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A Timely Question--Can Epidemiology Improve Public Health?

SER Symposium Organizers Seek To Find Out

Presumably, epidemiologists know the answer to the questionócan epidemiology improve public health and would answer in the affirmative. However, Lydia Feinstein and Jessie Edwards of the University of North Carolina, the organizers of a symposium on this topic, were aware that epidemiologic data can get ignored in policy and program implementation, i.e., lost in translation.

They convened speakers on such varied topics as antibacterial soaps, HIV and TB, and asbestos to explore the triumphs and failures of epidemiology. We interviewed Dr. Feinstein about the symposium to learn more about what insights were gained.


EM:  A question you asked in your abstract wasócan epidemiology improve public health? Why was that question timely in your opinion?

Feinstein: This question was timely because, in recent years, the SER meetings have placed a strong emphasis on developing causal inference methods that directly estimate intervention effects. These emerging 'consequentalist' approaches, so to speak, have expanded our ability to conduct epidemiologic studies with clear interpretations for public health policy and clinical practice. However, the promise of novel epidemiolgic methods is often unrealized in the implementation of interventions in the field or in the development of new policy. The goal of our symposium was to showcase examples of epidemiologic studies that have been successfully translated into clinical practice or policy and to examine the different ways this process can unfold. Many of us tend to get stuck in this bubble of conducting secondary or simulated data analyses, with an end goal of getting our work published in a respectable scientific journal. I think it's important to take a step back sometimes and think about what it would take to actually get our results translated into public health action.

EM:  Epidemiologic data are often not translated into policy or action. What are some main reasons for that in your opinion?

Feinstein: There are many reasons, one being that many epidemiologists have never done public health field work and another reason being that many field workers have never done epidemiology. I think it's important for us to try to close that gap in both directions.   

EM:  Did your symposium discuss any of these reasons or identify new ones?

Feinstein: We did. We also discussed political barriers, funding priorities, and feasibility. It was also noted that sometimes epidemiologists study effects of interventions that could not be conducted in some settings, or aren't generalizable to particular target populations. As epidemiologists, we can certainly do more to ensure that our work is relevant and timely.

EM:  How would you describe the relationship between epidemiology and implementation science? What is the latter doing that the former is not, if anything?

Feinstein: First of all, we should note that people and groups have their own definitions of "epidemiology" and "implementation science." We sought to point out how epidemiology can be more useful by addressing issues directly related to implementation of interventions. Usually, epidemiology estimates the effects of interventions assuming that those interventions can be replicated exactly and that all effect modifiers can be measured (and modeled).

Implementation science highlights reasons that interventions may not be implemented with high fidelity to the original design (for better or worse). When we, as epidemiologists, consider implementation of our findings (in the forms of interventions or policies), we are forced to think about the assumptions underlying the generalizability of our results to specific settings, the feasibility of implementing that intervention or policy in the same way in other settings, and whether the proposed intervention optimizes some utility function (e.g., overall population health) over other candidate uses of the resources required for implementation.

EM:  Did your symposium identify concrete ways in which epidemiology improved health?

Feinstein: Yes, our symposium provided a few examples. Michael Herce discussed how epidemiology can be used to evaluate interventions and refine them as needed to suite a specific setting. He applied this idea to enhance his field work in HIV clinics in Malawi and Zambia. Similarly, Allison Aiello discussed how her dissertation work on hand hygiene eventually led to significant policy changes, including the banning of antimicrobial soaps. 

EM:  Do you have any other comments you would like to make about your session that are not mentioned above.

Feinstein: My co-chair Jessie Edwards and I were really glad to have the opportunity to organize this session. We had a fantastic turn out and a strong showing from a wide range of individuals, including methodologists, those whose work focuses on addressing more substantive research questions, and public health field workers. Bringing together this sort of integrative audience is an important first step to improve our ability as epidemiologists to have a strong positive impact on public health.  ■

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