Public Health

Epidemiology is the science that underpins health and health care, and is concerned with the pattern, frequency, and causes of disease. This book describes and illustrates epidemiology and its applications to policy making, health service planning, and health promotion. This book's first edition developed a conceptual approach to epidemiology, which involves a systematic focus on underlying concepts and fundamental principles, and this edition expands upon this popular method. It emphasizes theories and principles, as the bedrock of methodology, countering the mounting criticism that epidemiology is an atheoretical discipline. The interdependence of epidemiological studies and their essential unit within a theoretical, technical, and ethical framework is an important theme of this book. The emphasis is on interactive learning throughout, with each chapter including learning objectives, both theoretical and numerical exercises, recent examination questions from relevant courses, and a summary. The text is illustrated, with material summarised in tables.

Coronary heart disease is the leading cause of death worldwide affecting millions of people in both developed and developing countries. The dual aims of this book are to review the well-established and emerging risk factors in coronary heart disease (CHD) and to apply this knowledge to public health approaches to disease prevention. The book includes authoritative accounts of studies within a single population and international studies, important areas of methodological development, trials to test preventive strategies, and the application of epidemiological and other knowledge to the development of public health policy for the prevention of widespread disease. It is an all-encompassing work containing contributions from the world authorities in the field. The book is divided into four sections. The introduction reviews advances in the understanding of, and the current status, of risk factors for CHD. Section Two looks at recent global trends and emerging patterns of CHD morbidity and mortality in several countries, and includes chapters on work done under the auspices of the World Health Organisation (WHO) on the global burden of disease in relation to smoking and blood pressure. Section Three focuses on advances in understanding the aetiology of CHD with each chapter focused on a particular risk factor. Section Four explores measures of prevention and intervention in terms of public health policy with specific examples from around the world.

This book presents a logical system of critical appraisal, and facilitates studies to be evaluated and carried out effectively. This system emphasizes the central importance of cause and effect relationships. Its great strength is that it is applicable to a wide range of issues, and both to intervention trials and observational studies. This system unifies the often different approaches used in epidemiology, health services research, clinical trials, and evidence-based medicine, starting from a logical consideration of cause and effect. The book looks at the issues of study design, selection of subjects, bias, confounding, and the place of statistical methods. Systematic reviews, meta-analysis, and the applications of this logic to evidence-based medicine, knowledge-based health care, and health practice and policy are discussed. Current and often controversial examples are used, including screening for prostate cancer, publication bias in psychiatry, public health issues in developing countries, and conflicts between observational studies and randomized trials. Statistical issues are explained clearly without complex mathematics, and the most useful methods are summarized in the appendix. The final chapters give six applications of the critical appraisal of major studies: randomized trials of medical treatment and prevention, a prospective and a retrospective cohort study, a small matched case-control study, and a large case-control study. In these chapters, sections of the original papers are reproduced and the original studies placed in context by a summary of current developments.

Highly active antiretroviral therapy (HAART) is a therapeutic intervention developed by clinicians and researchers in order to fight the HIV pandemic. It has contributed to a significant reduction in AIDS-related mortality and allowed many previously bed-ridden patients to live healthier, more productive lives. Until the advent of HAART in 1996, a diagnosis of HIV infection was considered a death sentence. A decade later, the disease has been transformed into a serious, yet potentially manageable, medical condition for thousands of people living with HIV/AIDS in the developed world — almost overnight creating a generation of ‘HIV Survivors’ — and forged a global movement to ensure that its Lazarus-like benefit reaches millions more in the developing world. This book reviews the achievements of HAART over the past decade and explores the challenges that may arise in the future. It recounts key landmarks in the development and introduction of HAART from the perspective of clinicians, researchers, economists, sociologists, and public policy experts, including the co-discoverers of HIV, Luc Montagnier and Robert Gallo. It explores the evolution of the disease, the evolution of HIV treatment, and the economic, social, and public policy impacts of both HIV and the introduction of HAART.

