This history derives from six papers by Professors Walter Holland, Roger Detels and Johannes Mosbech and Rodolfo Saracci. all of which have appeared in the International Journal of Epidemiology. We would like to thank the authors and the editor of the International Journal of Epidemiology for their kind permission to reproduce the work and we acknowledge the kind permission of Oxford University Press which holds the copyright of the original articles.
The references to the original articles are:
- Anon. The first twenty years of the International Epidemiological Association 1954-74. International Journal of Epidemiology 1974; 3:287-294.
- Anon. History of the International Epidemiological Association 1954-77. International Journal of Epidemiology 1977; 6:309-324.
- Anon. The history of the International Epidemiological Association brought up to date. International Journal of Epidemiology 1984; 13:139-141
- Holland W, Detels, R, Mosbech J. History of the IEA, 1984-1995. International Journal of Epidemiology 1997; 26:228 – 239.
- Saracci R. Epidemiology, the International Association and the International Journal of Epidemiology: a personal chronicle. International Journal of Epidemiology 2016; 45: 1727-1732
- Saracci R. My memories of Walter Holland: leader of promoting epidemiology collaboration in Europe. International Journal of Epidemiology 2018; 47: 1009-1010.
1) How it Started
The International Corresponding Club, as the IEA was first called, was started in 1954 by John Pemberton of Great Britain and Harold N Willard of the United States with the advice and help of the late Robert Cruickshank . They had found, as traveling Research Fellows each in the other’s country, that they were handicapped by not being sufficiently well informed about the research and teaching in the field of social and preventive medicine in the various medical schools and research institutes. Initially it was to try and remedy this defect, that the Club was established on a small and informal basis. At first it was just a corresponding club whose object was ‘to facilitate the communication between physicians working for the most part in university departments of preventive and social medicine, or in research institutes devoted to these aspects of medicine, throughout the world’. This was to be achieved by the publication of a Bulletin twice a year and by members endeavouring to ‘ensure a friendly and hospitable welcome for visitors’ from other countries. The first issue of the Bulletin appeared in January 1955 and contained contributions from 26 correspondents from nine countries.
Correspondents soon felt the need to meet to discuss research and teaching and the first formal meeting took place at the Ciba Foundation in London at the end of June 1956. By this time there were 49 correspondents from 18 countries, and one of them, A Querido of Amsterdam, who attended the London meeting, invited the Club to hold its First International Scientific Meeting in the Netherlands. As a consequence a ‘Study Group on Current Epidemiological Research’, supported by a grant from the Rockefeller Foundation, took place at Noordwijk in September 1957. There were 58 participants representing 44 university departments from 20 countries at this meeting.
A constitution was formulated and the following executive committee was elected:
Robert Cruikshank (UK): Chairman
Lester Breslow (USA)
Branko Cvjetanovic (Yugoslavia)
Charles M Fletcher (UK)
A Querido (Netherlands)
H J Ustvedt (Norway)
John M Weir (USA)
Joint Editors of the Bulletin:
John Pemberton (UK)
Harold N. Willard (USA)
One result of the meeting in Noordwijk was that a book entitled Recent Studies in Epidemiology was published embodying most of the papers given. Another was that a small follow-up seminar of members of the Club and of the staff of the Netherlands Institute of Preventive Medicine was held in Leiden the following year on ‘The Current Application of Epidemiological Methods’ (I, 2). At this meeting the name of the Club was changed to the International Epidemiological Club.
The Noordwijk meeting was the first of the seven international scientific meetings which have been held to date. The second was held in the Universidad del Valle in Cali, Colombia in 1959 when the present title of the Association was adopted. The next was held in 1961 on the island of Korcula, Yugoslavia, on the theme ‘The Application of Epidemiological Methods to Medical Problems’, and the edited papers of this meeting were published by the Oxford University Press under the title Epidemiology: Reports on Research and Teaching 1962 (I, 3).
By the time of the Fourth International Meeting held at Princeton, New Jersey in 1964 on ‘Comparability in Epidemiological Studies’ there were 144 members from 30 countries. At this meeting it was decided no longer to restrict membership to medically qualified men and women. The edited papers of the Princeton meeting were published by the Milbank Memorial Fund (I, 4).
The Fifth International Scientific Meeting was held in Primosten, Yugoslavia in August 1968. Following this meeting, and in addition to the Transactions (I, 5), a small editorial committee produced a book entitled Data Handling in Epidemiology (I, 6) based on some of the papers and a good deal of additional material.
