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FROM tuberculosis, malaria, polio to the less-publicised Chikungunya and Leishmaniasis,

diseases continue to inflict humankind. As the world battles ‘arch enemies’ like AIDS and
cancers, newer foes like SARS, anthrax, West Nile, avian influenza, etc. have been raising
their ugly heads (some being deadly bio-terrorism tools!).Even chronic ailments related to
heart, metabolism, etc, and behavioural, neurological and psychological disorders are major
health issues that concern all nations, whether developed or developing. In response, action
needs to be taken. But here, the health of populations at large is in question, and thus,
service of ‘individual-centric’ doctors is limited. It calls for an elite band of ‘population-
centric’ professionals called epidemiologists.

THE THING

Epidemiology is widely recognised as a


diagnostic and management tool of public
health. Earlier it was just the ‘study of
epidemics’ but current-day health scenarios
have broadened the definition and scope in
epidemiology. The draft outline of the World
Health Report 2006 of World Health
Organization (WHO) mentions epidemiology as an important field that will be responsible for
shaping the future of health work.

THE PAUCITY, NEED AND IMPORTANCE

Dr Fawad Khan, from United Kingdom, is an epidemiologist and an orthopedic surgeon, in


Middle East division of the World Health Organization (WHO). He laments, “Epidemiologists
are scarce world over. And most people do not know what they do. Secondly, people do not
understand the concept of public health. There should be awareness that in medical field
there are not only physicians or surgeons but also public health workers which include
epidemiologists.”
Trends, actions and events (like lifestyle, economic and cultural status, foreign aid to a
nation, wars, natural disasters, etc) constantly affect the health of a population. It is
imperative, thus, that some surveillance is in place which can identify these factors and see
to it that action can be taken as and when called for. That is the role of epidemiologists. The
WHO report cites the significance of epidemiologists in control and prevention of diseases
during the tsunami outbreak in Thailand, and also their role in surveillance of SARS in China,
Hong Kong (China), Philippines and Vietnam.

THE SEVEN USES OF EPIDEMIOLOGY

1. Historical study: The rise and fall of diseases


2.Community diagnosis, community health: Burdens of disease, surveys
3. Workings of health services: Need, demand and supply, quality of care
4. Individual chances and risks: Prediction, risk scoring
5. Identifying syndromes: Clustering of symptoms and signs
6. Completing the clinical picture: Icebergs of disease, normal and abnormal
7. Search for causes: Secular and geographic variation, individual susceptibility,
multifactorial causation
(From: Morris JN. The uses of epidemiology. 3rd ed. Edinburgh: Churchill
Livingstone, 1975)

The west is relatively disease free due to work of epidemiologists. As an example, Shailee
Tanna, a Canadian medical student, informs, “In Canada, aside from research, resources and
money have been invested in studying
and developing prevention and control programs for diseases such as the West Nile disease
and the SARS. Due to this, SARS has been effectively controlled since after the epidemic in
2003, and so has the West Nile virus.”

EPIDEMIOLOGISTS MAY SPECIALISE IN:

Î Clinical Health Industry (Clinical Epidemiology)

Î Infectious Diseases (eg, HIV, Tuberculosis, Sexually


Transmitted Diseases)

Î Chronic Diseases (eg, Heart Disease, Cancer, Diabetes)

Î Occupational/Environmental Diseases

Î School Health

We also need to understand that epidemiological research has profound influence on


‘routine’ clinical practice of doctors. It gives validation for treatments or practices, and helps
conceptualise new ones.

FOCUS INDIA

In India, there is a shortage of field trained epidemiologists in the public health system. It is
estimated that the country requires minimum of 1000 trained epidemiologists (one per
district). Shruti Priya, faculty at Institute of Science, Mumbai, observes, “In India,
epidemiology is still in a developing stage and needs lots of efforts to get ahead.”
However, the demand for trained epidemiologists is increasing with the Integrated Disease
Surveillance Project being implemented in the country.
SCOPE AND TRAINING

Dr Manoj Murhekar, deputy director, National Institute of Epidemiology (NIE) states,


“Undergraduate medical students are taught a little about epidemiology. Very few courses in
the country teach it exclusively. Most MBBS graduates who want to pursue epidemiology, do
MD in Preventive and Social Medicine or Community Medicine. Career options are aplenty in
research, or in state/central public health sectors and NGO’s.” Internationally, one could try
for organisations like WHO and UNICEF, or health centres and research universities.

TRAINING INSTITUTES
(indicative listing)

Î National Institute of Epidemiology (NIE),


Î IndiaClen, Dr MGR Medical University,
Î Chennai National Institute of Communicable Diseases

An epidemiologist should have good logical and analytical faculties. He must be ready to
work in rural areas and be able to travel extensively.

VIEWPOINTS

Not everyone is as enthusiastic about epidemiology. Rahul Unnikrishnan, a medical student


at Jubilee Mission Medical College in Trichur, Kerela, says, “As a student, I am not
particularly interested in epidemiology.” He is quick to add though,“As a health professional,
I feel it is important to learn the pattern of diseases. The epidemiological aspect helps
doctors understand symptoms better.”
Despite understanding the importance, what stops the young lot from pursuing
epidemiology? Primarily, it is the lack of awareness, general non-interest, and even
nonavailability of recognised courses. Dr Khan quips, “I know if the doctors get an idea that
they can earn more through epidemiology, they will surely join this field of health.”

THE FINAL WORD

Dr Vivek Gupta, MD, is a senior resident at Centre for Community Medicine at AIIMS, New
Delhi. In attempt to reduce the lackluster attitude towards epidemiology, he says, “There is
an urgent need to improve the level of exposure our graduates have to
epidemiology. The science of epidemiology does not need the knowledge of
medicine. There are numerous fields such as nutritional epidemiology,
environmental epidemiology, social epidemiology, etc that are open to
students from diverse fields such as sociology, dietics, statistics,
microbiology etc. I see it as an up and coming field and as a good career
path for our younger generation.” Epidemiology is a vast topic and there is more to it that
can be put on paper. In a nutshell, global initiatives to improve public health ensure that
epidemiologists are here to stay.

(With inputs from Smita Shanbhag)

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