In Snow's Footsteps: Commentary on Shoe-Leather and Applied Epidemiology

In Snow's Footsteps: Commentary on Shoe-Leather and Applied Epidemiology

1. Denise Koo* and 
2. Stephen B. Thacker

1. *Correspondence to Dr. Denise Koo, Scientific Education and Professional Development Program Office, Centers for Disease Control and Prevention, 1600 Clifton Road, NE, Mailstop E-92, Atlanta, GA 30333 (e-mail: dkoo@cdc.gov).

• Received July 6, 2010.
• Accepted July 6, 2010.

 

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Abstract

The term shoe-leather epidemiology is often synonymous with field epidemiology or intervention epidemiology. All 3 terms imply investigations initiated in response to urgent public health problems and for which the investigative team does much of its work in the field (i.e., outside the office or laboratory). Alexander D. Langmuir is credited with articulating the concept of disease surveillance as it is applied to populations rather than individuals. He also founded the Epidemic Intelligence Service (EIS) Program in 1951, a 2-year training experience in applied epidemiology that places professionals in the field, domestically and internationally, in real-life situations. Today, 70–90 EIS officers are assigned each year to Centers for Disease Control and Prevention programs and to state and local health departments to meet the broad spectrum of challenges in chronic disease, injury prevention, violence, environmental health, occupational safety and health, and maternal and child health, as well as infectious diseases. Throughout their assignments, EIS officers are encouraged to strive for analytic rigor as well as public health consequence, which requires technical competence blended with good judgment and awareness of context. Effective applied epidemiologists must have skills beyond just epidemiology to improve a population's health; the field of applied epidemiology requires multiple team members, all having different but complementary skills, to be effective.

Key words

• book reviews
 
• communicable diseases
 
• disease outbreaks
• epidemiologic methods
 
• health personnel
 
• population surveillance
 
• public health

Note from Jonathan M. Samet, Book Review Editor: The termepidemiology is often preceded by an adjective, making reference to the topic of its application. One of the most iconic and dramatic of these adjectival descriptors is shoe-leather, raising the image of an on-the-ground investigation racing to find a solution to a deadly epidemic. In this commentary, the authors provide a historical perspective on the origins and characteristics of shoe-leather and applied epidemiology. They bring notable clarity to these terms and remind us of the key role played by Alexander Langmuir in this area. Following this commentary are reviews of 2 books on shoe-leather epidemiology, one on the Epidemic Intelligence Service (EIS) of the Centers for Disease Control and Prevention (CDC) and the other on the CDC's Public Health Advisors. The reviews cover books that are replete with “real-world” stories of epidemiology and epidemiologists in action. Consider reading these books. The reviews suggest that those in the applied arena will be reminded of old stories and colleagues, and those in “academic epidemiology” will broaden their perspectives on the uses of epidemiology.