EPH Research Topics |
We focus on a range of methods linking diseases, environmental and ecological, genetic and biological, and socio-cultural factors, life styles, and health systems to efficiently approach public health and prevention.
Approaches and Methods
Epidemiology
Epidemiology is the study of health and diseases in populations. Successful public health interventions require a detailed understanding of how health and wellbeing are affected by biological factors, and by determinants not amenable to laboratory-based research methods such as socio-cultural factors, environmental conditions, or the interaction between genetic conditions and life styles. EPH scientists apply epidemiological methods to a range of topics, such as drug testing (clinical epidemiology), understanding the role of molecular pathways (molecular epidemiology), or unravelling the health relevance of ecology and the environment (environmental epidemiology). All capitalise on the essence of epidemiological science: to conduct research under real life conditions. EPH, thus, relies heavily on the willingness of people to participate in research.
Biostatistics
Biostatistics is the branch of statistics which is characterized by its specific focus on biological, medical or epidemiological research questions. The biostatistics expertise within Swiss TPH covers all three of the aforementioned domains. The Biostatistics unit of Swiss TPH has strong competences both in frequentist modeling (group of C. Schindler) and in Bayesian modeling (group of P. Vounatsou). The latter group has a strong methodological research agenda (spatio-temporal disease modeling) whereas the former group is specialized in modeling short and long term effects of air pollution on health. Moreover, the Biostatistics Unit offers statistical support within Swiss TPH and to customers from other faculties of the University of Basel. This support can be requested via the the Institute's home page.
Exposure assessment
Exposure assessment is a key part of epidemiological research and health impact assessment. Exposure refers to environmental factors such as air pollution, to biological agents, to a drug, to a health intervention, or even to a gene. Consequently, exposure assessments are conducted by all EPH scientists, who apply a variety of techniques such as modelling, measuring, gene sequencing or inquiring by questionnaire. A special focus of our institute is assessing exposure to environmental factors (air pollutants, noise, non-ionizing radiation).
Genetic epidemiology
Genetic epidemiology is an integral part of chronic disease epidemiology. Genetic variants associated with increased disease risks can be identified through both hypothesis-driven and agnostic approaches mostly applied to large-scale association studies. At Swiss TPH, different research groups contribute data from large longitudinal studies to international genetic research consortia. Genetic research at EPH aims to understand susceptibility to lifestyle and environmental risk factors and at elucidating underlying pathophysiological mechanisms.
Intervention studies
Developing new health interventions is a strong feature of the departments of Public Health and Epidemiology, Medical Parasitology (drugs, vaccines) and MedRes (clinical trials). In the EPH department, the main units involved in this field are the Health Interventions Unit (focusing essentially on malaria interventions) and the Human and Animal Health Unit (focusing on animal health and “one health”). Support also comes from the Biostatistics and Bioinformatics Unit, as well as the Health Systems Research and Dynamic Modelling Unit. Covering intervention from so many angles allows for an intense and successful range of activities in this area.
Medical anthropology
Medical anthropology is the study of how culture influences illness experience and how it produces the living conditions, political structures and technologies that determine health outcomes. In the EPH department, medical anthropology research focuses on understanding age-related health practices in diverse contexts and on explaining the underlying dynamics of vulnerability and resilience. We also contribute to international initiatives that develop participatory approaches as well as social determinants approaches to health.
Diseases and phenotypes
Asthma, COPD
In Switzerland and in other countries of the North and West, asthma is the most important chronic disease among children and a major respiratory disease among adults. Investigating the environmental causes of asthma is a long-standing topic of interest and activity in several interdisciplinary research groups. The research agenda is broad and covers the roles of gender and sex in the development of asthma, and the genetic and molecular underpinnings of asthma phenotypes. The research allows us to quantify the impact of environmental factors on the burden and cost of asthma.
