Essay: The Role of Epidemiology in Health Practice and History
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This essay delves into the critical role of epidemiology in health practice, emphasizing its significance in disease prevention, management, and understanding. It highlights the Framingham Heart Study as a pivotal historical event, detailing its contributions to cardiovascular health research and its lasting impact on modern epidemiological methods. The essay also explores the current scope of epidemiology, including its application in high-income and low-income nations, the concept of the exposome, and its diverse objectives such as disease etiology, disease extent, and public health policy development. It further examines the role of epidemiology in cancer research and the identification of risk factors, particularly within marginalized populations. The essay concludes with a critical analysis of recent trends, including the use of antibiotics, communicable diseases, and the development of vaccines, underscoring the ongoing evolution of epidemiology in response to global health challenges. This essay provides a comprehensive overview of epidemiology's past, present, and future in public health.
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1ESSAY
Introduction- Epidemiology encompasses the study of how illnesses occur in
particular groups of individuals and the underlying factors behind them. In other words,
epidemiological information is typically used for planning and evaluating strategies, with the
aim of preventing disease, and in the form of a guideline to management of patients. Similar
to pathology and clinical findings, epidemiology of particular illnesses is a core component of
the basic description of the illness (Fletcher, 2019). The major aspect of epidemiology is the
evaluation of illness outcomes, in relation to the population that is at identified at risk. The
people at risk might be healthy or sick, and are considered as cases, on manifesting signs and
symptoms of the illness that is being investigated. There is mounting evidence for the fact
that epidemiology saves lives of countless people and also enhances long-term and global
health. Hence, the objective of epidemiology is not merely restricted to disease prevention,
but also encompasses reversal of negative health consequences, and the impacts of
epidemiology are most profound for communities experiencing instability and/or poverty
(Lawlor, Tilling & Davey Smith, 2016). This essay will critically analyse and elucidate the
role of epidemiology in health practice, and will also investigate one significant historical
event in this domain.
Historical event and its contribution- One significant historical event in the field of
epidemiology was the Framingham Heart Study (FHS) that was initiated in 1948. This was an
ongoing, long-term cohort study of cardiovascular problems, conducted amid the residents of
Framingham. The study comprised of 5,209 adult subjects and before conduction of this
study, there was little or no information about epidemiology of arteriosclerotic or
hypertensive cardiovascular disease (Andersson et al., 2019). The purpose of this study was
to assess the risk factors that contribute maximum to the development of cardiovascular
problems. Initially sponsored by the National Heart, Lung, and Blood Institute, the study
correctly assumed that cardiac health is under the influence of environmental and lifestyle
Introduction- Epidemiology encompasses the study of how illnesses occur in
particular groups of individuals and the underlying factors behind them. In other words,
epidemiological information is typically used for planning and evaluating strategies, with the
aim of preventing disease, and in the form of a guideline to management of patients. Similar
to pathology and clinical findings, epidemiology of particular illnesses is a core component of
the basic description of the illness (Fletcher, 2019). The major aspect of epidemiology is the
evaluation of illness outcomes, in relation to the population that is at identified at risk. The
people at risk might be healthy or sick, and are considered as cases, on manifesting signs and
symptoms of the illness that is being investigated. There is mounting evidence for the fact
that epidemiology saves lives of countless people and also enhances long-term and global
health. Hence, the objective of epidemiology is not merely restricted to disease prevention,
but also encompasses reversal of negative health consequences, and the impacts of
epidemiology are most profound for communities experiencing instability and/or poverty
(Lawlor, Tilling & Davey Smith, 2016). This essay will critically analyse and elucidate the
role of epidemiology in health practice, and will also investigate one significant historical
event in this domain.
Historical event and its contribution- One significant historical event in the field of
epidemiology was the Framingham Heart Study (FHS) that was initiated in 1948. This was an
ongoing, long-term cohort study of cardiovascular problems, conducted amid the residents of
Framingham. The study comprised of 5,209 adult subjects and before conduction of this
study, there was little or no information about epidemiology of arteriosclerotic or
hypertensive cardiovascular disease (Andersson et al., 2019). The purpose of this study was
to assess the risk factors that contribute maximum to the development of cardiovascular
problems. Initially sponsored by the National Heart, Lung, and Blood Institute, the study
correctly assumed that cardiac health is under the influence of environmental and lifestyle
2ESSAY
factors, in addition to inheritance. According to Hajar (2016) during the 50s, the common
notion was that narrowing and clogging of arteries (arteriosclerosis and atherosclerosis) were
associated with aging, and were common in all older adults. Despite hypertension and
hypercholesterolemia being considered normal outcomes of aging, there were no definite
treatment for the same. Major findings from the study suggested that cigarette smoking, high
cholesterol, and hypertension increases heart disease risk (Burke et al., 2017). Both
hypertension and enlargement of left ventricle were associated with an increased risk of
stroke. In addition, it was also found that exercise and obesity exert opposite effects on
cardiovascular health.
