Keywords

chronic disease, epidemiology, program planning, public health

 

Authors

  1. Remington, Patrick L.
  2. Simoes, Eduardo
  3. Brownson, Ross C.
  4. Siegel, Paul Z.

Abstract

Although the role for epidemiology is widely accepted in public health programs in general, its role in chronic disease programs is not as widely recognized. One possible barrier to improving epidemiologic capacity in chronic disease prevention and health promotion programs is that chronic disease program managers and public health decision makers may have a limited understanding of basic chronic disease epidemiology functions. We describe the assessment process of data collection, analysis, interpretation, and dissemination, and, using examples from two states, illustrate how this approach can be used to support program and policy development in three areas: by defining the problem, finding programs that work, and evaluating the effects of the program over time. Given the significant burden of chronic diseases in the United States, the scientific guidance provided by epidemiology is essential to help public health leaders identify priorities and intervene with evidence-based and effective prevention and control programs.

 

By the end of the 20th century, chronic diseases and their risk factors had became the leading causes of preventable deaths in the United States.1 In response, public health programs at the national, state, and community level established a variety of chronic disease prevention and health promotions programs.2-4 As these programs have evolved, the Centers for Disease Control and Prevention (CDC) and others have encouraged states and communities to dedicate resources to support epidemiologic activities in chronic disease programs.5-7

 

Although the role for epidemiology is widely accepted in public health programs in general, its role in chronic disease programs is not as obvious. In public health departments, epidemiology is used to uncover the causes of disease, as in a communicable disease outbreak investigation. However, because many of the causes of chronic disease are well known (e.g., poor diet, physical inactivity, smoking), program directors may prefer to spend limited resources on intervention programs rather than supporting further "research."

 

According to recent study (see Frey et al. in this issue of JPHMP 9:4), one important barrier to improving epidemiologic capacity in state health department chronic disease programs was a limited understanding of basic chronic disease epidemiology functions among program directors.5 This study suggested that commitment may be tenuous from senior health officials and administrators, who often have the least understanding and appreciation for epidemiology and who were subject to frequent organizational and political changes.

 

To address these findings, we consider the role of epidemiology in chronic disease prevention and health promotion programs. We describe the assessment process of data collection, analysis, interpretation, and dissemination, and, using examples from two states, illustrate how this approach can be used to support program and policy development in three areas: (1) by defining the problem; (2) by finding programs that work; and (3) by evaluating the effects of the program over time.