Cancer
Cancer is increasing on a global scale and contributes in a substantial way to the disease burden. It is a major target for those fighting non-communicable disease epidemics. At EPH, different research groups investigate the association between lifestyle (physical activity; obesity), environment (ionizing and non-ionizing radiation), genes, and treatment and the incidence, progression, and mortality of cancers. We also actively engage in cancer monitoring and implementing relevant infrastructure and legal regulations.
Cardiovascular diseases
Cardiovascular diseases (CVD) are the leading causes of morbidity and mortality globally and in Switzerland. Cardiovascular disease is considered a course of life disease that originates early in life, while clinical outcomes occur mainly in adulthood. At Swiss TPH, different research groups investigate environmental factors and their impact on cardiovascular disease development. We also investigate exogenous and endogenous determinants in childhood and adulthood and the differences in determinants, prevalence or incidence and outcome by gender. Better understanding of the mechanisms and origins of the disease can lead to improved prevention strategies and policies.
Childhood asthma and allergy
Atopic eczema, hay fever and asthma are among the most common chronic diseases in childhood. Environmental exposures and their interaction with genetic factors appear to be crucial determinants of disease development. Research has shown that some environmental factors protect us from disease development, such as the diversity of environmental microbial exposures and consumption of untreated farm milk. The Swiss epidemiological centre of a large European cross-sectional study of school-aged children (GABRIEL) and of a European birth cohort of rural children (PASTURE/EFRAIM) is based at Swiss TPH. We investigate how environmental factors interact with innate immunity, in collaboration with the Christine Kühne - Center for Allergy Research and Education, Hochgebirgsklinik Davos.
HIV/AIDS
The global response to the HIV/AIDS epidemic has become more effective with the introduction of universal access programs. Increased coverage of antiretroviral therapy (ART) through these programs has brought benefit to affected persons in low- as well as high-income countries and has significantly reduced morbidity and mortality. This is the case in Southern Africa as well, where a large proportion of the HIV-infected people in the world live. However, health system constraints continue to pose considerable barriers to the roll out of ART services in these countries. In addition many people are confronted with other, non health system or finance barriers to access that continue to limit uptake of HIV testing and antiretroviral therapy. At Swiss TPH, several groups are conducting research aimed at improving equity, cultural sensitivity and support in all aspects of access to HIV care, including prevention, diagnosis, treatment, and support.
Malaria
Malaria is one of the major causes of ill-health and death in the developing world, especially on the African continent. Malaria has traditionally been a strong area of investigation at Swiss TPH. Numerous groups are working on a wide range of malaria topics, ranging from basic science (mainly immunology and molecular biology) to the development of new vaccines, the screening of drug candidates, the testing of new products, and finally their application under programme conditions. The range of activities and specialties in this research area is unmatched, and Swiss TPH has acquired an international reputation for malaria expertise.
Mental Health
Swiss TPH is concerned with the determinants of mental health problems and their effects on populations. Our work considers the role of society, culture and health systems, with reference to provision of services and innovative approaches to prevention and promotion. Community mental health interests are concerned with local concepts and priorities, and the use of media for public awareness. Suicide research clarifies the role of underlying problems and triggers of suicidal behaviour. Collaborations in cultural psychiatry contribute to developing cultural formulation in DSM-V and locally effective clinical practice. The Institute provides expertise to support mental health system capacity through the Swiss Centre, and mental health interests are integrated into frameworks for epidemiological studies of chronic disease and cohort studies.
Non-Communicable Diseases (NCDs)
NCDs are becoming highly prevalent worldwide due to increased life expectancy and other complex mechanisms, like urbanization. In low- and middle-income countries, NCDs will not necessarily replace, but additionally affect people, often at earlier ages. They are a major burden for household and national budgets and a poverty risk. The primary prevention of NCDs, as well as access to affordable treatment are central to fighting the NCD epidemic. EPH focuses on understanding the relevance of environmental and lifestyle risk factors in NCD etiology and progression. Policy activities evaluate the potential of structural prevention in slowing down the NCD epidemic. The department exhibits broad expertise in both communicable and non-communicable disease epidemiology in low, middle and high income countries.
