Interdisciplinary Programmes

Academic year 2019-2020 PROFESSOR

Introduction to Global Health: Biomedicine and Vinh-Kim Nguyen Epidemiology Office hours

MINT149 - Autumn - 3 ECTS ASSISTANT

Tuesday 18h15 - 20h00 Facundo Daniel Rivarola Ghiglione Room S8

Course Description Office hours

This course is intended for students intending to follow the Global Health specialization but wish to acquire basic literacy in biology and epidemiology relevant to biomedical topics in Global Health. It is highly recommended for students wishing to follow the specialization in Global Health who have no previous courses in biology or public health. Lectures, tutorials and exercises will be used to cover the following topics: infectious with a focus on chronic (i.e. HIV, hepatitis B and C, malaria and ) but also covering acute infections (, and ); key tropical diseases (leishmaniasis, schistosomiasis and trypanosomiasis); cardiovascular and metabolic diseases (e.g. diabetes); resistance; sexual and reproductive health; respiratory ; malnutrition; and trauma. Throughout we will examine the epidemiology, natural history and treatment of these conditions and their wider global health implications. Basic concepts in human pathophysiology, pharmacology, and descriptive and analytic epidemiology will be covered.

Chemin Eugène-Rigot 2 | CP 1672 - CH-1211 Genève 1 | +41 22 908 57 00 | graduateinstitute.ch

MAISON DE LA PAIX

Syllabus

The course serves as a foundation for the following courses:

Fall Term ANSO Biofinance: Pharmaceuticals, Finance and Global Health (Nguyen) 102 ANSO Medical Anthropology I: Health and Illness in Cross Cultural Perspective (Nguyen) 103 DE 123 Global Population and Reproductive Politics in the 20th Century (Bourbonnais) ANSO099 Anthropological Perspectives on Reproductive Politics in the 21st Century (Bharadwaj) Spring Term ANSO Medical Anthropology II: Contemporary Approaches to Biomedicine, Technology and Global Health 111 (Bharadwaj) DE 140 Global Health, Globalisation and Global Governance: Problems, Politics and Policies (Moon) HI 106 Global Health in History (Bourbonnais) DI 121 Global Health Law (Burci) ANSO Global Health: Anthropological Perspectives on Disease Eradication (Nguyen) 116

- Page 2 - Overview of the course (structure and topics):

Dat Class Topics Key epidemiological concepts Examples e 17 1. Introduction to  Triad model of disease causation  John Snow and Sep Epidemiology  Routes of of the Broad Street t communicable disease Pump  Surveillance  Cholera Outbreaks  Measures of morbidity and mortality 24 2. Transmissible  / , , Sep diseases  (AR) ebola, tuberculosis, t  Case fatality rate (CFR) ,  Types of spread (airborne, micro- gonorrhoea, syphilis, droplet, contact, sexual, blood- HIV… borne, etc) 1 3. Understanding  /environmental control Malaria (dengue, zika); Oct transmission  Incubation period onchocerciasis dynamics  Infectivity (leishmaniasis,  Reproductive rate R0 schistosomiasis); trypanosomiasis 8 4. Chronic infections  Survival (K-M) curves HIV, TB, HPV, H Oct and slow  Natural history pylori  Surrogate markers for outcomes 15 5. Non-communicable  Exposure, risk and causation Smoking and lung Oct disease  Odds ratios vs relative risk cancer;  Case control vs cohort studies  Types of limitations and bias 22 6. Experimental  Randomized clinical trials HIV treatment and Oct approaches  Types of confounding and prevention their solutions 29 7. Social  Social gradient of health Whitehall study, Oct epidemiology  Social determinants of health Marmot/Wilkinson  Health inequalities

Evaluation

 There will be a brief 15-minute quiz at the end of each class. The quiz will be based on class teaching and readings. The quiz will comprise short answer and multiple-choice questions and will evaluate students’ ability to apply basic concepts of the course (rather than regurgitating factual content). There will be seven quizzes for classes 2 through 8. Each quiz will be weighted equally but only the top 6 will count for the final grade.

Detail of course sessions

1. Introduction (17 Sept)

The historical conditions of possibility and emergence of epidemiology are explored: (i) the rise of the modern State and related practices of standardization, enumeration and aggregation (e.g. the national census, taxation, etc); (ii) the waxing of the biological paradigm, and the corresponding waning of a humoral approach, to understanding and addressing illness and (iii) a growing concern with mitigating the economic consequences of epidemics and resulting mechanisms to ensure that epidemics are promptly recognized and managed.

2. Communicable theory of disease

Mapping the distribution of diseases in populations pre-dates modern biological understandings of disease causation, and laid the groundwork for the realization that epidemics were ‘caused’ by

- Page 3 - microorganisms that were transmitted to hosts. In this session, we will briefly cover the history and the basic concepts of epidemiology, starting from the first study, of the 1854 cholera outbreak in London, conducted by John Snow. In addition, we will explore the basis for a comprehension of disease causation and routes of transmission for communicable disease. The following key epidemiological measures will be introduced: incidence and prevalence, attack rate (AR) and case fatality rate (CFR). These concepts will be seen throughout the course and applied to different types of disease. We will review basic mechanisms of spread of communicable diseases along with examples.

3. Understanding transmission dynamics

The primary modes of transmission (i.e. airborne, micro-droplet, contact, sexual, blood-borne, and vector-borne) will be further discussed and distinguished in terms of their epidemiology. Examples will be used to illustrate the public health implications of these differences, drawing on clinical and social aspects of specific infectious diseases. Key concepts covered include incubation period, infectivity, and basic reproductive rate (R0). Some of the top causes of human morbidity and mortality globally are transmitted to humans by intermediate hosts (or vectors). Their epidemiology – and at times their control – is therefore more complex, requiring that vector, environmental as well as human behavioural factors be taken into account. Key examples discussed are malaria, mosquito-borne viral illnesses such as , dengue and zika, leishmaniasis, onchocerciasis, schistosomiasis, and trypanosomiasis.

4. Chronic infections

While most infectious diseases are of short duration, some lead to chronic infections with prolonged incubation times, complicating their epidemiological understanding. In this class we explore classical “slow” infections such as HIV and tuberculosis as well as more recently discussed examples (hepatitis C, HPV, and H pylori infections. Prolonged incubation times have important implications for diagnosis and treatment. We will deepen our understanding of epidemiological approaches and tools for addressing chronic infections – or “slow epidemics” – such as natural history, survival curves, and the use of surrogate markers for distant outcomes.

5. Non-communicable diseases

The distinction between non-communicable and communicable diseases and the relevance for epidemiological analyses and public health intervention explored. Key notions include those of demographic and epidemiological transition, co-morbidity, , and the interaction of multiple risk factors. Causation in chronic disease can be examined retrospectively or prospectively, through case-control (odds ratios) or cohort studies (relative risk) respectively. The advantages and disadvantages of these designs, and of their attribution of causality, will be discussed. Clinical examples will draw from cardiovascular disease/metabolic syndrome and oncology.

6. Clinical trials

The distinction between observational and experimental designs will be explored through a discussion of randomized controlled trials and how they overcome weaknesses of observational studies. Different types of bias and confounding will be discussed as well as the role and mechanisms of randomization and blinding, and the limitations of randomized trial designs (despite their popularity). Prevention and treatment trials will be contrasted.

7. Social epidemiology

The field of social epidemiology will be introduced with a discussion of the seminal Whitehall study. The social gradient for health will be discussed as well as potential mechanisms, and distinguished from social determinants of health. We will also contrast social inequalities of health from inequity.

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