The two meetings in Yugoslavia were considered so successful that it was decided to hold the sixth meeting in the same country again in August 1971. The Seventh International Scientific Meeting was held at the University of Sussex, England in August 1974 (see Appendix II).
The two meetings in Yugoslavia were considered so successful that it was decided to hold the sixth meeting in the same country again in August 1971; the Transactions of this meeting were also published. The Seventh International Scientific Meeting was held at the University of Sussex, England in August 1974. Since the International Journal of Epidemiology was now available for the publication of papers presented at the meeting, and the Editor of the IJE was given “first refusal” on all of these papers, no transactions of that meeting were published.
In 1977, the venue shifted across the Atlantic again with the Eighth International Scientific Meeting being held in San Juan, Puerto Rico, in September. The theme was ‘Epidemiological Strategies for Health in a Changing World’ and the meeting was co-sponsored by the World Health Organization and its Regional Office, the Pan American Health Organization. In addition, a number of sessions were jointly sponsored with other international organizations.
In 1977 the decision was taken to hold the Ninth International Scientific Meeting in Iran in 1980.
2) How it Developed
The IEA has always attached great importance to the educational aspects of its work and its first Chairman, Robert Cruikshank, often used the phrase ‘spreading the gospel’ to describe these aims.
The meeting in Cali in 1959 stimulated great interest in epidemiology in Colombia and as a result three seminars on epidemiology were later organized by the IEA in that country. This marked the beginning of a series of seminars in the South American continent and the Caribbean area.
The Milbank Memorial Fund, on the recommendation of its then Executive Director, Alexander Robertson, helped to make this extensive series of seminars possible and the World Health Organization, through the Pan American Health Organization, also cooperated in these seminars. Additional support was subsequently provided by the Commonwealth Fund and the Esther A and Joseph Klingenstein Fund of New York, the Ahbotshill Trust and several commercial companies in the United Kingdom. By 1977 the IEA had organized, or played a prominent part in 23 Seminars, Symposia, or Workshops on epidemiology in 19 different countries. These were often conducted in association with the World Health Organization (Appendix IV). Although many requests are received the Association only undertakes to organize or participate in seminars at the invitation of the Headquarters Office or the Regional Offices of the World Health Organization or of international national or local educational or governmental bodies.
In 1969 it was decided to produce a guide on the teaching of epidemiology which would be suitable for use throughout the world. The World Health Organization agreed to cooperate in this project and C R Lowe and Jan K Kostrzewski were asked to edit the guide. A number of members were invited to contribute to it and after two drafts had been produced, the contributors met in the palace of Nieborow near Warsaw, Poland in April 1971 to produce a final version. It was published first in English as Epidemiology: A guide to Teaching Methods (Appendix I, 9), and also published in French, German, Polish, Serbo-Croat Slovak, and Spanish editions; an edition in Farsi is in preparation.
The success of this Guide led to the decision embark on a broader series of Handbooks Epidemiology, jointly sponsored by the International Epidemiological Association and the World Health Organization and published by Oxford University Press. The first of these is to be Medical Health Statistics: A Manual for Teachers of Medical Students, edited by C R Lowe and S S Lwanga (Appendix 1, 10). The second will be: Epidemiology in Health Care Planning, edited by E George Knox (Appendix I, II). Two other monographs Knox (Appendix I, 11). Two other monographs in active preparation include a case history of the historical development of regionalization in Puert Rico written by Guillermo Arbona and Annete, Ramirez de Arellano (Appendix I, 12), and one on the role of epidemiology in defining and organizing basic or primary health care, being edited by Basil Hetzel (Appendix I, 13), The first two handbooks involved have collaboration with the World Health Organization in Geneva and the two latter with the Pan American Health Organization and the Western Pacific Regional Office respectively. The Health Resources Administration of the United States Department of Health Education, and Welfare has provided funds to support the first and third of these monographs. It is anticipated that these first four handbooks will initiate a continuing series of joint IEA/WHO Handbooks on Epidemiology.
Plans are also underway to co-sponsor either independently or with other epidemiological organizations an annual Epidemiologic Review series that would also be published by Oxford University Press.
Two other volumes have involved the IEA indirectly through collaboration of Council members at meetings organized on behalf of the governments of the United Kingdom in Oxford in March 1974 (Appendix II, 1), and of the United States in Washington, DC, in March 1975 (Appendix II, 2).
