Global Health Epidemiology

Epidemiology is a field with a long and distinguished pedigree dating back to Hippocrates, who coined the terms epidemic and endemic.  Its methods and its practitioners have made such influential discoveries as the relationship between water supply and cholera outbreaks, the causal relationship between smoking and cancer and the dependence of health on social determinants.  Each of these discoveries have had profound implications for the health of whole populations and policies implemented on their evidence have affected some of the biggest improvements in the quality of human life through heath intervention.

The WHO defines epidemiology as ‘the study of the distribution and determinants of health-related states or events (including disease), and the application of this study to the control of diseases and other health problems.’ Epidemiological studies are broadly descriptive, analytical or experimental, employing the Bradford-Hill criteria for causality (see below). Epidemiologists are involved in study design, analysis and setting the context and implications of results.  All told the influence of epidemiology extends as far across the breadth of medical research as perhaps any other discipline.

Bradford-Hill criteria:

  1. Strength
  2. Consistency
  3. Specificity
  4. Temporality
  5. Biological gradient
  6. Plausibility
  7. Coherence
  8. Experiment
  9. Analogy

Global Health Epidemiology has been created to support collaboration and capacity building in the practice of epidemiology globally.  But why the need for research conducted locally, by local researchers and according to locally defined priorities?  Environmental and genetic risk factors historically identified in mainly European populations may differ markedly with risk factors in the local population.  The resultant impact on preventative public health measures and healthcare planning for country specific disease prevalence indicates the seminal importance of locally conducted epidemiological research.  Differential funding and reimbursement systems and country specific organization of healthcare institutions necessitate the exploration of locally generated health economic and health policy research.  Furthermore clinical trials, often conducted in special trial conditions in Western Healthcare systems, cannot be guaranteed to generate findings which are applicable in low resource healthcare systems and may even cause harm.  Pragmatic trials conducted locally may help to translate the findings of existing trials into new contexts.  Add to this the emergent field of personalized medicine with treatment according to individual patient genetics and the impact of ethnic variation between countries become yet another compelling reason to support local research.
Global Health Epidemiology has been started to create a research capacity building community in the field of Epidemiology research.  Global health Epidemiology provides a platform for sharing of expertise in the design and execution of both descriptive and analytical studies around the world.  It will create communities of practice in order to reduce redundancy in expertise, leverage global institutional partnerships and drive efficiency in building research capacity in LMICs.  Global Health Epidemiology provides a conduit for the Global Epidemiology research community to connect remotely and provides the tools to facilitate distance learning and mentoring of clinical researchers.  In so doing Global Health Epidemiology aspires to support others in training a cadre of clinical researchers in LMICs who can themselves begin to tackle the challenges that lie ahead.