Modern epidemiology has been shaped by this study owing to the fact that it helped in
gaining a sound understanding how cardiovascular health creates an impact on the human
body functioning. The study had around 14,000 individuals from three generations, together
with the original participants, their kids and grandchildren. In the last five decades, an
estimated 3,000 articles on epidemiology have been published from the study findings in
important medical journals. Though at the time of being launched, the original aim of the
study focused on identifying common characteristics or factors contributing to cardiovascular
illness, over the years, this cohort study has become a multigenerational and successful study
that investigates the family patterns of cardiovascular complications, while obtaining genetic
information from two generations that followed the participants from the original study
(Cooper & Mitchell, 2019). In addition, the impact of this event on modern epidemiology can
be accredited to the fact that the FHS has expanded to encompass dissimilar populations, in
order to gain awareness of the risk factors amid the diverse people. Additionally, findings
obtained from this study has positively contributed to a range of transformative discoveries
associated to heart disease prevention and management.
factors, in addition to inheritance. According to Hajar (2016) during the 50s, the common
notion was that narrowing and clogging of arteries (arteriosclerosis and atherosclerosis) were
associated with aging, and were common in all older adults. Despite hypertension and
hypercholesterolemia being considered normal outcomes of aging, there were no definite
treatment for the same. Major findings from the study suggested that cigarette smoking, high
cholesterol, and hypertension increases heart disease risk (Burke et al., 2017). Both
hypertension and enlargement of left ventricle were associated with an increased risk of
stroke. In addition, it was also found that exercise and obesity exert opposite effects on
cardiovascular health.
Modern epidemiology has been shaped by this study owing to the fact that it helped in
gaining a sound understanding how cardiovascular health creates an impact on the human
body functioning. The study had around 14,000 individuals from three generations, together
with the original participants, their kids and grandchildren. In the last five decades, an
estimated 3,000 articles on epidemiology have been published from the study findings in
important medical journals. Though at the time of being launched, the original aim of the
study focused on identifying common characteristics or factors contributing to cardiovascular
illness, over the years, this cohort study has become a multigenerational and successful study
that investigates the family patterns of cardiovascular complications, while obtaining genetic
information from two generations that followed the participants from the original study
(Cooper & Mitchell, 2019). In addition, the impact of this event on modern epidemiology can
be accredited to the fact that the FHS has expanded to encompass dissimilar populations, in
order to gain awareness of the risk factors amid the diverse people. Additionally, findings
obtained from this study has positively contributed to a range of transformative discoveries
associated to heart disease prevention and management.
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3ESSAY
The FHS has helped healthcare professionals realise that majority of the risk factors
can be modified, thus emphasising on the need of conducting routine physical examinations
for cholesterol, blood pressure, smoking, physical activity, eating patterns and body weight
(Andersson et al., 2019). A range of new Framingham initiatives are in development, such as
research about the genes correlated with cardiovascular disease, lung disease, hypertension
and osteoporosis. Moreover, recruitment of minority participants by researchers in recent
years is also helping them collect significant data on risk factors that make these populations
susceptible to cardiovascular problems (Mensah et al., 2019). Considering the fact that
modern epidemiology focuses on the distribution and occurrence of diseases or health events
in particular populations, together with study of the factors that result in such condition, the
FHS was a significant milestone in the development of epidemiology of cardiovascular
health.
Current scope- In high income nations, an increasing emphasis is being placed on
epidemiological research, in order to investigate causal associations. However, in low-income
nations, the implementation of epidemiology for controlling health problems is the primary
goal. While majority of molecular epidemiology investigations are still reliant on
conventional diagnosis of diseases and classification systems, a growing attention has been
placed on the fact that progression of a disease characterises the characteristically
heterogeneous developments differing from individual to individual (Davey Smith, 2019).