A third volume published under the joint auspices of the IEA, the International Hospital Federation and St Thomas’s Hospital Medical School was edited by Walter W Holland and Susie Gilderdale, Epidemiology and Health (Appendix II, 3).
THE INTERNATIONAL JOURNAL OF EPIDEMIOLOGY
An important decision was taken at the Sixth International Meeting in 1971 to found an international quarterly journal of epidemiology. The Council believed that the journal could replace the old Bulletin in providing a link between members in intervals between international meetings by publishing association news, and serve a valuable purpose by publishing original articles in the field of epidemiology, some of which would consist of papers given at IEA International Scientific or Regional Meetings. By an arrangement with the publishers, the Oxford University Press, members of the IEA receive the journal at a lower price than that paid by non-members or by libraries and other institutions. Walter W Holland was appointed the first editor in 1971 and four issues of the journal have appeared each year during his tenure from 1972-1977. A high standard of papers has been maintained and it has more than fulfilled the hopes of the Council that it would prove to be a valuable function of the IEA and would enhance the reputation and contribution of epidemiology.
In 1976 the Editorial Boards of the International Journal of Epidemiology and Revue d’Epidémiologie et de Santé Publique agreed to regular exchanges of articles and abstracts of articles to be translated and published in the two journals. It is anticipated that similar arrangements may be worked out with other journals in the future.
Having completed two extremely successful terms as its first editor, Walter Holland is succeeded as editor by Edward A Bennett, who assumes his responsibilities with Volume 7 of the IJE in 1978.
At the Fifth International Scientific Meeting in 1968 a decision was taken by the Council to try to promote the regional development of the Association and of epidemiology by holding scientific meetings in regions containing a group of countries. It was considered that the International Scientific Meetings were of necessity too infrequent and bound to be too distant and too costly for many members to attend at a given place. The first of these, an African Regional Meeting, was held at the University of Ibadan, Nigeria, in April 1970 in conjunction with a Council Meeting. There were 106 participants including 86 from 10 African countries. Thirty-five scientific papers were presented and later published in a special number of the Bulletin of the Association (Appendix I, 7).
The meeting, which was supported by the Commonwealth Fund, the Milbank Memorial Fund, International Medical Services, Inc and the Adolph Foundation, stimulated considerable interest in epidemiology in a number of African countries and was followed by a sizeable increase in the number of African members. The two objectives of strengthening the Association and stimulating the development of epidemiology in a Region were thus achieved. Another successful Regional Meeting was held in Sydney in August 1973. This was attended by about 300 people including participants from Australia, New Guinea and Papua, Malaysia, Japan,- the UK and the USA. Some of the papers given at this meeting were published in the International Journal of Epidemiology, Volume 3, Number 1, 1974.
In 1974 the Council embarked on a more explicit program for organizing Regional Meetings, Conferences, Workshops and Seminars in collaboration with the different WHO Regional Offices on a regular basis. Accordingly a Regional Workshop was held at the WHO European Regional Office in Copenhagen in August 1975; the Danish Medical Society Council assisted materially in the success of that meeting. A regional Meeting was held at the School of Medicine of the University of Isfahan, Iran in March 1976 under the joint sponsorship of the WHO Eastern Mediterranean Regional Office and the Iranian Public Health Association; the meeting was attended by over 260 individuals from 16 countries. In September 1976 the WHO Western Pacific Regional Office in Manila was the site of the jointly sponsored WHO/ IEA First Regional Working Group on Basic Health Services. At Nieborow, Poland a joint IEA/WHO Working Group on the Measurement of Levels of Health was held in March 1977; as a result a monograph will be published, edited by W W Holland, J Ipsen and 3 K Kostrzewski. At the meeting of the International Hospital Federation in Tokyo in May 1977, two major sessions were jointly sponsored by the IEA; the discussions were largely focused on material published in a book, Epidemiology and Health edited by W W Holland and S Gilderdale.
INTERNATIONAL EPIDEMIOLOGICAL RESEARCH
As a direct result of the opportunities that the IEA has provided for epidemiologists in different countries to meet and discuss their common interests, several international collaborative studies have been undertaken by members of the Association. The results of many of these have been published in the International Journal of Epidemiology. The large scale WHO/International Collaborative Study of Medical Care Utilization, extending from 1964 to 1976, and reported extensively in Health Care: An International Study, edited by R Kohn and K L White, London and New York, Oxford University Press 1976, is another example of an IEA generated study.
