes but not limited to:
• Cancer epidemiology
• Epidemiology of aging
• Neuro epidemiology
• Psychiatric epidemiology
• Nutritional epidemiology
• Pharmacoepidemiology
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• Reproductive, perinatal and pediatric Epidemiology
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 Purpose/use of Epidemiology
• The Ultimate purpose of Epidemiology is prevention and control of
disease, in an effort to improve the health status of populations.

• This is realized through:

1. Observation of the natural history of Disease.

• Knowledge of the natural history of Disease is essential to make

prognosis or the likely outcome of a patient's illness.

• The basis for rational decision about treatment.

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 Purpose/use of Epidemiology
2. Community health assessment and priority setting
• Epidemiological studies provide data for community
diagnosis, identification and detailed analysis of the
• health needs,
• demands,
• priorities and
• resources of a defined community.
• This would serve as basis for the planning and
implementation of health intervention measures.

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 Purpose of Epidemiology…

3. Identification of determinants of Disease:

• One of the most important purposes of epidemiological studies

is the identification of determinants of Disease whose
manipulation could lead to prevention and control of Disease.

• Many of the known causes of diseases are identified using

epidemiologic methods.

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Purpose of Epidemiology…
4. Improving diagnosis, prognosis and treatment:

• Epidemiology helps decision making in clinical medicine.

• Epidemiological research contributes to identification of

appropriate tests and criteria for diagnosis and screening tests.

• It can also help to determine the most effective treatment

and the likely outcome of patients for planning care.

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 Purpose of Epidemiology……
5. Evaluation of Methods of Disease Control.
• Any program designed to prevent and control a Disease must be
accompanied by methods for assessing whether the measures are
effective in reducing the frequency of the Disease.
E.g. the effectiveness of health education on infant feeding to
mothers attending ANC is evaluated by measuring decline in the
incidence of marasmus and kwashiorkor among children and the
change of knowledge, attitude and behavior of mothers.
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 Purpose of Epidemiology……
6. Identifying new syndromes and Classification of
Disease.

• investigation of outbreaks, case reports

• The epidemiological characteristics of Disease

• E.g. disease can be classified based on modes of
transmission , sexual , air borne, contagious , etc

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 Core Epidemiologic Functions
• Five major tasks of epidemiology in public health practice were
identified:
• Public health surveillance,
• Field investigation,
• Analytic studies,
• Evaluation, and
• Linkages
• Policy development [recently added].
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 Basic Assumptions in Epidemiology
There are two basic assumptions in epidemiology.

1. Non-random Distribution of Disease in human population.

• We didn’t get disease by random or chance but there are some
factors for the occurrence of the health problems

2. Human Disease has causal and preventive factors that can be

identified through systematic investigation of different
populations or subgroups of individuals within a population in
different places or at different times
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