University of Minnesota

Division Mission. Division of Epidemiology, 1985

In 1985 the research and training program of the Laboratory of Physiological Hygiene dating from 1939 was charged to merge with the Division of Epidemiology that dated from 1954. The following somewhat expansive statement was proposed as the mission and mode of operation of a new academic unit of the University of Minnesota School of Public Health.

April 3, 1985

Division of Epidemiology, Univ. of Minnesota, 1985

The Division of Epidemiology, recently merged with the Laboratory of Physiological Hygiene, has a 45 year experience and tradition in epidemiology and prevention of chronic diseases. It has believed in the assemblage of faculty having multiple skills, from several disciplines, to address major disease issues as an effective investigative strategy. It has deliberately assembled such multiple skills since its beginning.

The Division has sought and continues to seek to maintain clinical, laboratory and field capabilities so that it may move, according to the question, from small, individual studies to groups and to larger fields, whole communities and regions. From field work it has sought to maintain the capability to return to the clinic or laboratory for more clinically-based studies, or for the development of methods for application in the field.

This concept and this staffing has allowed it to move over the years to progressively more complex questions beyond those which continue to be answered with case series, case control studies, cross sectional surveys and randomized clinical trials.

It has allowed moving on to those issues requiring surveillance of whole regions with surveys and trend analyses, the determination of incidence and change in incidence and mortality in cohort and in cross-section. This base is followed by large-scale preventive trials and, finally, prevention and health promotion programs, research demonstrations, and public health trials in whole communities and regions of the upper mid-west.

This staffing and approach has allowed us also to use the investigative strategies appropriate to the stage of knowledge and to use the methods appropriate to the particular question being addressed. This strategy has allowed us to stay, we believe, on the forefront of observational, and experimental researches in the causes and prevention of non-communicable diseases.

The division has developed a faculty including the following disciplines: medicine, epidemiology, behavioral sciences, sociology, anthropology, communications, economics, marketing, computer science, nutrition, physiology, pharmacology, and biostatistics. The Division also has developed technical staff and facilities in data editing, processing, and analysis, in laboratory chemistry for field surveys, in a survey center, a media development and production group of education materials for youth and adults, and a staff concerned with community organization for health promotion.

The Division has necessarily developed an administrative staff, structure and procedures that provide competence and flexibility to develop grant proposals, submit them in an orderly fashion, prepare for site visits, and, when granted, to administer studies accountably, to analyze and report them in relation to other studies, and to juggle numerous grants to maintain a continuity of staff and facilities.

The Division, due to this tradition and maturity, has developed useful general concepts which allow it to pursue investigations of modern, chronic mass diseases in a related and comprehensible manner. These mass diseases include several types of cancers, atherosclerosis, and hypertension. This broad view is derived from the wide base of disciplines and a synthesis of results between a number of disciplines. For example, we find it useful to understand and consider the anthropological, even the paleontological background and the evolutional genetics of modern man and diseases, as well as their current socio-cultural, medical, pathological, and physiological aspects.

In this synthesis we have developed these propositions: that mass diseases represent an interaction of very powerful and ubiquitous socio-cultural factors on a very widespread genetic susceptibility. These powerful socio-cultural factors are clearly manmade, recent (involving only 500 generations since the advent of agriculture and civilization) and modifiable. Widespread susceptible genotypes in the population may be a legacy of evolutionary, genetic adaptations to hunter-gatherer subsistence in the 1-200,000 generations involved in the major evolutionary phases of humanity.

The concept, then is that interaction of mass socio-cultural factors on this mass susceptibility results in mass maladaptations which give us the wide distribution of elevated risk characteristics, the precursors to the modern mass diseases, primarily cardiovascular and malignant disease.

The corollary of these propositions is that an unfavorable environment assures the maximal development of susceptible phenotypes in the population and the maximal burden of disease. In contrast, a favorable environment assures at least the minimal exhibition of this phenotypic susceptibility in the population.

We suspect that the issue of cancer susceptibility in the environment may fall in this pattern just as may the metabolic derangements of obesity, hypertension, hyperlipidemia, diabetes, and atherosclerosis.

Based on this broad view then, our own investigative evolution has evolved from concern with disease, to those at particular risk for disease, to entire populations at excess risk of disease, to prevention of high risk in the first place, and to the promotion of optimal health.

We have sought to develop a population-wide, public health view of causes, with testing of applications to the prevention of disease and enhancement of health. This is not to replace but to complement traditional medical investigative strategies: the clinical-pathological studies concerned with individual maladaptations, and academic approaches in the never-ending search for mechanisms at the cell level. (HB)