South-East Asia Regional Conference on Epidemiology

Leadership, management and epidemiology:
issues at country level
Tee Ah Sian
Translation of epidemiological knowledge or evidence into public health action is an essential prerequisite
for success of public health programmes. Public health refers to the collective actions to
improve population health needs. Epidemiology in fact is a very important discipline which provides
evidence for public health leaders to take action. Epidemiology is not just the traditional study of
the distribution or the determinants of health-related states or events but its most important aspect
is the ability to apply it directly to solve a local health problem. It is not so easy for leaders to turn
the observation data into preventive action. It requires bold leadership and a real paradigm shift in
thinking.
There are several examples of how observational data were actually used for public health action.
Way back in the 18th century, Edward Jenner made an observation regarding very low incidence of
smallpox among dairy maids. Following the initial observation, more studies were carried out and
ultimately observational data led to the development of a vaccine for smallpox. The global leadership
took it further and eventually eradicated smallpox in 1977. There is also a very famous study of the
association between smoking and lung cancer. World leadership put in place control measures, and
convinced countries to sign on to the WHO Framework Convention on Tobacco Control (FCTC).
Epidemiology actually provides a sound and rational foundation for public health leaders to develop
public policies and make meaningful decisions. There are many examples of how a sound evidencebase
led to recommendations such as the use of seats belts while driving, screening for breast and
cervical cancer, folic acid supplementation during pregnancy, and vitamin A supplementation for
children. Over the years, the concept of epidemiology has taken a slightly different slant and is utilized
to evaluate new preventive and therapeutic measures, and also new modes of health care delivery, for
example, there is an initiative to re-evaluate screening strategies for cervical cancer in developing
countries. After years of efforts to implement cervical cancer screening as recommended in developed
countries, many programme managers in developing countries have learned that this is not feasible in
developing countries because of weaker health systems and due to cultural considerations. There is
now a move to try and see whether making use of a single visit of a woman using a visual examination
would replace the taking of a Pap Smear which used to require a cytology laboratory. This is the
use of epidemiology for evaluating new health care methods. Efforts are now underway to develop
malaria and HIV vaccines which can not be applied across the board; for different countries different
methodology would have to be used.
Epidemiology should also help bridge the gap in biological knowledge and enable public health
leaders to take public health action. The absence of biological knowledge should not hinder or prevent
the implementation of effective preventive services. One very good example is rheumatic fever. The
biological basis for rheumatic fever is not known. Only some children have rheumatic fever when