Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada.
Int J Epidemiol. 2012 Apr;41(2):540-56. doi: 10.1093/ije/dys018. Epub 2012 Mar 9.
Commissioned by the International Epidemiological Association, this article is part of a series on burden of disease, health indicators and the challenges faced by epidemiologists in bringing their discoveries to provide equitable benefit to the populations in their regions and globally. This report covers the health status and epidemiological capacity in the North American region (USA and Canada).
We assessed data from country-specific sources to identify health priorities and areas of greatest need for modifiable risk factors. We examined inequalities in health as a function of social deprivation. We also reviewed information on epidemiological capacity building and scientific contributions by epidemiologists in the region.
The USA and Canada enjoy technologically advanced healthcare systems that, in principle, prioritize preventive services. Both countries experience a life expectancy at birth that is higher than the global mean. Health indicator measures are consistently worse in the USA than in Canada for many outcomes, although typically by only marginal amounts. Socio-economic and racial/ethnic disparities in indicators exist for many diseases and risk factors in the USA. To a lesser extent, these social inequalities also exist in Canada, particularly among the Aboriginal populations. Epidemiology is a well-established discipline in the region, with many degree-granting schools, societies and job opportunities in the public and private sectors. North American epidemiologists have made important contributions in disease control and prevention and provide nearly a third of the global scientific output via published papers.
Critical challenges for North American epidemiologists include social determinants of disease distribution and the underlying inequalities in access to and benefit from preventive services and healthcare, particularly in the USA. The gains in life expectancy also underscore the need for research on health promotion and prevention of disease and disability in older adults. The diversity in epidemiological subspecialties poses new challenges in training and accreditation and has occurred in parallel with a decrease in research funding.
本文是国际流行病学协会委托撰写的一系列关于疾病负担、健康指标以及流行病学家在将其发现转化为其所在地区和全球人群公平受益方面所面临挑战的文章之一。本报告涵盖了北美地区（美国和加拿大）的健康状况和流行病学能力。
我们评估了来自特定国家的数据，以确定健康优先事项和可改变风险因素的最大需求领域。我们研究了健康不平等与社会剥夺之间的关系。我们还审查了该地区流行病学家在能力建设和科学贡献方面的信息。
美国和加拿大拥有技术先进的医疗保健系统，原则上优先提供预防服务。这两个国家的出生时预期寿命都高于全球平均水平。在许多结果方面，美国的健康指标衡量值都比加拿大差，尽管通常只是略有差异。在美国，许多疾病和风险因素的指标存在社会经济和种族/族裔差异。在加拿大，这种社会不平等程度较小，但在原住民群体中存在。该地区的流行病学是一门成熟的学科，拥有许多授予学位的学校、学会以及公共和私营部门的工作机会。北美流行病学家在疾病控制和预防方面做出了重要贡献，通过发表的论文提供了近全球科学产出的三分之一。
北美流行病学家面临的关键挑战包括疾病分布的社会决定因素以及获得和受益于预防服务和医疗保健的机会不平等，特别是在美国。预期寿命的提高也强调了需要研究促进健康和预防老年人疾病和残疾的问题。流行病学子专业的多样性带来了新的培训和认证挑战，并且与研究资金减少同时发生。
