Some idea of the contribution of epidemiology comes from just two examples.1 During the 19th century, population studies revealed that people who lived and worked in dirty, overcrowded and unsanitary conditions with little food or clean water, were much more likely to die of infectious disease. Social reformers such as Edwin Chadwick in Britain and Lemuel Shattuck in the United States used these epidemiological findings to influence sanitary reform and the resulting improvements in public health were chiefly responsible for the increase in life expectancy over the following 100 years. Drugs and vaccines had only a comparatively small effect. The same measures would transform health in Third World countries today where the pressing need is for food, clean water, sanitation and improved living and working conditions. And it is careful detective work by modem day epidemiologists that has identified the main causes of heart disease, cancer, strokes and AIDS, showing how major killers in the West can be prevented.
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