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Early in the 1980s, those involved in public health held symposiums to
assess the training of epidemiologists in France showed inadequacies in
the teaching of field epidemiology. Hitherto epidemiology in France had
been largely confined to research. Evolution of public health practice,
with an increasing demand to base decisions on epidemiological data, made
it necessary to develop a network of intervention epidemiologists trained
to work with standardised methods.
In September 1984, on the initiative of Professor Louis Massé from the
Ecole Nationale de Santé Publique (ENSP, the National School of Public
Health), Dr Charles Mérieux, president of the Mérieux Foundation, and Dr
Michael Gregg, from the Centers for Disease Control (CDC) in Atlanta, USA,
an intervention epidemiology course was organised in Talloires on the
shores of the Annecy lake, Haute-Savoie, France. This three week
residential course was comparable to the Epidemic Intelligence Service
(EIS) summer course run by CDC. Most of the trainees who attended this
course were from local departments of the French Ministry of Health, from
the National Institute for Health and Medical Research, and from
universities. The course emphasised the importance of field epidemiology
in the public health process, and the need to set up the necessary means
to develop this practice in France. At the end of this first course, an
alumni association (Epiter) was created to build up a network of
professionals eager to share experiences and promote field epidemiology.
Since 1985, the course has taken place each year at the Centre des
Pensières of the Mérieux Foundation (the WHO collaborating centre for
the training of human resources) in Veyrier-du-Lac, Haute-Savoie, France.
The courses are organised and managed by the Institut pour le
Développement de l’Epidémiologie Appliquée (IDEA, Institute for the
Development of Applied Epidemiology). To date, 740 public health
professionals (including physicians, chemists, veterinaries, public health
engineers, nurses) working in public or private facilities in different
continents have attended this course. The initial teachers have been
succeeded by former trainees, and the coordination of the course is now
shared between the Institut de Veille Sanitaire (InVS, formerly the
Réseau National de Santé Publique) and the ENSP.
The teaching methods resemble those of the EIS course: lectures, case
studies based on real life experiences, the completion of a field survey
from the definition of the study objectives to the analysis and
presentation of the results. Case studies have been adapted to the French
context over time, but teaching methods have changed little. Practical
exercises on oral and written communication have been included in the
teaching curriculum.
Within 17 years, this course has fulfilled its initial objectives,
mainly the development of a network of field epidemiologists, supported by
Epiter, with ramifications in many French speaking countries. Two courses
similar in structure, content, and objectives have been created – in
1994 in Quebec, Canada, and in 1997 in Dakar for French speaking African
countries with the same purpose to develop intervention epidemiology in
these countries or regions. The French course also contributed to the
creation in 1995 of the European Programme for Intervention Epidemiology
Training (EPIET).
In recent years, the French public health scene has changed, with
public health surveillance and safety having been reinforced by a
structure of different health agencies. The InVS focuses on surveillance
of the population’s health and on generating alerts in the event of
threats to public health. It relies on a network of partners, who
(individually and in their organisation) require skills in intervention
epidemiology. The InVS has acquired know-how and a statutory role in
investigation, surveillance, and health risk assessment. It is in a
position to share its knowledge within a national training programme akin
to EIS or EPIET. The intervention epidemiology training courses held at
Veyrier-du-Lac, innovative in 1984, should now evolve and take part in
this new expansion by being the starting point of a more in-depth
training. |