Introduction to Epidemiology & Public Health
Learning Module
- Creator(s):
If I told you to picture a classroom, you might have an image in your head that is reminiscent of this classroom pictured below.
Students in this classroom would be considered as consumers of knowledge, listening to a teacher's lecture, or reading a textbook. They might memorize specific facts, and then they would take a test on the material that was presented to them, showing the teacher that they "mastered" it. What they actually mastered was how to remember the required information for a test. They had a one-interaction with this material and understood it in one way - through language.
Students today need to be prepared to enter a world in which meaning is conveyed through multiple modalities, not just language exclusively. According to Cope and Kalantzis, in today's world of new communications and media, written-linguistic modes of meaning have meshed with oral, visual, audio, gestural, tactile, and spatial patterns of meaning (2012). Students must be able to communicate these meanings effectively. Therefore multimodal meanings must be integrated into curricula through the use of text, image, sound, gesture, object, and space (Cope & Kalantzis, 2012). In other words, to learn, students must do something.
This Learning Module was designed for students to explore and engage with content that has been curated from various sources on the web. My goal is for them to interact with the material in such a way that leads them to become active knowledge producers.
I chose an Introduction to Epidemiology and Public Health for the topic of this learning module. I teach high school biology, chemistry, and anatomy/physiology. The dysfunction of human body systems is a topic that presents itself for discussion quite frequently, and whenever that occurs, students are highly interested in what happens to the human body and human populations as a result of certain diseases. In the time of a global pandemic, I thought it would be timely and relevant to facilitate students' learning of epidemiological principles and the history of the field. I have only ever mentioned epidemiology in passing discussions in class, but I have never taught a formal unit of study on this topic.
After completion of this module, students will be able to:
This module was designed for 11th and 12th-grade anatomy and physiology class. The purpose of the module is to introduce students to epidemiology's history and its importance to public health. Background knowledge required for this module includes an understanding of homeostasis: the body's sustainment of physical stability carried out by various organ systems, as well as the negative impacts on the body when this balance is not maintained. The formative assessments within this module are mostly what the students will have written on their updates and comments. I encourage teachers to participate in the dialogue with the students.
Course: Human Anatomy and Physiology
Unit of Study: Introduction to Epidemiology
Materials Required: Students require laptops and internet access.
Duration of Learning Module: 1-2 weeks, depending on the mode of delivery and grade level being taught.
Objectives
After completion of this module, students will be able to:
Next Generation Science Standards (NRC, 2012).
Core Ideas - Interdependent Relationships in Ecosystems
Crosscutting Concepts
Science and Engineering Practices
Learning Goal: Using historical examples, define epidemiology, and describe its goals.
Watch this video to get a picture of 1854 London.
Simple History. (2018, May 10). Tosher/sewer hunter (worst jobs in history) [Video]. YouTube. https://www.youtube.com/watch?v=lMNRQix_QzQ
Listen to this podcast episode at the following timestamps:
Look at the map of 1854 London below. A darkened rectangle represents the number of fatalities from cholera.
Think:
1. What do you think the bigger rectangles signify?
2. What do you notice about the location of the black boxes relative to the water pumps?
3. What do you think the cause of the cholera outbreak was?
Watch this video to determine if you were correct.
Make a Comment:
John Snow, oftentimes called "The Father of Epidemiology," had a difficult time proving that it was not "miasma" that caused disease. Do some research on how he proved that the Broad Street Pump was the cause of the outbreak. What are some specific pieces of evidence he used to rule out miasma? What are some pieces of evidence he used to support that cholera was a waterborne disease and its source was the Broad Street Pump?
Post an Update:
The podcast referenced areas that still have problems with sanitation and disease. Find an example of a place or event in which poor living conditions and sanitation led to public health issues. Cite at least one credible source and use at least one form of media in your post. (Media could include a picture, audio/video file, attachment, or linked media.)
Students: Make at least three comments on peers' updates or comments. Comments should add meaningful dialogue to the discussion. ("Nice post!" and similar comments are kind, but they do not add dialogue.)
The purpose of this first update is for students to imagine themselves in London in the time of the 1854 cholera outbreak. They are presented with a video, a podcast, and John Snow's cholera map in order to figure out that the cause of the cholera outbreak was a contaminated water pump. The media presented helps connect students' existing knowledge of disease spread to the formal field of epidemiology in practice. John Snow is often considered to be the "Father of Epidemiology," and his systematic tracing of disease and shoe leather epidemiology are processes that are still practiced in today's modern world. Because the scene that is being set is pretty disgusting, hopefully, it hooks students to want to learn more. This learning module will cover different aspects of the cholera case study in 1854.
