Determining the cause of a disease or the positive effect of a health activity is an important part of decision-making in public health. But how do we know if something actually does cause a disease or improve our health? Inferring causality is a step-by-step process requiring a variety of information. In this course, Dr. Victoria Holt discusses seven guidelines to use in determining whether a specific agent or activity causes a health outcome. She illustrates each guideline with a public health example. This is part of a nine-part series on epidemiology.

Learning Objectives

After completing this course, you should be able to:

  • Describe and distinguish between association and causality in epidemiology
  • List and describe features of associations that support inferences of causality
  • List the principal concerns in inferring causality

Intended Audience

Public health professionals who want to increase their familiarity with the basic concepts of epidemiology. It is recommended that people are familiar with material presented in the following modules: What is Epidemiology in Public Health?, Study Types in Epidemiology, Measuring Risk in Epidemiology, and Data Interpretation for Public Health Professionals.

Epidemiology Series

What Is Epidemiology in Public Health?

Data Interpretation for Public Health Professionals

Basic Infectious Disease Concepts in Epidemiology

Introduction to Public Health Surveillance

Introduction to Outbreak Investigation

Study Types in Epidemiology

Measuring Risk in Epidemiology

Cause and Effect in Epidemiology

Screening in Public Health Practice


Web-based, Flash presentation. This online course has audio narration and interactive exercises and scenarios. This course should take about 0.75 hours to complete.

Course Instructor

Victoria Holt, RN, MPH, PhD
Northwest Center for Public Health Practice
University of Washington School of Public Health

Technical Requirements

This course requires certain software and browser plugins to be installed. See our technical requirements.


This online training course is audio narrated. A print version is available in the Supplemental Material section at the bottom of this page. Please note that the print version does not include interactive exercises, quizzes, or the final assessment. To receive a print version of the quizzes in this module, or if you have any difficulties, please contact

October 11, 2007
Infectious Disease & Immunizations
Self-Paced Course
45 minutes
Competency Domains: 
Analytical/Assessment Skills
Public Health Sciences Skills