What is MCH Epidemiology ? 9 th Annual MCH EPI Conference December 11, 2003 Tempe, AZ.
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What is MCH Epidemiology ? 9 th Annual MCH EPI Conference December 11, 2003 Tempe, AZ
From whose perspective? l An epidemiologist, trained in epidemiology, practicing epidemiology, who was never an MCH program person, and who is responsible for all aspects of epidemiology in a local public health department covering 3.3 million persons.
Why are we NOW asking the question? l Because now there are programmatic, funding and legal requirements to document the use of data for evaluation, policy making and program design. l NOT because it was not happening before
What is MCH Epi? l The definition is no different than what is epi in any other content area context: the study of the determinants and distribution of health and disease.
l Implicit in this is the PURPOSE of epi, which ultimately is the development of interventions, whether curative or preventive, to improve the health of the population, whether defined by longevity or quality of life.
Historical issues l Although there were no legal and funding requirements in the US to use epidemiology in MCH programs prior to the 70’s, MCH epi has existed in exactly this manner for a while. l As mentioned before, the Children’s Bureau was doing MCH epi, and some local jurisdictions, like Ohio.
l However, internationally, there has been MCH epi being practiced in places like Costa Rica, Chile, Argentina, Cuba, Israel, South Africa and European countries since the 50’s and before, for the purposes mentioned here, such as policy development, program design and implementation and evaluation of program effectiveness.
MCH epi is not a “sui generis” animal, and, in fact, is very, very similar to all other types of applied epi.
l Disease control is not infectious epi, however, applied infectious epi is used in exactly the same manner as MCH epi is used in MCH programs.
l It seems that too many administrative and programmatic functions are being rolled into the functions of an epidemiologist: If the outcome is not a health condition (lbw, premature delivery, rate of influenza in children under 5, etc), in my book, it is not epidemiology
l Evaluating program effectiveness (does x or y activity result in lower infant mortality) is epidemiology, because it is in many ways a clinical trial, whether a community prevention trial or an actual clinical trial. l Evaluating whether giving people an incentive causes them to use prenatal care more often, is not epi. Evaluating whether a program is delivering clinically adequate prenatal care is not epi. l Whether clinically adequate prenatal care makes a difference in the health outcome of the pregnancy is epi.
Research l Research is perfectly appropriate in the context of MCH programs, but it is applied research. l I don’t do research on whether topical anesthetics or needle-less injectors work. I do research on whether they work in mass immunization clinics.
Difference between using epi- related skills and doing epi l A biostatistician is not an epidemiologist l A program evaluator is not an epidemiologist. l A policy analyst is not an epidemiologist l A director who keeps track of the efficiency (not the effectiveness) of her program is not an epidemiologist.
l They are all using skills that epis use, but they are not doing epi. l We all know how to read, write and do arithmetic, but everyone uses them to do something different. l That does not mean that if I write, I’m a writer, or if I use math, I’m a mathematician.
What mch epis do not do in Maricopa County? l If we use a needs assessment, or a PPOR or PRAMS process as an example, l They present data in stakeholders’ meetings, but they are not responsible for the process. l They do not evaluate the efficiency of programs, they do evaluate the efficacy l They participate in discussions relating to recommendations based on the data analysis, but only to assure that they are consistent with the interpretation of the data
What do they do that has not been mentioned here? l They incorporate issues related to infectious diseases, bioterrorism, and other areas that are generally segregated from MCH. l Thus, next year we might examine the effect of influenza on deliveries. l Or, from our epizoology surveillance the emergence of pet-family owners clusters of disease.
Competencies l Epi content knowledge, epi methods knowledge, biostatistics knowledge, ability to convey and explain epi finidngs to non-epis and lay public. l Administrative competencies, not much.
Is MCH-EPI different from: Perinatal EPI, Pediatric or Obstetric EPI, Reproductive EPI, etc? No, they are susbsets of MCH epi. There is MCH epi and applied MCH epi.