Modern epidemiology is based on the notion that all persons have unique illness processes
that differ from others, considering the uniqueness of exposome. Modern epidemiology
focuses on the concept of exposome that refers to the totality of environmental factors and
their influence on the pathologic manifestation of illnesses (Stingone et al., 2017).
Therefore, modern epidemiology has a range of objectives that are namely, (i)
identification of cause or aetiology of a disease, (ii) determination of the disease extent, (iii)
The FHS has helped healthcare professionals realise that majority of the risk factors
can be modified, thus emphasising on the need of conducting routine physical examinations
for cholesterol, blood pressure, smoking, physical activity, eating patterns and body weight
(Andersson et al., 2019). A range of new Framingham initiatives are in development, such as
research about the genes correlated with cardiovascular disease, lung disease, hypertension
and osteoporosis. Moreover, recruitment of minority participants by researchers in recent
years is also helping them collect significant data on risk factors that make these populations
susceptible to cardiovascular problems (Mensah et al., 2019). Considering the fact that
modern epidemiology focuses on the distribution and occurrence of diseases or health events
in particular populations, together with study of the factors that result in such condition, the
FHS was a significant milestone in the development of epidemiology of cardiovascular
health.
Current scope- In high income nations, an increasing emphasis is being placed on
epidemiological research, in order to investigate causal associations. However, in low-income
nations, the implementation of epidemiology for controlling health problems is the primary
goal. While majority of molecular epidemiology investigations are still reliant on
conventional diagnosis of diseases and classification systems, a growing attention has been
placed on the fact that progression of a disease characterises the characteristically
heterogeneous developments differing from individual to individual (Davey Smith, 2019).
Modern epidemiology is based on the notion that all persons have unique illness processes
that differ from others, considering the uniqueness of exposome. Modern epidemiology
focuses on the concept of exposome that refers to the totality of environmental factors and
their influence on the pathologic manifestation of illnesses (Stingone et al., 2017).
Therefore, modern epidemiology has a range of objectives that are namely, (i)
identification of cause or aetiology of a disease, (ii) determination of the disease extent, (iii)
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4ESSAY
investigating the progress of a disease, (iv) development of public health policies, and (v)
evaluation of therapeutic and/or preventive measures. Modern epidemiology also
accommodates a range of exposures that contribute to an increase in the likelihood of
acquiring one illness and circumstances when one particular risk factor might contribute to
the development of multiple illnesses. The individual risk factors in modern epidemiology are
generally characterised as: (a) essential and sufficient, (b) essential but not sufficient, (c)
sufficient but not essential, and (d) neither essential nor sufficient. Epidemiological
investigations directly contribute information on the risk factors amid humans. One such
example is the contribution of modern epidemiology to the field of cancer. Epidemiologists
have played an important role in the establishment and development of cancer registries that
originally began in Germany and the US in the 20s and presently exist globally (Rahu &
Rahu, 2018).
Population-dependent cancer registries gather information on occurrence of cancer in
delimited population and also help in identification of intervention priorities, particularly in
locations where the resources are limited. The 20th century was characterised with the
clarification of signs to causation of cancer from detected correlations with exposures to diet,
environmental chemicals, tobacco, and numerous exogenous factors. With such repeated
affirmations of the causal association, the researchers identified the possibility that like
different infectious diseases, cancer might also be prevented (Thun et al., 2017). Modern
epidemiology has established the fact that cancer contributes to the excess mortality in New
Zealand, particularly amid the socioeconomically, indigenous and marginalised population,
and that much of this disparity is avoidable. It has been found that greatest contributors in
mortality were lung cancer, breast cancer, and stomach cancer in 2006-11. In addition, an
increase has also been observed in the percentage and absolute size of cancer contribution to
mortality in Māori population (Teng et al., 2016). Furthermore, development and
investigating the progress of a disease, (iv) development of public health policies, and (v)
evaluation of therapeutic and/or preventive measures. Modern epidemiology also
accommodates a range of exposures that contribute to an increase in the likelihood of
acquiring one illness and circumstances when one particular risk factor might contribute to
the development of multiple illnesses. The individual risk factors in modern epidemiology are
generally characterised as: (a) essential and sufficient, (b) essential but not sufficient, (c)
sufficient but not essential, and (d) neither essential nor sufficient. Epidemiological
investigations directly contribute information on the risk factors amid humans. One such
example is the contribution of modern epidemiology to the field of cancer. Epidemiologists
have played an important role in the establishment and development of cancer registries that
originally began in Germany and the US in the 20s and presently exist globally (Rahu &
Rahu, 2018).