Tuberculosis
Tuberculosis remains as one of the major unsolved public health issues mostly in Africa, Asia and countries of the former Soviet Union. Swiss TPH and EPH specifically addresses social and cultural determinants, gender, and access to care for tuberculosis. Molecular epidemiology and the cost of disease of zoonotic tuberculosis in Africa are also addressed. The Swiss TPH Tuberculosis Research Unit strategically pulls together all tuberculosis activities.
Zoonoses
Diseases transmissible between animals and humans, known as Zoonoses, have been rather well-controlled in developed countries, but they remain endemic in developing and transitioning countries. Understanding the ecology of zoonoses between wildlife/livestock and humans helps to identify interventions that best interrupt transmission. Cross-sector economic analyses assess under which conditions zoonoses can be controlled, particularly in low-income countries. With the increased risk of worldwide zoonotic outbreaks, our research also contributes to future Swiss preparedness.
Environment and Ecology
Air pollution
Indoor and outdoor air pollution are among the most important environmental causes of morbidity and mortality. EPH air pollution and health expertise ranges from measuring and modelling exposure and ambient air pollution to investigating its cardio-respiratory health effects, and understanding its interaction with genetic factors. We complement our research by reviewing international literature for the interested public (LUDOK). It provides the foundation for estimating the related public health burden, as well as the benefits of clean air policies. EPH researchers serve on committees and advisory boards to advance research- and science-based policies at an international level. We collaborate with local and national authorities who provide instrumental information on air quality. Seminal long-term projects such as SAPALDIA, ECRHS, ESCAPE, EGEA, REGICORE, SALIA or the Southern Californian Children’s Health Study highlight our international involvement. Additional research relates to improving indoor air quality in low-income countries, as solid fuel use within households increases the risk of respiratory infections, especially in children.
Climate Change
Climate change is expected to negatively impact health and wellbeing in all countries of the world. It is estimated that by 2050, 6 billion people will be at risk of one or several of the ‘big 7’ climate-related diseases: malaria, haemorrhagic fevers, schistosomiasis, human African trypanosomiasis, Chagas disease, leishmaniasis and onchocerciasis. Swiss TPH applies interdisciplinary research linking climate science, disease trend forecasting, mitigation and adaptation strategies. Better protection of the most vulnerable populations requires collaboration among several EPH research groups and their partners in Switzerland and abroad.
Noise
Noise is usually defined as unwanted sound. It is a by-product of various human activities such as traffic, building construction or industrial processes. As most of these activities also produce air pollutants, investigation of noise and air pollution health effects goes hand in hand in many EPH studies. Our studies on environmental noise exposure focus mainly on sleep quality and cardiovascular health
Non-ionizing radiation
Nowadays, exposure to non-ionizing radiation is unavoidable in our everyday environment. For example, electricity use results in extremely low frequency electromagnetic fields (EMF), wireless communication produces radio-frequency EMF. Both types of non-ionizing radiation are suspected to impair human health. EPH researchers conduct epidemiological studies, including personal measurements, and regularly review related international literature (ELMAR). We address a variety of potential health consequences, ranging from tumours to sleep disturbances. The possible biological pathways of non-ionizing radiation are elucidated by means of bioinformatics.
Humans and animals
The health of humans and animals are closely interlinked because of the infectious diseases they can transmit to one another. However, many other factors determine human-animal relationships, like psychological support for pets undergoing depression therapy. Yet, human and veterinary medicine most often work in separate realms. A “one health” approach to addressing human and animal health shows the synergistic benefits from closer cooperation between human and animal health research and action.
Sanitation
Lack of basic sanitation puts millions of lives at risk of disease and is linked to 25% of all child deaths in developing countries. Nearly 40% of the world’s population still lacks adequate sanitation. Improved water and sanitation services at home and in the community can accelerate health benefits and leverage other public health promotion interventions. EPH investigates the interrelations between sanitation, disease and ecosystems in the context of global change.
