• CPS - Tiffany Stallings

    By Tiffany Stallings, Adjunct Faculty, Kaplan University School of Health Sciences 

    Both leather shoes and gigabytes have been used to make advancements in the field of public health. These key terms refer to methods of collecting public health data.  Leather shoes relates to a more old-fashioned method of physically traveling to the data source to gather information while gigabytes corresponds to modern electronic data sources stored digitally.  Gigabytes may appear to be the way of future research, however the leather shoe method still has an important place in today’s research, and its previous accomplishments should be reviewed and built upon.

    Public health research includes, but is not limited to, vaccines, medications, medical treatments, lifestyle modifications, safety measures, proper food handling, and environmental exposures.  John Snow is a historical figure in public health and is often known as the “father of modern epidemiology.”  Epidemiology has been defined as “the study of how disease is distributed in populations and the factors that influence or determine this distribution.”1  Public health research uses epidemiologic methods, statistical tests, and modeling techniques to help understand how risk factors (e.g. genetics, lifestyle behaviors, or environmental exposures) may cause certain diseases or health conditions.  It is through identifying and limiting these risk factors that diseases can be prevented or the severity of the condition lessened.


    Much of today’s public health research consists of digital data sources such as medical records, online surveys, and electronic imaging techniques. Research hypotheses are often tested using computer-based data analysis systems such as Statistical Product and Service Solutions (SPSS) and Statistical Analysis System (SAS).  This allows for some primary and many secondary data analyses to be completed without physically interviewing study participants or leaving the computer desk. Digital data sources and analyses often reduce the time needed to complete research which in turn allows for quicker implementation of study findings. However, first-hand accounts that aid in deeper understanding of the problem could be missed with this method.

    Leather Shoes

    Public health research has not always been so technologically advanced.

    Take for example the story of John Snow’s admirable pen and paper research on cholera. Snow conducted leather shoe epidemiology or field epidemiology, meaning that he was out walking the streets of London to see and interview patients/study participants. John Snow was born in York, England in 1813 and by 1843 he was practicing medicine in London.2 A common disease of that time was cholera. It causes such severe dehydration due to diarrhea and vomiting that death can occur within hours.3 The cause of cholera, a bacterium called vibrio cholerae, and the method of transmission or spread of disease was unknown at that time.1  

    Following the 1848–1849 cholera epidemic, Snow published his hypothesis that cholera affected the stomach and intestines by consumption of water contaminated with feces from those ill with the disease.4 At first, Snow’s theory was not accepted by the medical community. However, his research through an investigation during the 1854 cholera epidemic helped prove his theory to be true.

    For this investigation, Snow went door to door with a list of names and addresses of the fatal cholera cases, asking family and friends for the deceased’s source of drinking water.  This research found that more than three-fourths of the cases had consumed water from the public water pump on Broad Street.4 Further, Snow created a map of the streets, water pumps, houses, and businesses encompassing the area of the cholera outbreak. He marked the location and number of cholera deaths and found they centered around the location of the Broad Street pump. A note of interest is that there were no reported cholera deaths among the workers at the brewery because cholera bacteria were killed during the beer’s fermentation process.5 Following Snow’s report of these findings, the handle of the contaminated pump was removed and the number of cases was greatly reduced.4 This research provided convincing support of his theory. While Snow’s work was time consuming, he viewed the full extent of the problem first-hand.

    Whether you use the leather shoes or gigabyte method of data collection, we as Kaplan University faculty hope that you contribute to advancements in the field of public health. Whether through following Dr. Snow’s example and building on field epidemiology or staying at your computer and expanding on the advancements of current heath information and technology, we encourage you to put to use the  knowledge and skills learned at Kaplan University to conduct public health research.  We also invite you to visit the Center for Public Service resources section for health and public service related information.



    Bergman, N.A.  (1958). The Legacy of John Snow: An Appreciation of His Life and Scientific Contribution on the 100th Anniversary of His Death. Anesthesiology, 19(5), 595-606.

    Centers for Disease Control and Prevention. (2011, February 24). Cholera – Vibro cholerae infection.  Retrieved from http://www.cdc.gov/cholera/general/  

    Gordis, L. (2004). Epidemiology (3rd ed.).  Philadelphia, PA:  Elsevier Saunders.

    Mackenzie, J. (n.d.). Mapping the 1854 London Cholera Outbreak. Retrieved from http://www.udel.edu/johnmack/frec682/cholera/ 

    Snow, S. (2002). Commentary: Sutherland, Snow and water: the transmission of cholera in the nineteenth century. International Journal of Epidemiology, 31(5), 908-911.

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