This book marks the 50th anniversary of the foundation of the International Epidemiological Association (IEA). It is a compendium by the world's leading epidemiologists of how the field has developed, and how it can be (and has been) applied to the control of common conditions and threats to public health. Five distinct sections detail through the wealth of material. The first section gives an historical account of the concepts and ideas, and current importance of epidemiology to global health issues and to organisations such as the WHO. The second section illustrates the advances and contributions to epidemiologic knowledge and the control of disease in specific areas such as cancer, cardiovascular disease, respiratory disease, tuberculosis, maternal and child health, non-biologic disorders such as war and disasters, and new infectious diseases. The next section outlines the use of epidemiology in areas such as public health, health services, occupational and environmental medicine, and social epidemiology and nutrition. Section Four discusses methodological developments such as statistics, information sources, investigation of disease outbreaks, and clinical epidemiology. The final section looks at how the subject has developed internationally, with perspectives on regions such as the Americas, Poland, Spain, Eastern Mediterranean, New Zealand, China, Thailand, and Japan. This insight into how epidemiology has developed is essential reading for both existing and aspiring epidemiologists, as well as public health practitioners and health managers.

Numerous research programs have developed over the last decade to improve the understanding of the causes, prevention, and treatment of diabetes and its complications. Efficient synthesis of the data and information from these diverse sources is crucial to prioritize interventions and assemble resources for the implementation of public health programs. This book meets this need and builds on previous works to reflect the evolution of science related to diabetes public health. Through compelling evidence related to the current health and economic impact of diabetes, the book provides effective approaches to prevent and manage diabetes through the practice of public health. It combines descriptions of risk factors and complications, effective and cost-effective approaches to prevention and treatment, translational research, and genomics to give an analysis on diabetes public health. Critical review and synthesis of influential epidemiologic studies and consensus statements, expected future advances in trials and technologies, and public health information resources are also highlighted topics.

Fifteen to twenty years is how long it takes for the billions of dollars of university-based research to translate into evidence-based policies and programs suitable for public use. Over the past decade, an exciting science has emerged that seeks to narrow the gap between the discovery of new knowledge and its application in public health, mental health, and health care settings. Dissemination and implementation (D&I) research seeks to understand how to best apply scientific advances in the real world, by focusing on pushing the evidence-based knowledge base out into routine use. To help propel this crucial field forward, this book aims to address a number of key issues, including: how to evaluate the evidence base on effective interventions; which strategies will produce the greatest impact; how to design an appropriate study; and how to track a set of essential outcomes. D&I studies must also take into account the barriers to uptake of evidence-based interventions in the communities where people live their lives and the social service agencies, hospitals, and clinics where they receive care. The challenges of moving research to practice and policy are universal, and future progress calls for collaborative partnerships and cross-country research. The fundamental tenet of D&I research—taking what we know about improving health and putting it into practice—must be the highest priority.

Drug use represents a significant burden to public health, through disease, disability and social problems, and policy makers are becoming increasingly interested in how to develop evidence-based drug policy. It is therefore crucial to strengthen the links between addiction science and drug policy. Drug Policy and the Public Good is collaboratively written by an international group of career scientists, to provide an analytical basis on which to build relevant global drug policies, and to inform policy makers who have direct responsibility for public health and social welfare. Drug Policy and the Public Good presents the accumulated scientific knowledge on illicit drugs that has direct relevance to the development of drug policy on local, national, and international levels. The authors describe the conceptual basis for a rational drug policy, and present new epidemiological data on the global dimensions of drug misuse. The core of the book is a critical review of the cumulative scientific evidence in five general areas of drug policy: primary prevention programs in schools and other settings; supply reduction approaches, including drug interdiction and legal enforcement; treatment interventions and harm reduction approaches; criminal sanctions and decriminalization; and control of the legal market through prescription drug regimes. The final chapters discuss the current state of drug policy in different parts of the world, and describe the need for a new approach to drug policy that is evidence-based, realistic, and coordinated.