Population-dependent cancer registries gather information on occurrence of cancer in
delimited population and also help in identification of intervention priorities, particularly in
locations where the resources are limited. The 20th century was characterised with the
clarification of signs to causation of cancer from detected correlations with exposures to diet,
environmental chemicals, tobacco, and numerous exogenous factors. With such repeated
affirmations of the causal association, the researchers identified the possibility that like
different infectious diseases, cancer might also be prevented (Thun et al., 2017). Modern
epidemiology has established the fact that cancer contributes to the excess mortality in New
Zealand, particularly amid the socioeconomically, indigenous and marginalised population,
and that much of this disparity is avoidable. It has been found that greatest contributors in
mortality were lung cancer, breast cancer, and stomach cancer in 2006-11. In addition, an
increase has also been observed in the percentage and absolute size of cancer contribution to
mortality in Māori population (Teng et al., 2016). Furthermore, development and
5ESSAY
advancement of technologies for identification of biological molecules greatly promoted the
integration of the molecular indicators of biological deviation into epidemiological research,
in the form of exposure and surrogate markers of cancer consequences.
Critical analysis- Over the last five decades there have been substantial variations in
the patterns of diseases all across the world. The population explosion that has occurred in the
previous half century, in addition to the range of lifestyle and environmental changes
prevalent all across the globe have resulted in noteworthy shifts in the reasons behind
mortality and morbidity, in addition to incidence of illnesses. One of the most significant
trend in epidemiology is the increased emphasis placed on usage of statistics for keeping a
track of the illness trends and discovering the underlying factors. In the domain of drug
therapy, current trends encompass usage of different antibiotics. These can be accredited to
the wide availability of penicillin, the effective antibiotic, and its impact on incidence of
infectious illness such as, strep infections, bacterial pneumonia, gonorrhoea and syphilis
(Jackson, Czaplewski & Piddock, 2018). In present times, epidemiology focuses on
conducting population based monitoring for not less than 100 reportable illnesses and
conditions that are a matter of public health importance, with the aim of quick case finding
and control measure implementation for prevention of secondary illness cases. Not only do
epidemiological studies emphasise on conducting surveillance of occupationally associated
diseases and injuries, but also focus on development of strategy for improving safety of
workers (Stayner et al., 2017).
Recent trends also encompass maintenance and development of reportable illness
surveillance software, imparting training and education to healthcare professionals, facilities,
general public and business on environmental factors and illness control, and toxicology
consultations. Communicable disease are a matter of grave concern in the Māori population
with meningococcal disease, tuberculosis, and rheumatic fever being most prevalent. The
advancement of technologies for identification of biological molecules greatly promoted the
integration of the molecular indicators of biological deviation into epidemiological research,
in the form of exposure and surrogate markers of cancer consequences.
Critical analysis- Over the last five decades there have been substantial variations in
the patterns of diseases all across the world. The population explosion that has occurred in the
previous half century, in addition to the range of lifestyle and environmental changes
prevalent all across the globe have resulted in noteworthy shifts in the reasons behind
mortality and morbidity, in addition to incidence of illnesses. One of the most significant
trend in epidemiology is the increased emphasis placed on usage of statistics for keeping a
track of the illness trends and discovering the underlying factors. In the domain of drug
therapy, current trends encompass usage of different antibiotics. These can be accredited to
the wide availability of penicillin, the effective antibiotic, and its impact on incidence of
infectious illness such as, strep infections, bacterial pneumonia, gonorrhoea and syphilis
(Jackson, Czaplewski & Piddock, 2018). In present times, epidemiology focuses on
conducting population based monitoring for not less than 100 reportable illnesses and
conditions that are a matter of public health importance, with the aim of quick case finding
and control measure implementation for prevention of secondary illness cases. Not only do
epidemiological studies emphasise on conducting surveillance of occupationally associated
diseases and injuries, but also focus on development of strategy for improving safety of
workers (Stayner et al., 2017).
