EPID160/EPID600: Role of epidemiology in public health

University of North Carolina at Chapel Hill
Gillings School of Global Public Health
Department of Epidemiology

EPID600, Principles of Epidemiology for Public Health

Instructors: Victor J. Schoenbach, Lorraine K. Alexander

Role of epidemiology in public health

Supplemental readings and notes
for my lecture on “The role of epidemiology in public health”

World poverty

Status of women

Muneeza Naqvi (Associated Press). "Despite economic growth, India lets girls die" (article)

Violence against women

"SPLC Wins Settlement for Woman Sexually Assaulted at Tuscarora Yarns Inc. of Mt. Pleasant, N.C (story)

Trafficking in human beings

UNICEF Innocenti Research Centre in Florence, Italy - April 2004
Series: Innocenti Insight, 9 - 2004 - ISBN: 88-85401-89-9 [link]
Summary PDF [5p.] http://www.unicef-icdc.org/presscentre/presskit/insight9/ct_is_eng.pdf
In recent years child trafficking has gained visibility as a major violation of children's rights and is a priority concern for the UNICEF Innocenti Research Centre. Trafficking of human beings affects every country in Africa for which data are available, either as countries of origin or destination. This report looks at information from 53 African countries and provides an analysis of the patterns, root causes, and existing national and regional policy responses and effective practices. Trafficking occurs when a child's protective environment collapses from such insults as conflict, economic hardship, and discrimination. Traditional attitudes and practices, early marriage, and lack of birth registration further increase the vulnerability of children and women to exploitation.

The Gillings School of Global Public Health Office of Global Health participated in national conferences on trafficking in April 2006 and 2007. For more on trafficking and contemporary slavery, see www.iabolish.com.

Sex Slaves "An undercover journey deep into the world of sex trafficking, following one man determined to rescue his wife - kidnapped and sold into the global sex trade." PBS Frontline

Population and the environment

"We are altering the physical, chemical, and biological systems of the planet in ways that have enormous implications for all living things, including ourselves. . . . the greatest danger for the environment lies in the profound lack of understanding among political leaders and policymakers, particularly in the United States, of the fact that human health ultimately depends on the health of the global environment." Eric Chivian, quoted in Harvard Magazine, March-April 2003 [Full article]

". . . food has quickly become the hidden driver of world politics . . . At issue now is whether the world can go beyond focusing on the symptoms of the deteriorating food situation and instead attack the underlying causes. If we cannot produce higher crop yields with less water and conserve fertile soils, many agricultural areas will cease to be viable.... If we cannot move at wartime speed to stabilize the climate, we may not be able to avoid runaway food prices. If we cannot accelerate the shift to smaller families and stabilize the world population sooner rather than later, the ranks of the hungry will almost certainly continue to expand." Lester R. Brown, "The New Geopolitics of Food" Foreign Policy May/June 2011 (link) ( Food: The Hidden Driver Of Global Politics, 5/18/2011 interview with Terry Gross, on Fresh Air)

Scores for hyperactivity and aggression in two-year-old children were associated with levels of prenatal exposure to Bisphenol A, a weak estrogenic substance contained in many products made from polycarbonate plastics or epoxy resins. (Braun et al., 2009)

Al Gore’s film on global warming, An Inconvenient Truth, offers a powerful presentation of some of the themes from this lecture and, I was pleased to see, also identifies human consciousness as the critical element to address.

". . . intertwined, global-scale challenges spawned by the accelerating scale of human activity . . . are outpacing the development of institutions to deal with them . . . The core of the problem is inducing cooperation . . ." Brian Walker, Scott Barrett, Stephen Polasky, et al. Looming global-scale failures and missing institutions. Science 11 Sept 2009;325:1345-1346. (Summary)

Social determinants of health

For those inspired or intrigued by my last lecture, here is an aphorism attributed to epidemiology grandfather Abe Lilienfeld in a commentary by Sir Michael Marmot, writing in the European Journal of Epidemiology: “without epidemiology there is no public health; without public health there is no epidemiology” (Marmot also quotes Olli Miettinen, “astronomy is about the cosmos and not about the telescope”. The Epidemiology Monitor reported on a WHO Commission that Sir Michael is chairing on the Social Determinants of Health (www.who.int/social_determinants/en/ ) and on his article in the 3/19/2005 issue of The Lancet [365(9464):p1099-1104].

The Equality Trust (www.equalitytrust.org.uk/) has compiled evidence that large scale income inequality is an underlying determinant across a range of health and social problems. (Thanks to Paul Brodish for pointing me to this resource.)