AFFILIATION WITH INTERNATIONAL ORGANIZATIONS
The IEA became affiliated with the Council for International Organizations of Medical Sciences (CIOMS) in 1955 and has been represented on its executive committee periodically.
In 1966 the Association was recognized by the World Health Organization as a Non-Governmental Organization. In addition to representation at the World Health Assembly this affiliation has contributed to excellent working relationships with WHO in the planning and execution of our education programs and meetings and in the planning and production of several publications.
FINANCIAL SUPPORT OF THE ASSOCIATION
In the early years of the Association’s existence the annual expenditure was less than £50 (US $120) a year derived from the annual subscription of members which was then ten shillings sterling or two US dollars. Secretarial expenses, including the cost of producing and distributing the Bulletin were, to a considerable extent, absorbed by “various university departments and the Chairman and the two Secretaries met to transact IEA business whenever they found themselves in the same part of the world travelling on other business.
The Association has, however, been fortunate since those early days in attracting generous grants from foundations, governments, individuals and the World Health Organization, which enabled it to develop and carry out its scientific and educational programs (see Appendix VI). Because of these grants, the income of the Association rose to about $37,000 annually in the period l969-7l. About two-thirds of the income in that period was spent on Seminars, Regional Meetings and other educational activities, and meetings of the Council and Executive Committee. The remainder went on administrative expenses. The major support over the years has come from charitable foundations notably the Rockefeller Foundation and the Milbank Memorial Fund, which were largely responsible for the early growth of the Association, and the Commonwealth Fund, which contributed $21,000 annually for a period of five years. Other early contributors were International Medical Services, Inc the Pfeiffer Foundation, the Wellcome Trust, and the Adolph Foundation. The bulk of the support for the Fifth and Sixth International Scientific Meetings at Primosten, Yugoslavia, and for publication of the transactions of these meetings, was provided from the PL-480 Counterpart Funds in Yugoslavia, through special agreements between the United States Department of Health, Education, and Welfare and the Federal Administration for International Technical Co-operation of Yugoslavia.
On 11 July 1967, the IEA Incorporated was established, and registered in the State of Maryland in the United States, in order to exempt the Association from liability for US and UK income tax, to receive grants, contracts, endowments and bequests in its own right, and to ensure that no other Organization can assume the same name. The officers of this entity are the same as those of the Association and their decisions control the corporation.
From 1971 to 1974 the income of the Association depended very largely on the subscriptions of its members and was therefore smaller than in the previous period. In 1973, for example, the total income of the IEA was US $11,269, of which US $7,453 was provided by member subscriptions. The fares alone for one meeting of the Executive Committee can easily amount to more than US $2,500 and it is almost impossible for Council to meet between International Scientific Meetings without funds from outside. From 1974 to 1977 this was achieved; the average annual income for the Association was about US $50,000.
The Seventh International Scientific Meeting in 1974 was mainly financed by the registration fees and by participants finding their own traveling and subsistence expenses. Although grants were provided by the Abbotshill Trust, the King Edward V1I’s Hospital Fund of London, the Population Council, the Wellcome Trust, the Howey Foundation, and the British Tourist Authority, a number of grants were also made by the pharmaceutical industry and by foundations associated with it. This meeting set a precedent, in that no US dollars were used to finance it and virtually all participants apart from major speakers found their own funds to attend.
Over the years the governments of Argentina, Australia, Brazil, Canada, Colombia, Denmark, Iran, Poland, Sweden, the United Kingdom, the United States and Yugoslavia, have contributed substantially to the work of the IEA, particularly recently.
The Eighth International Scientific Meeting was financed largely by the registration fees of participants, but generous support from both the United States Government and the Government of Puerto Rico was critical for its success. Additional support was received from the Commonwealth Fund, the Pan American Health Organization, the International Agency Against Cancer, the International Research Development Centre of Canada, the Esther A and Joseph Klingenstein Fund, the Milbank Memorial Fund and the Good Samaritan Foundation. A number of commercial firms also contributed to the success of the Puerto Rico meeting (see Appendix VI).
Three contracts from the US Department of Health, Education, and Welfare (Health Resources Administration) helped to finance three recent publications and three Council meetings during the l974-l977 period.