Recent trends also encompass maintenance and development of reportable illness
surveillance software, imparting training and education to healthcare professionals, facilities,
general public and business on environmental factors and illness control, and toxicology
consultations. Communicable disease are a matter of grave concern in the Māori population
with meningococcal disease, tuberculosis, and rheumatic fever being most prevalent. The
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6ESSAY
frequency of meningococcal illness was greater in 2013 for Māori. In addition, initial rate of
hospitalisation for rheumatic fever amid the population was thrice more than non-Māori
during 2012-14 (Ministry of Health, 2018). Though SARS and AIDS are a major threat to the
word, there are several less threatening infections as well that are caused by Borrelia
spp, Bartonella henselae, Campylobacter spp, Hanta viruses, and Clostridium difficile that
have brought about significant changes in epidemiological research and clinical practice
(Giesecke, 2017). Apart from new infectious agents, several already identified
microorganisms have also developed new virulence like the Staphylococcus aureus and
group A streptococcus, both of which are responsible for the toxic shock syndrome
(Totapally, 2017). These developing infections provide a reflection of the adaptable nature of
microorganisms, thereby representing the chief challenges that will be encountered in near
future.
Moreover, antimicrobial resistance (AMR) has also been identified as a matter of
public health concern that necessitates immediate political and professional action. AMR is
affected by a range of interrelated factors like climate change, mass transportation, mass food
production and environmental perturbations (Akova, 2016). Epidemiological studies have
addressed this challenge by stating that the widespread implementation of point‐of‐care
resistance diagnostics (POCRD) decreases ineffective usage of antibiotics, however, also
increases overall antibiotic usage. POCRD has been associated with an acceleration in the
increase of resistance in illness-causing bacteria (McAdams, 2017). However, the findings
have elucidated that on usage of multiple antibiotics, POCRD might decrease the increase in
resistance, contradicting the notion that antibiotics are exhaustible, whose augmented use
essentially endorses the growth of resistance. Similarly, epidemiological research has also
brought about an increase in the complete rate of dispensing antibiotics in New Zealand,
when compared to developed countries (Thomas et al., 2019). Furthermore, with the aim of
frequency of meningococcal illness was greater in 2013 for Māori. In addition, initial rate of
hospitalisation for rheumatic fever amid the population was thrice more than non-Māori
during 2012-14 (Ministry of Health, 2018). Though SARS and AIDS are a major threat to the
word, there are several less threatening infections as well that are caused by Borrelia
spp, Bartonella henselae, Campylobacter spp, Hanta viruses, and Clostridium difficile that
have brought about significant changes in epidemiological research and clinical practice
(Giesecke, 2017). Apart from new infectious agents, several already identified
microorganisms have also developed new virulence like the Staphylococcus aureus and
group A streptococcus, both of which are responsible for the toxic shock syndrome
(Totapally, 2017). These developing infections provide a reflection of the adaptable nature of
microorganisms, thereby representing the chief challenges that will be encountered in near
future.
Moreover, antimicrobial resistance (AMR) has also been identified as a matter of
public health concern that necessitates immediate political and professional action. AMR is
affected by a range of interrelated factors like climate change, mass transportation, mass food
production and environmental perturbations (Akova, 2016). Epidemiological studies have
addressed this challenge by stating that the widespread implementation of point‐of‐care
resistance diagnostics (POCRD) decreases ineffective usage of antibiotics, however, also
increases overall antibiotic usage. POCRD has been associated with an acceleration in the
increase of resistance in illness-causing bacteria (McAdams, 2017). However, the findings
have elucidated that on usage of multiple antibiotics, POCRD might decrease the increase in
resistance, contradicting the notion that antibiotics are exhaustible, whose augmented use
essentially endorses the growth of resistance. Similarly, epidemiological research has also
brought about an increase in the complete rate of dispensing antibiotics in New Zealand,
when compared to developed countries (Thomas et al., 2019). Furthermore, with the aim of
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7ESSAY
preventing the spread of communicable disease, epidemiological studies have focused on the
development of vaccines in the immunisation schedules. This in turn has resulted in
88.9% and 91.9% vaccination of Māori and total New Zealand children in the year 2014, for
those who were aged eight months, which in turn increased to 91.9% and 92.8% for the same
population (Ministry of Health, 2019). Not only has epidemiological research made HPV
vaccination free for young women and girls, but also decreased their risk of developing
cervical cancer.
