Burden of disease, health indicators and challenges for epidemiology in North America.

BACKGROUND 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). METHODS 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. FINDINGS 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. CONCLUSIONS 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.