Although the Association has achieved a healthy degree of independence, it needs to be emphasized that this can only continue if the Executive Committee and the Council can continue to meet as economically as they have done in the past, if the Officers of the Association are willing to go on giving freely of their time and facilities, and if foundations, governments, corporations and individuals continue to be as generous in the future. It goes without saying that nobody, international or national, private or public, and no government, national or local, has ever attempted to influence the policies or decisions of the Council with respect to either its membership or its activities.
Any discussion of the IEA’s finances should include some reference to the vagaries of international currency fluctuations. These have been particularly acute in recent years and have resulted in imbalances in the revenues and expenses of an association which is active in so many different countries. Although the accounts of the Association have been externally audited by independent auditors since the Association’s inception, the Council has tightened its accounting practices in recent years, and has established an Audit Committee, separate from the Officers of the Association, to review the accounts periodically and report to the General Business Meeting at each of the International Scientific Meetings.
In 1978 the Association resumed direct collection of annual dues (or subscriptions) from its membership; this should improve the Association’s financial situation considerably.
Above all, it is essential if the IEA is to increase its influence and independence that the active, paid-up membership should grow. The Executive Committee was reduced from five to four at the Seventh International Meeting as an economy measure. In addition, successful efforts enabled the Council to meet annually between the Seventh and Eighth International Scientific Meetings; these meetings were financed from external sources and not from membership dues and enabled the Association to embark on its present program of expansion.
In the earlier years of the IEA, British and North American members were in the majority, mainly because the Association had its origins in the UK and USA. The Council of the Association has always been very conscious of this tendency and made active efforts to broaden the representativeness of the Association by encouraging members to nominate epidemiologists from other countries. At the same time Council determined to maintain a high standard for membership and to require the proposer of a new member to comment on the work of the person proposed and to indicate how he or she was contributing to epidemiology.
At the time of the Sixth International Meeting in 1971 there were 465 members from 54 countries. In August 1974 there were 628 members from 58 countries. However, careful analysis of the records showed that many of these were not paying their dues, indeed some had not paid for several years. Accordingly, it was decided to develop a computerized file and billing system for collection of membership dues and journal subscriptions. In addition, a questionnaire has been completed by most members which permits a record to be kept and made available to the IEA, to WHO, or other international agencies of the experiences, interests and availability of IEA members for services that involve epidemiologists and epidemiological skills.
Successful membership drives have resulted in a considerable growth in paid-up ordinary membership since 1974, although not a large increase in the number of countries represented. At the time of the Eighth International Scientific Meeting there were over 900 active, paid-up, ordinary members, three senior members and 14 honorary members representing 66 different countries; the net growth of the membership has been about 25 per cent since August 1974. The increase in paid-up membership is very encouraging, but there are still many countries without a single member. Together with an increase in membership numbers, the effects of inflation required the Council reluctantly to increase the world-wide annual dues to US $30.00 effective from 1 January 1978. It is anticipated, however, that in addition to the International Journal of Epidemiology, paid-up members will receive free copies of each of the IEA/WHO Handbooks as they are published.
At the Seventh International Scientific Meeting in 1974 the procedure for the election of membership was simplified, and since then the Membership Committee has made substantial progress in rapidly processing nominations. A Manual of Procedures has been prepared for present and future members of this important committee.
In 1977 the Council appointed one of the IEA’s founders, John Pemberton, as the Official Archivist of the IEA with headquarters in the King’s Fund Centre, 126 Albert Street, London NW 1 7NF. This consolidation of our historical documents and records is the initial move towards establishing a full-time secretariat, a move that can only be justified when our paid-up ordinary membership reaches about 1,500.
The constitution allows the Council to elect a number of Honorary Members which is not to exceed two per cent of the active, ordinary membership. By 1984, the following had been elected:
Sir John Brotherston
Sir Frank MacFarlane Burnet
Marcolino G Candau
Archibald L Cochrane
John Everett Gordon
Sir Austin Bradford Hill
Alexander D Langmuir
Karl Friedrich Meyer
Chitnaman Govind Pandit
John Rodman Paul
Frederick Lowe Soper
Professor Su De Long
Dr Abdul Hosian Taba
Harold N Willard
THE CONSTITUTION AND BY-LAWS
A formal Constitution and set of By-Laws were first adopted at the International Meeting at Princeton in 1964. These were modified at Pnmosten in 1968 and again in 1971. After extensive review by a sub-committee nominated by Council in 1974 and further review by the entire membership, a new revised Constitution was overwhelmingly approved by secret postal ballot in October 1976; the new Constitution and By-Laws became at the Puerto Rico meeting in 1977. Their intent is to make the organization more open with respect membership, ideas and activities and to encourage its leadership to be responsive to the needs and wisdom of the membership.