Conclusion- Thus, it can be concluded that epidemiology offers significant tools for
quantifying the extent to which humanitarian interventions and risk factors create an impact
on health of the population at the time of crisis. Modern epidemiology generally focuses on
surveillance, surveys, program data analysis and rapid assessment and provide information on
a range of health indicators and their association with a disease. The FHS was a historical
event that paved the way for investigating cardiovascular diseases and their risk factors amid
different populations. Epidemiology offers a range of benefits such as, benchmarking the
severity of an illness and keeping a track of its development over time, assessing the extent of
presence of risk factors in the affected population, and monitoring trends in the incidence and
prevalence of particular illnesses over time. The critical analysis done above suggests that
communicable diseases are a public health concern in New Zealand and several
advancements have been made in epidemiology for addressing the current challenges.
preventing the spread of communicable disease, epidemiological studies have focused on the
development of vaccines in the immunisation schedules. This in turn has resulted in
88.9% and 91.9% vaccination of Māori and total New Zealand children in the year 2014, for
those who were aged eight months, which in turn increased to 91.9% and 92.8% for the same
population (Ministry of Health, 2019). Not only has epidemiological research made HPV
vaccination free for young women and girls, but also decreased their risk of developing
cervical cancer.
Conclusion- Thus, it can be concluded that epidemiology offers significant tools for
quantifying the extent to which humanitarian interventions and risk factors create an impact
on health of the population at the time of crisis. Modern epidemiology generally focuses on
surveillance, surveys, program data analysis and rapid assessment and provide information on
a range of health indicators and their association with a disease. The FHS was a historical
event that paved the way for investigating cardiovascular diseases and their risk factors amid
different populations. Epidemiology offers a range of benefits such as, benchmarking the
severity of an illness and keeping a track of its development over time, assessing the extent of
presence of risk factors in the affected population, and monitoring trends in the incidence and
prevalence of particular illnesses over time. The critical analysis done above suggests that
communicable diseases are a public health concern in New Zealand and several
advancements have been made in epidemiology for addressing the current challenges.
8ESSAY
References
Akova, M. (2016). Epidemiology of antimicrobial resistance in bloodstream
infections. Virulence, 7(3), 252-266.
Andersson, C., Johnson, A. D., Benjamin, E. J., Levy, D., & Vasan, R. S. (2019). 70-year
legacy of the Framingham Heart Study. Nature Reviews Cardiology, 1.
Burke, G. M., Genuardi, M., Shappell, H., D'Agostino Sr, R. B., & Magnani, J. W. (2017).
Temporal associations between smoking and cardiovascular disease, 1971 to 2006
(from the Framingham Heart Study). The American journal of cardiology, 120(10),
1787-1791.
Cooper, L. L., & Mitchell, G. F. (2019). Incorporation of novel vascular measures into
clinical management: Recent insights from the Framingham heart study. Current
hypertension reports, 21(2), 19.
Davey Smith, G. (2019). Post–Modern Epidemiology: When Methods Meet
Matter. American journal of epidemiology, 188(8), 1410-1419.
Fletcher, G. S. (2019). Clinical epidemiology: the essentials. Lippincott Williams & Wilkins.
Giesecke, J. (2017). Modern infectious disease epidemiology. CRC Press.
Hajar, R. (2016). Framingham contribution to cardiovascular disease. Heart views: the
official journal of the Gulf Heart Association, 17(2), 78.
Jackson, N., Czaplewski, L., & Piddock, L. J. (2018). Discovery and development of new
antibacterial drugs: learning from experience?. Journal of Antimicrobial
Chemotherapy, 73(6), 1452-1459.
References
Akova, M. (2016). Epidemiology of antimicrobial resistance in bloodstream
infections. Virulence, 7(3), 252-266.
Andersson, C., Johnson, A. D., Benjamin, E. J., Levy, D., & Vasan, R. S. (2019). 70-year
legacy of the Framingham Heart Study. Nature Reviews Cardiology, 1.
Burke, G. M., Genuardi, M., Shappell, H., D'Agostino Sr, R. B., & Magnani, J. W. (2017).
Temporal associations between smoking and cardiovascular disease, 1971 to 2006
(from the Framingham Heart Study). The American journal of cardiology, 120(10),
1787-1791.
Cooper, L. L., & Mitchell, G. F. (2019). Incorporation of novel vascular measures into
clinical management: Recent insights from the Framingham heart study. Current
hypertension reports, 21(2), 19.
Davey Smith, G. (2019). Post–Modern Epidemiology: When Methods Meet
Matter. American journal of epidemiology, 188(8), 1410-1419.
Fletcher, G. S. (2019). Clinical epidemiology: the essentials. Lippincott Williams & Wilkins.
Giesecke, J. (2017). Modern infectious disease epidemiology. CRC Press.