Second hand smoke
Passive exposure of non-smokers to tobacco smoke continues to be a health concern. EPH investigates the cardio-respiratory impact of second hand smoke both in children and adults, taking into account the role of genes in modifying one’s sensitivity to these toxicants. The SAPALDIA study highlighted the effects of smoke exposure at work on respiratory health, thereby making a strong global contribution to the adoption of smoking bans at work. COSIBAR is evaluating the effect of smoking bans on the cardio-respiratory health of hospitality workers. .
Water
Water affects health, both directly and indirectly, through water borne, water washed, water based and water related diseases. Access to clean drinking water plays a key role in this context; the water supply must be reliable, affordable, accessible, sustainable and available in adequate quantity and quality. Since water borne diseases are transmitted via the faecal oral route, drinking water is strongly linked to sanitation and hygiene. EPH researches the health impacts of water supply and quality interventions at the community and household levels. Water related diseases are also investigated in the context of climate change. It is crucial to understand water and health as a part of the social and ecological systems (ecohealth approach).
Social and cultural factors
Cultural epidemiology
Cultural epidemiology has been developed at the Swiss TPH in the framework of health social sciences. The approach extends social epidemiological study of social determinants to consideration of the distribution of cultural concepts and the relevance of illness explanatory models for public health. Our research relies on integrated quantitative and qualitative research that reflects ethnographic interests and benefits from epidemiological methods. Much of our research is concerned with how concepts of illness influences risk-related and help-seeking behaviours. Gender, stigma and mental health remain focal interests, and current topics of study include vaccine acceptance; consumer awareness, access, preference and use of essential medicines; risk-related behaviour affecting risk of widespread chronic diseases, such as hypertension; and community contexts of control of neglected tropical diseases, such as Buruli ulcer, cholera and leprosy
Gender
Gender is a major determinant of health. It shapes behaviour and influences environmental exposures, access to health care and provision of health care. In the EPH department, we address a variety of related research topics such as health reporting, sexual and reproductive health, the interrelatedness of maternal and child health, the role of early life factors, and gender-specific smoking cessation interventions. Sex- and gender-related factors in the aetiology of chronic diseases like asthma, COPD and cardiovascular diseases are investigated in close collaboration with long term projects such as SAPALDIA, ECRHS, and RHINE. Gendered social and intra-family dynamics affecting HIV-related decision-making are studied in Zambia. Gender analyses are offered for a broad range of health outcomes.
Poverty
Research in the EPH department considers poverty as both a cause and a consequence of disease and illness. Poverty creates ill-health because it forces people to live in dangerous environments. Our research projects examine the links between clean water, adequate sanitation and other environmental risks and health. Poor individuals and groups are further deprived of the information, money or access to health services that would help to promote health and prevent and treat disease. In turn, disease and illness traps them in poverty. The costs of medical consultation, drug treatment and transport to reach a health facility can be devastating. In the worst cases, the burden of illness may cause families to sell their property, take children out of school to earn a living or even start begging. Missing out on education has long-term implications for opportunities later in life and for people’s own health. EPH projects examine many of these aspects, especially with regard to malaria, HIV/AIDS and neglected diseases in urban and rural settings.
Social status
Social status describes an individual’s position in society and reflects material and immaterial resources such as education, income and the availability of such resources through the social position. It also refers to the particular societal group to which one belongs, such as migrants, single educated parents, working poor, etc. Low social status is one of the most important factors negatively affecting physical and psychic health through its association with unhealthy living conditions, higher environmental and occupational exposures, unhealthy behaviour, and lower propensity to seek and access health care. In the EPH department, many projects address the role of social status in disease occurrence and disease burden, and its relation to gender, culture, poverty, help seeking, resilience, and consider how to integrate findings in health policies in different contexts.