JOHN PEMBERTON’S COMMENT, 1984
Epidemiology has developed a great deal since the foundation of the Association. It was only in the early 1950s that the term epidemiology began to be applied to non-communicable disease as well as to infectious disease. Indeed, as late as 1960 at a meeting of epidemiologists in Prague, the late Donald Reid, with all his persuasive wit, was unable to persuade some distinguished epidemiologists from Eastern Europe that epidemics were not always spread by ‘a living chain of organisms’ and that the dancing mania of the middle ages was just as much an epidemic as measles.
A good deal of the early ‘missionary’ work of the Association was carried out under the inspiration of our first chairman, Robert Cruikshank, who never ceased to tell us that we must ‘spread the gospel’. We were, of course, aware that many of the most serious health problems were in the poorer countries and that these were particularly amenable to the epidemiological approach. For this reason, members made special efforts to contact their opposite numbers in Asia, Africa and South America when on their travels and to encourage them to become members. WHO helped in these early beginnings and this association has continued to the present time with benefits to both organizations.
Pemberton, co-founder of our Association, has recounted its early history up to 1984. It is remarkable to observe what developments have occurred in the past 10 years and that similar problems have been with us since the inception of the IEA.
The objectives of the IEA are to:
- Promote the use of epidemiology and its application to the solution of health problems.
- Encourage the development of epidemiological methods and improvement in these methods.
- Promote the communication of epidemiological methods and findings amongst epidemiologists throughout the world as well as amongst all others concerned with health.
- Co-operate with both national and international organizations which are concerned with the promotion of health in the application of epidemiological methods in the solution of problems.
- Improve the dissemination of epidemiological findings nationally and internationally.
- Improve the recruitment, education and training of epidemiologists.
These objectives can be achieved through national, regional and international seminars, workshops and conferences as well as individual contact between individuals at all levels. These have guided our activities over the years.
A determined effort was made in this decade to develop regional activities and to strengthen our links and co-operation with the World Health Organization.
The development and strengthening of regional activities is manifested by the record of the regional meetings. These have been stimulating affairs as shown by the publications which resulted. There have been regular meetings in most Regions, e.g. Africa, S.E. Asia, and Europe and occasional ones in the remainder. Of particular note have been those which marked the foundation and strength of national epidemiological associations as in Japan, China and Holland. The growth and interest in epidemiology and the enormous improvement in the quality, as well as the quantity of epidemiological research has been particularly notable in South East Asia. For example, the Australian Regional IEA meeting in 1973 was attended by 9 Japanese – at that time the only such practicing scientists in that country. There is now (1995) a flourishing national Association with more than 900 members and its own Journal published in English). It is the host for the next International Scientific Meeting (1996). The number of participants, at Regional Meetings in this area e.g. from China, Indonesia, Malaysia, Philippines, Singapore and Thailand illustrates the increasing penetration of our discipline.
The growth and strengthening of our discipline outside Western Europe and North America has also led to an increase in bids to act as a host for an International meeting. These have been held in Finland and Australia. All have been successful.
THE DISCIPLINE OF EPIDEMIOLOGY
The promotion of epidemiology as a discipline, its methods and applications have been successful in most countries. We have been helped by an co-operated with, the International Clinical Epidemiology Network (INCLEN) founded and initially supported by the Rockefeller Foundation, and the Field Epidemiology Training Program (FETP) of the United States Centers of Disease Control (CDC). The CDC have developed and supported a range of joint educational and training activities, including courses, seminars, centers and meetings in most parts of the world.
The application of epidemiology to health services research, planning and evaluation as well as to disease control and surveillance has now been accepted in all parts of the world. It is difficult to estimate what the role of the IEA has been in the acceptance of the subject, at the least it has been significant. This is evident from the participation of Ministers Health and senior officials at our meetings and their confirmation of the importance of subject to their policy determination.
Organizationally the IEA has developed its Regional structure. This has been based WHO Regions. In many there are now sound, powerful national associations. The IEA has always consisted of individual members. In the past 5 years, we have agreed to national associations or groups of 10-20 individuals as members from countries with a very low GDP, where the dues of membership to the IEA would be an unfair burden on the income of individual practitioners.