Learning Goal: Using historical examples, define epidemiology and describe its goals.
Notice the image below.
What do you think the red dots represent? What do you think the green lines represent? Why are some areas denser than others?
Keep that in mind as you watch the video below.
TED-Ed. (2011, March 11). How pandemics spread [Video]. YouTube. https://www.youtube.com/watch?v=UG8YbNbdaco
Epidemiologists are important because they study the distribution and determinants (causes) of health-related states or events in specified populations. What implications might the map above have for the spread of disease to populations?
Play the Great Flu game to simulate a global pandemic.
Make a comment.
How has COVID-19 affected your area? Describe any outbreaks and their sources. Describe the measures that have been taken to prevent outbreaks in your area. Which of them are effective? Which are not as effective?
Post an update.
Do some of your own research on the field of epidemiology and public health. Why are epidemiologists important members of the scientific community? In what ways do they contribute to society? What can epidemiology tell us about the past, present, or future? You may want to cite a specific finding from historical pandemics or epidemics.
Students: Make at least three comments on peers' updates or comments. Comments should add meaningful dialogue to the discussion. ("Nice post!" and similar comments are kind, but they do not add dialogue.)
This second update is intended to engage students by having them focus on a natural phenomenon that is currently happening: the pandemic spread of a pathogen. It was designed to help students connect their past and present learning experiences: what do they know already? What learning is this learning module leading them towards?
The image is a map of flight paths with the green representing a flight path, and the red dots representing airports. The densest portions of the map correspond to a higher population density. Travel patterns and population density are crucial in understanding the spread of communicable diseases. They are two of the many factors that epidemiologists take into account when they investigate disease ecology.
The video connects the events of today to pandemics of the past, leading students to question: "What causes disease?" How can we stop it?" and "What can we do to prevent it?" All of those questions are the purview of epidemiologists as well.
Learning Goal: Understand the various modes in which disease is transmitted.
In this learning module, we are specifically looking at the epidemiology of infectious diseases, or rather, how pathogens cause disease in populations. Pathogens or "germs," spread in various ways.
As you may have learned from your peers in the previous sections of this learning module:
The epidemiological triad or sometimes called the epidemiological triangle is a model to help us understand factors that contribute to the etiology of a disease. It is one of the fundamental public health conceptions of disease causality.
DrGoduti (2015, March 30). Epidemiology and the Epidemiological Triangle [Video]. YouTube. https://www.youtube.com/watch?v=BfGyEyDz_uc
The Triangle has three corners:
Agent, or microbe that causes the disease (the “what” of the Triangle)
Host, or organism harboring the disease (the “who” of the Triangle)
Environment, or those external factors that cause or allow disease transmission (the “where” of the Triangle)
This triangle helps us understand what causes diseases and why they spread. Another factor in disease spread is viral load, which will be explained in the video below.
TED-Ed (2014, October 21). How do germs spread (and why do they make us sick)? [Video]. YouTube. https://www.youtube.com/watch?v=yxonJTWhBJQ
Some characteristics used to describe infectious disease include (CDC.gov):
Comment: How can humans directly control the evolution of germs?
Post an update: Look at the infographic below. Choose one of the diseases and describe it in the context of the Epidemiological Triangle. Use at least three of the italicized words that are numbered or bulleted from this section of the module.
Students: Make at least three comments on peers' updates or comments. Comments should add meaningful dialogue to the discussion. ("Nice post!" and similar comments are kind, but they do not add dialogue.)
Hopefully, the students will have gathered information on epidemiology on their own as well as learned from their peers in the first two sections. This third section clarifies what epidemiology is and provides a model called the Epidemiological Triangle which is how diseases within a population are understood in the field. Students' prior knowledge should include the ways that some diseases are spread: through the air, food contamination, mosquitoes or other insects (vector-borne), and various body fluids. What they might not be familiar with is viral load, which is introduced in the Goldilocks and the bear video.
For the update, students will have to take a deeper look at diseases they may or may not be familiar with and research their transmission.
Learning Goal: Explain the importance of public health surveillance.
