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DEVELOPMENTS IN PUBLIC HEALTH

The importance of epigenetic for public health

Epigenetic was originally defined as the interaction between genetics and

environment. A more accurate definition refers to gene functionality which is

not encoded into the DNA sequence, but can be hereditary. The important aspect

is that the function of the gene is modified by environmental influences. Of

particular interest for public health might be the epigenetic features in

embryogenesis and postnatal developments related to gestational diabetes and

efforts to prevent non-communicable diseases in later life within the framework

of mother and child health services.

A German medical student dared to

accuse his examiner of giving him a too

easy question while going through the

final state exam. The candidate thought

that the stupid question was much below

his intellectual capacity. He was asked to

discuss the so called ‘epidemiological

triangle’ (Figure 1) and was expected to

refer to environmental factors in disease

occurrence. In addition he should have

discussed why the model is more suitable

for infectious diseases than for chronic

diseases. Generally, not only medical

students but also medical doctors tend to

focus on curative medicine concentrating on

the disease and the direct relation of the

causative agent to the patient, giving them the

opportunity to apply, in case of an infectious

disease, an appropriate antibiotic. According to

the model, this means that the connection

between the causative agent and the patient is

blocked. The opportunity for treatment let the student to more or less neglect the upper corner of

the triangle – namely, the environment. Only when it comes to thinking about prevention of

infectious diseases does the consideration of the environment becomes essential. The model

helps to search for the appropriate ways and means to prevent the spread of the disease.

To look into environmental factors causing diseases is the duty of public health

A medical doctor is not to be blamed for ignoring where and why the patient got malaria

in the first place while fighting for the life of the patient infected with P. falciparum, but it is the

Fig.: 1 Epidemiological triangle