Empowering communities to remove the pump handle. An emerging role in epidemiology

PURPOSE: The epidemiologist's role in relation to the populations they study needs to be reconsidered in order to maximize the contribution of epidemiology to public health, and to balance science with social responsibility.METHODS: Historical analysis and a case study of community-based, collaborative epidemiology conducted in Eastern Virginia as the basis for identifying and improving child health outcomes.RESULTS: The origins of epidemiology in Snow's work on cholera provides a dynamic model of etiologic research combined with community intervention to prevent disease. While in past decades, epidemiology was excessively objectivist and focused on identifying individual-level risk factors, epidemiologists are now reclaiming a vital role in community health promotion. Yet the historic role of the epidemiologist, whether as the white knight who saves the community from an epidemic, or alternatively, as the remote scientist who studies populations but bears no responsibility for improving their health, is no longer viable. The emerging role is that of collaborator, a scientist working in partnership with communities. In Eastern Virginia, academic epidemiologists work closely with diverse community-based coalitions to assess child health needs, prioritize health problems, design and enact interventions, and monitor health outcomes. Diagnostic studies of child health outcomes, published in peer-reviewed journals and in community reports, have identified serious health needs in Eastern Virginia, e.g., under-immunization, attention deficit hyperactivity disorder, asthma, and adverse perinatal health indicators. Epidemiologic research is being used to guide interventions planned and enacted by the community, with evidence of improved outcomes in certain indicators.CONCLUSIONS: A vitally important, emerging role for epidemiologists in the 21(st) century is to empower communities to identify and effectively address their own health needs. Epidemiologic data not only evaluates health status, but should be used to guide community action.