Epidemiologists are part of a greater team of healthcare professionals who are responsible for surveillance, or the collection and interpretation of data to prevent and control disease in a population. Locally, public health departments monitor public health, but it is also carefully regarded at the state and federal levels. The CDC puts out a Weekly Morbidity and Mortality Report (WMMR) that "timely, reliable, authoritative, accurate, objective, and useful public health information and recommendations" (CDC, 6 June 2020). When there is a sudden increase of disease in a particular area, there must be an investigation to control and prevent further public health crises. A list of CDC required-to-be-reported communicable diseases can be found here.
Let's Learn Public Health (2017, May 21). Public Health Surveillance – a brief overview [Video]. YouTube. https://www.youtube.com/watch?v=3IpE8dE4cVc&t=9s
Consider the media below.
1. STD Infographic
2. Map of E. coli outbreak from romaine lettuce
3. News Clip
Make a comment: What role do you think public health surveillance played in any of the three examples of media above? If you would like to use your own example, please do!
Post an update: In the first video, Public Health Surveillance - a brief overview, mentions several diseases and conditions that are not infectious diseases. Find one example of non-infectious disease surveillance, and describe its importance to public health.
Students: Make at least three comments on peers' updates or comments. Comments should add meaningful dialogue to the discussion. ("Nice post!" and similar comments are kind, but they do not add dialogue.)
Students get an idea of what public health surveillance is and why it is importance. This specific area in the field is much more complex, but has been simplified for its introduction.
The STD infographic, E. coli outbreak map, and contaminated tattoo ink story should trigger learners' memories about specific outbreaks that may have occurred in their area. Public health surveillance is happening constantly, and we may not realize it. Students should connect what they might already know to epidemiology which is a new concept for them.
Learning Goal: Identify and describe the process epidemiologists use to determine the cause of a disease outbreak. Use epidemiological principles to conduct a simulated outbreak investigation.
Where do epidemiologists start when an outbreak occurs? According to the Centers for Disease Control, epidemiologists have a systematic approach to follow that includes the following steps:
These steps do not necessarily have to occur sequentially - they may occur out of order and repeat several times as new data comes to light. Watch the video below in which the steps to investigate an outbreak have been consolidated.
Let's Learn Public Health (2017, July 31). Outbreak Investigation - a step by step approach [Video]. YouTube. https://www.youtube.com/watch?v=kUlKRIMxpZQ
Students: Open up the document below or get a printed out copy from your teacher. You will be simulating an outbreak investigation in an assigned team.
When you are finished with the investigation, come back to Scholar to finish the assignment.
Make a comment: Why is it crucial that infection prevention and control crucial be implemented as early as possible in an investigation? What benefits are there when this happens?
Post an update: Imagine you are implementing the control measures that are described in the assignment in a developing country in which resources are scarce. How might you address these challenges?
Students: Make at least three comments on peers' updates or comments. Comments should add meaningful dialogue to the discussion. ("Nice post!" and similar comments are kind, but they do not add dialogue.)
The Ebola investigation is meant to simulate an actual outbreak and what types of questioning epidemiologists need to perform. It is important that students understand investigation of outbreaks is not sequential, and it may in fact be cyclical or repeating depending on what evidence is discovered. The video can be played multiple times and students can pause or restart it at their discretion.
Learning Goal: Describe vaccines and their role in public health. Analyze ethical considerations of vaccine research.
Watch the video below to learn about the origin and history of vaccines.
OpenMind (2016, April 28). The Origin of Vaccines [Video]. YouTube. https://www.youtube.com/watch?v=E_PKQ_M7AtU&feature=youtu.be
The findings of Edward Jenner can be summarized in the image below.
Watch the video below from 0:00 to 9:43.
Herd immunity is resistance to the spread of a disease that occurs if a sufficiently high proportion of individuals are immune to a disease in a population.
Explore the simulation attached to this link to see herd immunity in action.
In this section of the module, students investigate the history of vaccines and the very basic idea of how they work. The idea is to introduce them to vaccinations as they relate to the larger picture of epidemiology and public health. Vaccinations in and of themselves could be another learning module entirely. (For the future, maybe?)
The first video introduces students to Edward Jenner and creating the smallpox vaccine. The concept of vaccination is much older, but Jenner is probably the most credited with the discovery.
The image from Mayo Clinic is a summary of what happens to the body on a cellular level when individuals are vaccinated.