Hajar, R. (2016). Framingham contribution to cardiovascular disease. Heart views: the
official journal of the Gulf Heart Association, 17(2), 78.
Jackson, N., Czaplewski, L., & Piddock, L. J. (2018). Discovery and development of new
antibacterial drugs: learning from experience?. Journal of Antimicrobial
Chemotherapy, 73(6), 1452-1459.
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9ESSAY
Lawlor, D. A., Tilling, K., & Davey Smith, G. (2016). Triangulation in aetiological
epidemiology. International journal of epidemiology, 45(6), 1866-1886.
McAdams, D. (2017). Resistance diagnosis and the changing epidemiology of antibiotic
resistance. Annals of the New York Academy of Sciences, 1388(1), 5-17.
Mensah, G. A., Jaquish, C., Srinivas, P., Papanicolaou, G. J., Wei, G. S., Redmond, N., ... &
Green Parker, M. C. (2019). Emerging concepts in precision medicine and
cardiovascular diseases in racial and ethnic minority populations. Circulation
Research, 125(1), 7-13.
Ministry of Health. (2018). Infectious Disease. Retrieved from
https://www.health.govt.nz/our-work/populations/maori-health/tatau-kahukura-maori-
health-statistics/nga-mana-hauora-tutohu-health-status-indicators/infectious-disease
Ministry of Health. (2019). Immunisation. Retrieved from https://www.health.govt.nz/our-
work/populations/maori-health/tatau-kahukura-maori-health-statistics/nga-mana-
hauora-tutohu-health-status-indicators/immunisation
Rahu, M., & Rahu, K. (2018). The Estonian Cancer Registry: foundation and further
history. Acta Oncologica, 57(10), 1407-1410.
Stayner, L. T., Collins, J. J., Guo, Y. L., Heederik, D., Kogevinas, M., Steenland, K., ... &
Demers, P. A. (2017). Challenges and opportunities for occupational epidemiology in
the twenty-first century. Current environmental health reports, 4(3), 319-324.
Stingone, J. A., Buck Louis, G. M., Nakayama, S. F., Vermeulen, R. C., Kwok, R. K., Cui,
Y., ... & Teitelbaum, S. L. (2017). Toward greater implementation of the exposome
research paradigm within environmental epidemiology. Annual review of public
health, 38, 315-327.
Lawlor, D. A., Tilling, K., & Davey Smith, G. (2016). Triangulation in aetiological
epidemiology. International journal of epidemiology, 45(6), 1866-1886.
McAdams, D. (2017). Resistance diagnosis and the changing epidemiology of antibiotic
resistance. Annals of the New York Academy of Sciences, 1388(1), 5-17.
Mensah, G. A., Jaquish, C., Srinivas, P., Papanicolaou, G. J., Wei, G. S., Redmond, N., ... &
Green Parker, M. C. (2019). Emerging concepts in precision medicine and
cardiovascular diseases in racial and ethnic minority populations. Circulation
Research, 125(1), 7-13.
Ministry of Health. (2018). Infectious Disease. Retrieved from
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Teng, A. M., Atkinson, J., Disney, G., Wilson, N., Sarfati, D., McLeod, M., & Blakely, T.
(2016). Ethnic inequalities in cancer incidence and mortality: census-linked cohort
studies with 87 million years of person-time follow-up. BMC cancer, 16(1), 755.
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antibacterial dispensing in New Zealand-is current antibacterial dispensing for Māori
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644.
Teng, A. M., Atkinson, J., Disney, G., Wilson, N., Sarfati, D., McLeod, M., & Blakely, T.
(2016). Ethnic inequalities in cancer incidence and mortality: census-linked cohort
studies with 87 million years of person-time follow-up. BMC cancer, 16(1), 755.
Thomas, M., Whyler, N., Tomlin, A., & Tilyard, M. (2019). Ethnic disparities in community
antibacterial dispensing in New Zealand-is current antibacterial dispensing for Māori
and Pacific people insufficient or excessive, or both?. The New Zealand Medical
Journal (Online), 132(1505), 100-104.
Thun, M., Linet, M. S., Cerhan, J. R., Haiman, C. A., & Schottenfeld, D. (Eds.).
(2017). Cancer epidemiology and prevention. Oxford University Press.
Totapally, B. R. (2017). Epidemiology and outcomes of hospitalized children with
necrotizing soft-tissue infections. The Pediatric infectious disease journal, 36(7), 641-
644.
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