Epidemiology is the study of the Spread of Disease.
The term "epidemic" refers to a disease which exists exists in higher incidence in a certain area at a certain time, and which has not existed in all areas at that incidence in all times. So for example, if a certain percentage of people always have some disease in a region, then that disease is not an epidemic. But when some new disease appears which was not there before, then that disease is an epidemic. Epidemics are almost always tied to some change in environment, behavior, or social practices.
Sexually transmitted diseases and diseases spread by the use of injection drugs are epidemics, because they are reaching new areas as new trends in social interaction arise.
Epidemics are usually tracked through the use of statistics. To get statistics about communities from communities, researchers use a tool called a survey. A "survey" is a standardized list of questions which an interviewer asks and which randomly-chosed respondents answer. Even the best respondents will misunderstand the questions in the best surveys sometimes. Also, some people mistakenly or purposefully give wrong answers, especially in areas of sensitive topics like sex practices or drug use. Because of this, surveys have a certain level of inaccuracy which must be corrected. One to correct this inaccuracy is to take a huge number of surveys.
An example of corruption in surveys
It is difficult to prove the existence of corruption. When
the Indian government does studies on corruption, those studies
get corrupted, so it is difficult for Sanjeevani Booti to relate
the effect of corruption as a hindrance to its mission. In short,
there is a problem in India that different parties corrupt data
about diseases in two ways, both understating them and exaggerating
them. This example may help the reader understand. This is a true
story but we changed the names:
Ravi the field survey technician has been commissioned by the Indian government to go to a rural area and go through a ten-question survey with local people. The survey asks questions that will give a preliminary indication of the need of the respondents to be tested by a doctor for HIV, hepatitis C, and whatever else. Ravi lives in the city and does not like to be in rural areas. He does not get paid enough. The survey is anonymous to protect the privacy of the respondents, so there are few ways for anyone to check to see if he does his work. If a person answers questions in such a way that indicates that they might need medical evaluation, then Ravi will have to fill out a lot of paperwork for each person to get that person free medical care (remember that this work is on paper, not computer!). Anyway, the symptoms all seem mild and ambiguous - HIV and Hep C can be almost benign for years. Lastly, neither Ravi nor most other survey takers even believe in the existence of HIV or any other sexually or blood transferred disease - and if it exists, surely not in India.
Ravi goes through the motions of doing his work by conducting part of the survey on some of the people, and he gives the entire area a clean bill of health. Ravi is a little corrupt, but he is also just an average family man who has to many assignments, not enough time and money, and no understanding of the importance of his work. After all, even if he does find someone with HIV, there is no money for treatment beyond a blood test to confirm that a person is positive. A person who is positive will almost certainly be ostracized, so no one wants to get tested and take the risk of knowing anyway.
Back at the main office Ravi submits his reports. They show that no one in the area has HIV. For a lot of reasons, the perception of some health offices is that they need to exaggerate the instances of disease, because there is potentially benefit to apply for aid depending on how large the number of infected persons there are in an area. For example, if a small number of people are reported with a disease, then maybe no government official will pay attention. If an area is especially bad, though, maybe someone will give money to build or improve a hospital, and even hire more workers for the office, thus bringing in more capital for the organization.
Corruption is tied to poverty. It is the way of life that poverty increases corruption. There is plenty of other information on this topic.
Sanjeevani Booti does surveys.
Sanjeevani Booti does its own surveys. We give independent data,
and this is one instance in which there is a positive point
that we are not able to give medical treatment other than to
talk to people. The government surveys are almost always biased
to prove some point so that someone can get more funding. All
we have to do to justify our existence is say that somewhere in
Varanasi, with its 1.4 million residents, HIV and Hepatitis C
exist somewhere. Whether this number is high or low, we do the
same work. It is our informal opinion that
probably as time passes we will find that these diseases
spread here the same as everywhere else without safer sex
and drug education, but our organization and probably no
organization has the scale of operations to say more than that
about this city.
Links
New York Times article about Indians exaggerating incidence of HIV
