1. The Impact of Epidemiology in Public Health Robert Hirokawa Epidemiologist, Science and Research Group HHI / TSP, Hawaii Department of Health

2. 3 Core Functions of Public Health The Institutes of Medicine (IOM) defines the three core functions of governmental public health as: Assessment Assessment Policy development Policy development Assurance Assurance

3. 10 Essential Public Health Services Monitor health status to identify community problems. Diagnose and investigate health problems and health hazards in the community. Inform, educate, and empower people about health issues. Mobilize community partnerships and action to identify and solve health problems. Develop policies and plans that support individual and community health efforts. Enforce laws and regulations that protect health and ensure safety. Link people to needed personal health services and assure the provision of health care when otherwise unavailable. Assure a competent public health and personal health care workforce. Evaluate effectiveness, accessibility, and quality of personal and population- based health services. Research for new insights and innovative solutions to health problems.

4. Epidemiology Defined The study of distribution and determinants of health and disease in human populations

5. 3 Essential Components of Epidemiology Disease distribution Disease determinants Disease frequency Expected levels Expected levels Endemic Endemic Sporadic Sporadic Epidemic Epidemic Pandemic Pandemic

6. Types of Epidemiologic Studies DescriptiveAnalytic

7. Descriptive Studies Frequency of occurrence of a particular condition Patterns of occurrence Person Person Place Place Time Time

8. Hawaii Obesity and Diabetes Trends 1. Percentage of Hawaii adults that are obese, BRFSS 1990 - 2006 2. Percentage of Hawaii adults who have been diagnosed with diabetes, BRFSS 1995 - 2006 2. Percentage of Hawaii adults who have been diagnosed with diabetes, BRFSS 1995 - 2006

9. Hawaii crude adult obesity (BMI > 30) prevalence (%), BRFSS, 2005

10. Hawaii crude adult obesity (BMI > 30) prevalence (%) by race/ethnicity, BRFSS, 2005

11. Hawaii crude adult diabetes prevalence (%), BRFSS, 2005

12. Hawaii crude adult diabetes prevalence (%) by race/ethnicity, BRFSS, 2005

13. Analytic Studies Observational Studies (exposure not controlled) Case-control Case-control Cohort Cohort Experimental (exposure controlled)

14. Case-Control Study (Observational Study) ExposureDisease Group 1 has disease (Cases)??? Group 2 disease free (Controls)???

15. Cohort Study (Observational Study) ExposureDisease Group 1 has exposure??? Group 2 not exposed???

16. Experimental Study Intervention Studies Clinical Trial

17. Basic Presentation of Results YesNoTotals Yes4060100 No1090100 Totals50150200 Lung Cancer? Smoke? Relative Risk = Probability of disease among those exposed divided by the probability of disease among those not exposed

18. Basic Presentation of Results YesNoTotals Yes4060100 No1090100 Totals50150200 Lung Cancer? Smoke? RR = 40/100 divided by 10/100 =.4/.1 = 4

19. Measurement Errors Bias Information Information Selection SelectionConfounding Statistical Errors

20. Cause – Effect Relationship Strength of association ConsistencyTemporality Biological plausibility Gradient (dose – response)

21. Measures of Disease Frequency Prevalence Rate = # of existing cases / total population Incidence Rate = # of new cases / total population at risk

22. Commonly Used Rates CrudeCategory-specificAge-adjusted

23. Impact of Epidemiology in Public Health Improved understanding of the distribution and determinants of health and disease in human populations Used to drive program planning, resource allocation, interventions, and evaluation

24. Thank you!