Biology and genetic
Biobanks & Biomarkers
The field of molecular epidemiology is progressing fast, thanks to advancements in informatics and various high-throughput omics technologies. Novel biomarkers of exposure, susceptibility and disease status provide unique opportunities in health research. Not only do they provide better understanding of disease mechanisms, but they are also valuable for disease screening and for developing dose response models. Swiss TPH researchers have established several large biobanks containing well-characterised human and non-human biospecimens. State-of-the-art infrastructure and analytical technology is available for the safe storage and efficient retrieval of these specimens and for sample analysis in the context of genomic, proteomic, lipidomic and other omic-oriented research projects.
Llifestyle
Physical activity
Physical activity (PA) is one of the most important modifiable lifestyle factors affecting mortality and morbidity. Interdisciplinary collaboration among several groups allows us to study correlates and determinants of physical activity with a special focus on environmental aspects. Important work focuses on developing better assessment tools and seeking effective intervention strategies for children and adults with or without chronic disease.
Smoking
Smoking is a major risk factor for chronic diseases, thus a central target for their prevention. Smoking prevalence is increasing dramatically in many low- and middle- income countries, particularly among men. EPH assesses the interplay between smoking and other factors, ranging from genetics to gender, with regard to various chronic disease health outcomes. EPH members actively participate in developing and evaluating policies aimed at smoking prevention.
Diet
Diet is an essential part of lifestyle and is subject to change, due to globalised lifestyle patterns. Nutritional epidemiology investigates the health impact of macro- and micronutrients as well as of microorganisms or toxins contained in the nutrition. Through surveys and observational studies, these dietary components are investigated for both acute and chronic effects. EPH also conducts research in the areas of food borne diseases and food safety.
Obesity
Obesity has become the primary non-chronic disease risk factor, along with smoking, in high-income countries. It is associated with increased risk of numerous chronic diseases. EPH assesses the interplay between obesity and other factors, ranging from genetics to gender, with regard to various chronic disease outcomes. EPH members actively participate in developing and evaluating policies aimed at obesity prevention in both children and adults.
Systems
Health policy
Global and national health policy-makers are increasingly experimenting with health policy and health system reforms, ranging from global subsidies to essential medicines, public-private partnerships, changes to provider payment mechanisms, demand side incentives such as conditional cash transfers, and new service delivery mechanisms. We develop and apply innovative methods to analyze health policies and to assess their impacts. This include analysis and evaluation of international and national influences on health policy; assessment of how to put health policy into action; and assessments of how health systems are funded - from the raising of revenue, to allocation of revenue to payers, to the paying of providers – and the implications for the population in terms of health and financial risk protection. We also assess how best to bridge the gap between researchers and policy-makers to translate evidence to policy. Finally we put heavy emphasis on developing and testing concepts for strengthening governance of health system and policies and its implications for health systems effectiveness.
Health systems
Health systems are complex, adaptive, and dynamic systems. System thinking works to reveal the underlying characteristics and relationships among the key functions of health systems such as governance and leadership; financing; human resources; informatics; medicines and technologies; and service delivery. By applying systems thinking to health systems new synergies can be revealed and exploited to leverage systems to higher levels of performance. We use systems dynamic modeling to explore these tipping points. To assist these models, we develop methods for measuring systems effectiveness of health interventions, considering all health system factors that determine the actual effectiveness of an efficacious. We also develop and apply methods to evaluate health interventions as well as health system interventions in real-world health systems.
Mobile Populations
In the past, Swiss TPH’s work on mobile populations concentrated on the health of migrants in Switzerland and mobile pastoralists in the Sahelian countries. Work on novel health services that integrate the provision of health care to humans and their livestock has been extended to address the health of mobile populations in Central Asian countries and Mongolia. Most recently, EPH established a programme considering mobile populations in general, for example migrant worker’s health in VietNam, in the framework of the NCCR North-South
One Health
The “One Health” concept is a strategy for interdisciplinary collaboration in human and veterinary medicine. This approach has shown substantial added value in zoonoses control and health service provision among mobile pastoralists. Recently, “One Health” approaches have been extended to include an ecological dimension. The newly formed concept of health in social-ecological systems has become a key area of research at Swiss TPH. It emphasises the inextricable links between human and animal health and their ecosystem.