Celebrations marking the 200^th anniversary of the birth of John Snow have revealed some surprising new ideas and perspectives about “the father of epidemiology”. One example is the recent two-day meeting held on April 11-12 at the London School of Hygiene and Tropical Medicine entitled “Snow’s legacy: epidemiology today and tomorrow.”

In addition to the normal fare which can be heard at epidemiology meetings such as talks about causation, surveillance, infectious agents, and/or public health, the London meeting included speakers on the use of epidemiology to study financial networks, violence, economic development, crime, and even education.

What Is Epidemiology Anyway?

According to Paul Fine, one of the organizers of the meeting, a key purpose was to “expand on the conventional” and showcase the variety of applications of epidemiology. The presentations succeeded in raising questions about the boundaries of epidemiology, according to Fine. He added “after all, the term disease is not part of the original meaning of ‘epi’ and ‘demos’, the root words of epidemiology.”

In preparing for the meeting, Fine noted  the field of epidemiology has evolved from an initial focus on infectious disease such as cholera, to chronic diseases, to health related events other than disease, and now its methods are being applied to an ever widening group of population phenomena and social challenges such as those noted above. “Where do you draw the line between epidemiology and these other disciplines which use similar methods”, asked Fine. Some of these new disciplines such as crime science even go so far as to claim Snow as a pioneer in their fields as well.

Conference Speakers

A review paper based on the abstracts from the meeting has already appeared in The Lancet in early April entitled “John Snow’s legacy: epidemiology without borders”. Among the presentations which expanded the conventional thinking about the use of epidemiology was one by Chicago’s Gary Slutkin. He described his use of epidemiologic concepts such as mode of transmission to better understand and prevent homicides.

Robert May discussed financial networks and noted that the rise in financial assets and subsequent crash of financial markets resemble very closely the epidemic curves one sees with measles or other infections. Using the concept of superspreaders derived from infectious disease epidemiology, investigators are better able to prevent problems in some banksfrom spreading to others in the financial system. May stated that society owes Snow and others more than is often realized.

Richard Wortly describes how Snow’s mapping of disease has helped to create “situational crime prevention” in which crime scientists map the distribution of crime around “environmental crime generators” and create prevention strategies accordingly.

Carole Torgerson described the relevance of epidemiology in the field of education by focusing on the need for clinical trials in this field. “Immense opportunities exist for rigorous educational randomized controlled trials”, said the speaker. In contrast, Angus Deaton said the increasing use of randomized controlled trials in economics to study economic development has proven unhelpful. Trials have limitations of their own (they do not help to understand underlying mechanisms of action), and often have not been well designed in studying economic development.

In concluding the review paper, the authors/speakers at the event note that “Almost all self-described epidemiologists nowadays work within the health arena, and this is the focus of most of the societies, journals, and courses that carry the name epidemiology. The range of applications evident in these contributions might encourage some of these institutions to consider broadening their remits. In so doing, they may contribute more directly to,and learn from, the non-health-related areas that use the language and methods of epidemiology to address many important problems now facing the world.  ■
 

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