A great deal of public health can be regarded as effective management of people. When people are not managed well, problems arise. Vivid examples are stampedes that result in death and injury when no vital needs are at stake. Two persons died and others were injured trying to attend a speech by Pope Benedict XVI in Angola in March 2009 (article). During fall 2008, a Wal-Mart greeter was trampled to death by shoppers rushing to get items on sale at a Valley Stream, NY Wal-Mart (Newsday story).

James S. Marks, MD, MPH presented an eloquent lecture at the annual meeting of the American College of Epidemiology about Epidemiology, Public Health and Public Policy, in which he addressed social and policy determinants of health, the role of epidemiology, and the relation between public health and social justice. He presented many of these ideas in a Dean’s Lecture at the UNC Gillings School of Global Public Health in 2010 (webcast).

"To maximize the health of its citizens, society should pursue interventions in proportion to the ability of those interventions to improve outcomes. . . . The 'silo' mentality that pervades so much of clinical practice and policy in the United States often finds decision makers focusing their attention and resources on a specific patient or disease - any one is a worthy cause - without stepping back to examine the balance of their efforts." Stephen H. Wolff, "Potential Health and Economic Consequences of Misplaced Priorities", JAMA 2007;297:523-526.

Corporate behavior

Why having Phillip Morris' support for your tobacco control legislation should give you pause. [read]

Founded by a UNC graduate (Kathryn Mulvey '88), Corporate Accountability International challenges irresponsible and dangerous actions by large corporations. Corporate Accountability International (formerly Infact) has led successful campaigns in relation to marketing infant formula, nuclear weapons business, corporatization of health care, tobacco, and protection of air and water. (Carolina Alumni can read about Kathryn Mulvey's work in the July-August 2005 issue of the Carolina Alumni Review).

“Factory Defies Sweatshop Label, but Can It Thrive?”, Stephen Greenhouse, NY Times, 7/16/2010 (article) (Short video, 2010)

On a positive note, some corporations are moving toward integrated reporting that in principle could improve corporate behavior toward society and the environment. A revolution in corporate reporting, Harvard Magazine March-April 2011. (Robert G. Eccles website)

Government and political behavior

In 2007 CDC Director Julie Gerberding’s testified before the Senate Environment and Public Works Committee. In the White House review of her draft testimony, according to Donald Kennedy, Editor-in-Chief of Science, “The Office of Science and Technology Policy raised questions about particular statements and made suggestions, but then the Office of Management and Budget, apparently unwillilng to work on the suggestions, simply eliminated every section about which questions had been raised.” (21 Dec 2007, p1833), thus eliminating 6 of the 12 pages of testimony. (New York Times report)

Over 300,000 people have died and 2.7 million been driven from their homes in the 8-year-old conflict in the Darfur region of Sudan. In response to an indictment from the International Criminal Court, the Sudanese government ordered the expulsion of aid groups attempting to meet the basic needs of Darfur refugees.

In his Fresh Air interview with NPR's Terry Gross about his new book, The Fear: Robert Mugabe and the Martyrdom of Zimbabwe, journalist Peter Godwin explains that Robert Mugabe's armed supporters ". . . killed hundreds of people, but they tortured vast numbers of people. And then they released them back to their communities so they acted like human billboards - they were advertisements for what happens if you oppose the regime." (A Journalist Bears Witness To Mugabe's Massacre)

The so-called War on Drugs should perhaps be subtitled "shooting ourselves in the feet". See President Jimmy Carter's op-ed "Call off the global drug war" in the 6/16/2011 New York Times (read)

Universities emphasize reasoned discourse in which arguments are based in logic and evidence. In principle, insights and decisions arrived at through dispassionate inquiry and a commitment to honest discussion should be superior to those informed by half-truths, distortions, misleading statements, and appeals to emotion. Sadly, political campaigns and policy debates are frequently characterized by the latter (witness the 2009 debate over health care reform). But even nasty and dishonest campaigns are a preferred alternative to terrorism and armed combat!

New approaches

A 2009 report from the New Economics Foundation (NEF), National Accounts of Well-being: bringing real wealth onto the balance sheet, "presents a radical, robust proposal to guide the direction of modern societies and the lives of people who live in them. It demonstrates why national governments should directly measure people’s subjective well-being: their experiences, feelings and perceptions of how their lives are going. It calls for these measures to be collected on a regular, systematic basis and published as National Accounts of Well-being. The measures are needed because the economic indicators which governments currently rely on tell us little about the relative success or failure of countries in supporting a good life for their citizens." The NEF also has a website for National Accounts of Well-being.