ABSTRACT
Public health is about surveillance and reliability of statistics. This is essential
to predict and prevent a problem. This view is not new; indeed, advocates of
this approach (Satcher, 1998) often point to a mid-19th century example as
epitomizing the approach. In 1854, a major cholera outbreak occurred in
England. Many people were dying; thousands were hospitalized throughout
England. Physicians and other health workers responded with health care, but
one doctor, Dr. John Snow, started to investigate the epidemic. He asked questions
of the patients; he asked where they had been, what they ate, what they drank,
and so on. After sampling hundreds of patients, he found a common link: They
all drank water from London Broad Street pump. He then did something quite
unusual: he went out into the field. He went to the Broad Street pump. He
studied the pump; studied the water, and so on. Dr. Snow concluded that the
water was contaminated. He discovered that a sewage line was contaminating
the water, in fact. This was public health research at not only its first, but also
its best. But Dr. Snow did more; he intervened, and, to the upset of many, he
removed the handle from the pump. Soon after that, the cholera epidemic ended.
Dr. Snow is a father of public health; his work is a classic in our field. How can
we apply Dr. Snow’s approach to surveillance of military suicide?