The last video is a TED Talk about herd immunity. The speaker is a doctor and proponent of vaccination. The video is in Spanish, but there are subtitles.
Read this article.
Morbidity and Mortality Report - February 20, 2015
For this task, you will need to be familiar with evaluating scientific evidence. Examine the media below.
1.
2. CrashCourse Video
CrashCourse (2019, February 12). Evaluating Evidence: Crash Course Navigating Digital Information #6 [Video]. YouTube. https://www.youtube.com/watch?v=hxhbOvR2TGk
Post a comment:
Why would epidemiologists be concerned with what percentage of the population is vaccinated? Cite at least one historical example.
Post an update:
With your team members, select four of the following claims and categorize them as either an assumption, a concern, or a misconception. Specify your source, and evaluate its reliability and credibility based on the criteria provided in media sources 1 and 2 of this section. Does the claim have any validity based on your research?
Students: Make at least three comments on peers' updates or comments. Comments should add meaningful dialogue to the discussion. ("Nice post!" and similar comments are kind, but they do not add dialogue.)
Students may come from a wide variety of backgrounds and upbringings, coming to the classroom with different beliefs about vaccinations. Teachers should be aware of the religious or familial reasons why children are not vaccinated and be sensitive to students' upbringings. In this activity, facilitate a respectful discussion in which the main focus of the lesson is to practice scientific literacy and critical thinking.
The Next Generation Science Standards require students to be able to engage in argument from evidence. This activity gives students an opportunity to evaluate sources and demonstrate how to determine the validity of information presented to them. Additionally, they must communicate that information to others.
Your final assessment includes a project as well as this check-in.
Click the link here to take an assessment on Google Forms.
As a final assessment for the module, I am asking students to write a final paper or compose a product that takes what they have learned to compile a cohesive case study about a specific infectious disease. Here is the description of the project:
In addition, there is a Google Form that summarizes what they have learned and also gives them an opportunity to think logically about certain diseases and their modes of transmission.
[Classroom stock photo]. (n.d.). https://www.pikist.com/free-photo-svkpl
Cope, Bill and Mary Kalantzis. 2015. "The Things You Do to Know: An Introduction to the Pedagogy of Multiliteracies." Pp. 1-36 in A Pedagogy of Multiliteracies: Learning by Design, edited by B. Cope and M. Kalantzis. London: Palgrave.
CrashCourse (2019, February 12). Evaluating Evidence: Crash Course Navigating Digital Information #6 [Video]. YouTube. https://www.youtube.com/watch?v=hxhbOvR2TGk
Let's Learn Public Health (2017, May 21). Public Health Surveillance – a brief overview [Video]. YouTube. https://www.youtube.com/watch?v=3IpE8dE4cVc&t=9s
Mayo Clinic Health System. (2018). How vaccines work. Accessed from https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/top-5-faq-about-vaccines
National Geographic. (2019). Methods of disease transmission [Infographic]. National Geographic. https://www.nationalgeographic.org/media/methods-disease-transmission/
National Research Council (NRC). (2012). A framework for K–12 science education: Practices, crosscutting concepts, and core ideas. Washington, DC: National Academies Press.
Simple History. (2018, May 10). Tosher/sewer hunter (worst jobs in history) [Video]. YouTube. https://www.youtube.com/watch?v=lMNRQix_QzQ
Snow, J. (1854). On the mode of communication of cholera [digitally enhanced image]. UCLA Department of Epidemiology, Los Angeles, CA, United States. https://www.ph.ucla.edu/epi/snow/highressnowmap.html
TED-Ed. (2011, March 11). How pandemics spread [Video]. YouTube. https://www.youtube.com/watch?v=UG8YbNbdaco
TED-Ed (2014, October 21). How do germs spread (and why do they make us sick)? [Video]. YouTube. https://www.youtube.com/watch?v=yxonJTWhBJQ
"Understanding the Epidemiologic Triangle through Infectious Disease" by Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, 2018, Centers for Disease Control (https://www.cdc.gov/healthyschools/bam/teachers/documents/epi_1_triangle.pdf)
Welsh, E. & Allman Updyke, E. (Hosts). (2018, February 10). The poop show (No. 4) [Audio podcast episode]. In This podcast will kill you. Exactly Right Media. https://thispodcastwillkillyou.com/2018/02/10/episode-4-the-st-show/