By Virginia Kotzias, PhD Research Fellow at the Centre for Global Health Inequalities Research (CHAIN), Institute for Sociology and Political Science, Norwegian University of Science and Technology
There’s a running joke on the internet that the COVID-19 pandemic turned everyone into an amateur epidemiologist. Suddenly, people who had never even heard of the field were well-versed in case-fatality ratios, risk factors, and the burden of infection. As months wore on and results from epidemiological studies were translated into policies that affected people’s daily lives, the importance of epidemiology within the field of Public Health became very clear, very fast.
Spoiler alert: I am not an epidemiologist (except in the armchair-internet sense), but as a researcher in health policy and practice, I’ve worked closely with some amazing epidemiologists and have long understood the value of the field. This is why, when the Norwegian Research School of Global Health (NRSGH) offered an opportunity to take a deep dive into the discipline, I jumped.
In April 2022, NRSGH and the Centre for Intervention Science in Maternal and Child Health (CISMAC) at the University of Bergen co-hosted two back-to-back epidemiology courses. The first, “Conceptual Foundations of Epidemiologic Study Design and Analysis,” was taught by the blockbuster scholar, Kenneth Rothman (Boston University) and pharmacoepidemiologist Vera Ehrenstein (Aarhus University). The purpose of the class was to provide an introduction to the core concepts, methods, study designs, and limits of modern epidemiology. Preparation for the 5-day intensive course was no joke: we were required to read Epidemiology: An Introduction, several articles, and complete homework assignments that served as the basis for group discussions. It was pretty awesome, and meant that I walked away from the class with a solid, beginner’s grasp of measures of disease and effect, types of epidemiologic study design, approaches to analysis and managing bias, and the strengths and limitations of each.
The second course, simply titled “Advanced Epidemiology” was taught by Matt Fox (Boston University). This class built upon the basics of the prior week to “go deeper” into epidemiological topics, with a special focus on causal inference and models. We spent a significant amount of time on the importance of framing clear research questions and describing the counterfactual, and learned varying approaches to identify and account for different types of confounding and bias. We ended with a survey of statistical and other approaches to identifying associations between exposure(s) and disease(s) and the threshold of validity and precision necessary to make causal claims in epidemiological research. I gained so much from this class that I didn’t want it to end – so I was thrilled to find that Matt is the co-host of two podcasts (SERious EPIand Free Associations) that continue these discussions about epidemiological topics. (I may or may not have listened to the entire back catalogue of SERious EPI episodes over the summer).
Since completing these classes, I’ve been able to define my current PhD project more clearly and think through tough questions in a more systematic way. I work pretty definitively in the social science space, which is complicated – relationships between social policies, complex health phenomena, and the natural world are messy and confounding (in every sense of the word). Luckily for me, epidemiology is a discipline that tackles difficult relationships like this all the time and has developed a pretty robust toolbox of methods and approaches to handle them. Thinking like an epidemiologist – or at least, trying to – helped me approach my research questions and study design in new ways.
I appreciate the importance of public health, am dedicated to the field, and have always found my work to be meaningful. But by combining my prior training as a health policy analyst with what I learned from these classes, I feel better equipped to take on the increasingly complex challenges faced by all of us working in the public health world. Though it required a lot more effort than a long night scrolling Twitter and earning my social media badge as an armchair epidemiologist, my training as an amateur epidemiologist has been useful in my current PhD work – and will continue to shape my thinking about research, populations, and study design throughout my career as a health researcher.
Special thanks to Drs. Rothman, Ehrenstein, and Fox for teaching excellent courses, to NRSGH and CISMAC for hosting them, and to NRSGH for generous travel funding to support my attendance.