Members in the European Region have created a formal Regional Association of the IEA with its own Newsletter and an additional subscription fee. It is hoped that this may prevent the development of competing international regional associations which would splinter international efforts to promote epidemiology. A variety of subject oriented epidemiology associations, e.g. environmental epidemiology, pharmaco-epidemiology, have been founded. We have attempted to co-ordinate our activities, e.g. through joint meetings.
COOPERATION WITH WHO
Successive Directors-General (Mahler and Nakajima) have participated and addressed the International Scientific Meetings (ISM’s) and members of WHO have played a prominent part in the ISM’s both through sponsoring and leading specific sessions, supporting participation and attending. The IEA, however, has had little input into the epidemiological efforts of the WHO nor has the work of WHO in epidemiology been as prominent as we had hoped. The Director of the European Region (Dr. J. Asvall) was enthusiastic to promote epidemiological training and the application of epidemiological methods to the problems of Eastern Europe where the collapse of past regimes has been associated with a resurgence of a number of infectious disease, e.g. diphtheria, and collapse of many public health and health service structures. In addition, in these countries, the expectation of life has decreased, while smoking cigarettes has increased and diet has got worse. A training course for epidemiologists from these countries was held in Hungary in 1993. This was successful and it is hoped that as a result an opening has been provided for the development of future co-operative developments between epidemiologists throughout Europe.
In 1988, Professors Gordis and Noah, at the invitation of the Director General, reviewed epidemiological activities in WHO and put forward a series of recommendations, which would have led, if implemented, to a sounder basis for making health policy decisions within WHO, its regional offices and in member countries. These entailed the education and training of staff members, the application of epidemiological methods in more WHO activities and the creation of an Advisory Board that would supervise and support these activities.
Unfortunately, WHO has not been able to create such a structure, although we have continued to co-operate. Although these developments may offer opportunities in the future, the difficulties should not be underestimated. It is easy for the Council of the IEA to offer help and make suggestions of how epidemiology could help with the solution of international and national health problems. For the help to be effective the body to whom it is offered must both want help, be willing to accept outsiders and be ready to implement the findings. As the IEA has few monetary resources, funding has to be provided for the activity. Most importantly the IEA has no staff and all it can do is to identify possible suitably qualified members for involvement in such an activity. As most members are employed in Universities etc. and have full-time commitments, there are often insuperable difficulties.
The International Journal of Epidemiology (IJE) has continued to gain status in the field. It is now published six times per year, has increased in size and regularly publishes supplements. Contributions to the IJE come from researchers in all parts of the world. The Journal is popular with readers, libraries and the publisher. Both the IJE and the abstracts and proceedings of our meetings provide a fascinating picture of the breadth of interests of our members, students and colleagues.
THE PRESENT AND THE FUTURE
Even with all these problems it is surprising how often the Association has been able to facilitate co-operative activities, whether formally or informally. It is crucial for the IEA to continue to foster the informal, as well as formal, links and contacts between members so that those with mutual interests can establish effective working relationships. Much of epidemiology consists of investigation of contrasts. The strength of our Association is to enable members in different countries with widely different environmental, social or behavioral conditions and disease frequencies to meet, discuss and develop co-operative investigations.
There has been no shortage of volunteers to serve on the Council and Executive. Two changes have been introduced in 1993. To provide continuity in policy, we now elect a President- elect. Thus the President has three terms on Council – 9 years – as President-elect, President and Past President. Because of the increase in size of the Association, as well as breadth of geographic memberships, Regional Councilors are now only to be elected by members from their own Region. This will need to be done by postal ballot and will mean that Regional Councilors will, hopefully, be more representative of their Region. The election of a Councilor by attendees at an ISM when only perhaps 5-10 came from a particular Region had become increasingly anachronistic. Some members have suggested that the election of officers of the Association should also be by postal ballot. This could have both advantages and disadvantages. Future Councils of the Association face a difficult problem in this proposal. It is a common problem for many associations, societies or other bodies and the increase in participating electors through postal ballot may have quite unintended consequences. In this decade we have been fortunate that every post have been contested, so that members have been able to make choices for the officer posts.
