It might have appeared to the audience that the opening keynote speakers at the recent SER meeting in Boston aligned their presentations in advance since they were both about how epidemiologists can be relevant. In fact, the speakers did not know what each would be saying, according to Denise Cardo, Acting Director of the Office of Surveillance, Epidemiology, and Laboratory Science at the Centers for Disease Control and Prevention.

Cardo followed Sandro Galea, Columbia University epidemiologist and outgoing SER President, to the podium to speak about “Ensuring Relevance for Epidemiologoy in a Changing World”. Galea had just finished exhorting his colleagues to adopt a more “consequential” epidemiology.

While the speakers covered the same general topic, they did so from different vantage points in academia and a federal agency, and thus emphasized different ideas about what is needed for epidemiologists to be more relevant.

Questions

Galea saw the need for epidemiologists to ask more relevant questions with a more direct bearing on health outcomes. As a health agency epidemiologist, Cardo appeared to take it for granted that epidemiologists would encounter real world problems and thus have useful questions to ask. For her, ensuring relevance entailed assuring the quality of the data, conducting timely analyses, and communicating the results effectively. All of these she deemed essential ingredients for epidemiologists to add value to the process of moving from data to action.

New Realities

Cardo described many 21^st century drivers that are impacting the capacity of epidemiologists to act successfully for public health. These include big data, cell phones, geographic information systems, the need for lab and epidemiology linkage, privacy/confidentiality, public health accreditation, informatics, translation science, need for greater transparency, social media, syndromic surveillance and many others. 

Not surprisingly, along with these new realities come new expectations. She cited the challenges which CDC epidemiologists faced during the recent fungal meningitis outbreak associated with steroid injections. Because more data could be

collected and transmitted in real time, she said, CDC had to make decisions rapidly, sometimes after normal hours. Investigators had to make decisions with less than optimal data, and to learn and modify their recommendations as the outbreak unfolded and more data were received.

The challenges for epidemiologists in this situation and potentially many others in population health are 1) rapid and accurate data collection, 2) thoughtful, fast, and thorough data analysis, and 3) dissemination of information to those who need to know.

Poised To Add Value

One of the key points emphasized by Cardo is that while there may be numerous new data sources and tools in the 21^st century, epidemiologists have the training and intimate knowledge of data and data management issues which positions them to add unique value to the effective utilization of data. She quoted Einstein to remind the audience that data is not information, information is not knowledge, and knowledge is not understanding.

Communication

Another key challenge for epidemiologists to be relevant is how to display and present data in such a way that audiences can visualize and grasp the messages being delivered. She reminded attendees that epidemiologists need to communicate data in terms appreciated by different audiences. Population health means very different things to different people, she said. Thus, actual numbers rather than rates may be more effective for some audiences. Also, some audiences care more about patients, others about dollars, and others about lives saved. “If we want to have impact, we have to adapt our messages to the audiences,” said Cardo.

Winnable Battles

Cardo was actually filling in for CDC Director Tom Frieden at SER and she used the second half of her talk to present CDC themes linked to being relevant. Cardo highlighted the concept of “winnable battles” articulated by Frieden as examples of how epidemiologists can make a difference for population health. These “winnable battles” are topics where the disease burden is large, interventions exist, and opportunities are there to save or improve lives. Cited as winning battles are tobacco, health care associated infections, teen pregnancy, nutrition-physical activity-obesity, motor vehicle injuries, and HIV.

Affordable Care Act

Another important area where epidemiologists can seek to be relevant related to implementation of the new Affordable Care Act (ACA). There are many changes in the works associated with insurance coverage, payment, models of care, accountability, and health information technology and other topics. Cardo said epidemiologists need to pay attention to this important new development to figure out how public health can improve health care. She suggested that evaluation of the many aspects of the ACA will be an important issue, and that epidemiologists need to be engaged.

In summarizing how to use data to promote action and achieve relevance, Cardo told The Epidemiology Monitor investigators need not only the right questions, but also the right data, the right tools, and they need to provide the answers in a timely way which meets the expectations of those who need to know and can act on the information.

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