The record of the past decade has been hopeful, and some problems have been resolved. We are now united in accepting a definition of epidemiology and using similar language and terms. For this we have John Last to thank. His Dictionary of Epidemiology has had widespread acceptance and acclaim. We no longer battle about the role of epidemiology in the control and investigation of non-communicable disease, or health services. Most of us accept the danger of neglecting to apply our methods in the investigation of chronic diseases or health services and no longer believe that “classical” epidemiology should only tackle infectious conditions.
The disintegration of the Communist regimes in Eastern Europe has removed some barriers between our members. But it has not been accompanied by an upsurge of activity or membership in that part of the world. This is partly because the problem is now of shortages of actual resources – most academics in Eastern Europe have very low incomes – rather than the inability to exchange roubles or crowns to dollars or pounds. The other problem that has arisen is that the few Eastern European members that the Association had were, obviously, acceptable to their government and universities. This has meant that, in the eyes of current local politicians, they are viewed with some mistrust and, in many cases, have lost their positions as a result of general government policy rather than considering the contributions they have made. Thus the establishment and reinforcement of links between Eastern European epidemiologists, and those in the rest of the world is a crucial priority. As indicated a successful seminar was held near Budapest, with WHO (EURO) support. A number of co-operative activities between researchers in Hungary, the Czech Republic, Slovakia and Poland – as well as with a number of the new Republics which have replaced the U.S.S.R are beginning but need tender nurturing.
A Region where development of IEA activities does not match with activity in epidemiology or number of epidemiologists, is South America. A number of attempts to develop links, hold regional meetings and recruit members have been made. It is surprising, in view of the strength of the subject in this Region and the influence of PAHO, that better relations have not developed. The last 3 Presidents, have tried hard – but failed. In Africa, where there are major health and health care problems, there are other difficulties. There are relatively few trained epidemiologists and although we have held successful Regional Meetings, we have not been able to fulfil the expectations of local members.
Membership of the IEA has grown in the past decade – but not dramatically. Membership dues have remained low, largely so as to encourage epidemiologists from poorer countries to join. The Association has continued to receive generous help from the Rockefeller Foundation and various donors have assisted in specific, identifiable projects e.g. educational seminars. Foundations and other donors have also assisted the participation of individuals in their own Regional and International meetings. Nonetheless the major barrier to progress of the IEA has been the lack of finance. Unfortunately our subject does not appear to be one which donors are willing to endow generously. Since its foundation our aspiration has been to accumulate a sufficient amount of capital which would enable us to be able to support activities of help both to individual members and countries or institutions e.g. in the form of education, pilot studies, exchange fellowships etc. If this was available it would be far easier to respond to requests for help and to spread the word of how good epidemiology can help. None of our officers receives more than expenses. None of our members, when involved in IEA activities, is paid by the IEA. Since most of our active members are in full-time University or other employment and in view of world-wide employer- employee policies providing such voluntary effort is becoming increasingly difficult. We cannot raise fees for attendance at our meetings, or membership fees, nor are our meetings particularly attractive to those commercial sponsors who spend large amounts on such activities (e.g. pharmaceutical companies), nor are we willing to have our name associated with products, e.g. tobacco, or some drugs, which would probably be only too willing to pay for using our name. We thus have a major problem – which is unlikely to improve with time. The authors, past presidents, have no solution to this quandary although it has always been at the forefront of our concerns.
Even with all these caveats, attendance at an IEA meeting demonstrates an encouraging vibrancy of outlook and a hopeful future. One of the initial aims of our founders, John Pemberton and Harold Willard, was that opportunities for friendship should be created. That has certainly been the experience for many of our members – and of the authors of this piece.
3) How it is progressing in the New Century
The last decade of the 20thcentury started with a change introduced at the World Congress of Epidemiology in Sydney in September 1993. A ‘President-elect’ was elected for the first time to serve for three years before taking office as President at the time of the next World Congress of Epidemiology. The change improved continuity in management and longer term planning in the IEA activities as a President-elect remains in office within the Executive Committee and the Council for nine years first as President-Elect and then as President and Past President. Rodolfo Saracci became President-Elect while Kunio Aoki took office as President : among the successes of his presidency stands the Nagoya 1996 World Congress of Epidemiology for which the host country, Japan, offered a remarkable support to participants’ from low and middle-low income countries. The World Congress of Epidemiology held in Florence in August-September 1999 opened the door to the new century, and a broad sketch of progress in the first two decades is provided in the two papers that follow, underlining the continued contribution of Walter Holland, who had been active in IEA since the earliest days.