In the past, there was not much interaction between the investigations carried out by law enforcement and those conducted by public health authorities. The classic health inspector would examine a restaurant and had the power to fine or even close the establishment without involvement of the police. The risk to the public was mainly from food contamination resulting from improper storage, cross-contamination, or poor hygiene practices. However, in today’s society, the deliberate contamination of water, food, air, or land as an act of bioterrorism has become very real. Working alone, law enforcement may not initially recognize these incidences as a bioterrorism threat; the same holds true for public health personnel. The problem is that law enforcement personnel are not trained to spot these types of crimes. On the other hand, public health care personnel are able to detect abnormal or unseasonable increases in illness or types of death but are ill-equipped in the proper protocols in identifying, collecting, and preserving forensic evidence. An unusual or off-season increase in a specific strain of virus would not raise suspicion among police officers, but it would be alarming to those in the public health setting. In turn, public health personnel are not trained in the legal methods and procedures of collecting, preserving, and chain-of custody documentation required to bring a case to trial.

Beginning in the late 1970s, joint investigations involving law enforcement and public health authorities began (Goodman, 2003). These investigations centered on health problems that were suspected to have been intentionally caused or crimes that had potentially significant public health consequences. Examples include foodborne outbreaks caused by intentional contamination of food products (Torok, Tauxem, & Wise, 1997) or, in the case of the “Angel of Mercy” syndrome, where healthcare providers deliberately assisted patient deaths by administering lethal doses to their patients (Buehler, Smith, & Wallace, 1985; Franks, Sacks, & Smith, 1987; Istre, Gustafson, & Baron 1985; Sacks, Herdon, & Lieb, 1988; Sacks, Stroup, & Will 1988; Stross, Shasby, & Harlan, 1976).

During the late 1990s, the term forensic epidemiologists typically referred to traditionally trained epidemiologists who functioned as expert witnesses in civil trials. They testified to issues relating to methodology of the study: number of subjects, subject selection and exclusions, length of the study, methods of analysis, interpretation of the results, and any other limitations. They were also frequently called on to address issues relating to association, such as exposure levels of certain chemicals to certain birth defects or the association of performing a task repeatedly and carpal tunnel syndrome (Last, 1988; Lane, 2004).

The term forensic epidemiology was first associated with bioterrorism in 1999 when the former chief deputy of the USSR bioweapon program, Ken Alibek, used the term. Forensic epidemiology was defined then as the activity that would help distinguish natural from manmade epidemics. After the anthrax attacks in September and October of 2001, Dr. Julie Gerberding, a senior official with the Centers for Disease and Control (CDC) National Center for Infectious Disease, defined forensic epidemiology as that practiced by an epidemiologist who would be trained to respond to bioterrorism attacks as well as other public health emergencies.

The events of 2001 underscored the need for law enforcement and public health personnel to work together to conduct joint investigations, especially those centered around a possible bioterrorism event. In 2002, the CDC developed the “The Forensic Epidemiology: Joint Training for Law Enforcement and Public Health Officials on Investigation Reponses to Bioterrorism.” A joint collaboration was also conducted between the CDC and the Federal Bureau of Investigation (FBI) that resulted in the “Criminal and Epidemiological Investigation Handbook” (Criminal and Epidemiological Investigation Handbook, 2005). Many states have developed courses specifically designed to help law enforcement officers operate closely and more effectively with public health officers when investigating a public health problem that may have been caused intentionally or with crimes that have a public health consequence. This is accomplished by familiarizing officers with the basic principles of public health and the epidemiological approach to investigation (Forensic Epidemiology, 2007).

In 2002, several definitions of forensic epidemiology emerged. They included (1) the use of epidemiological methods as part of an ongoing investigation of a health problem for which there are suspicions or evidence regarding possible intentional acts or criminal behavior as factors contributing to the health problem and (2) the use of epidemiological and other public health methods in conjunction with or an adjunct to an ongoing criminal investigation (Koehler & Brown, 2009).

The field of forensic epidemiology, while initially developed to focus on acts of bioterrorism, has expanded its role to include the investigation of deaths and various types of crimes. A forensic epidemiologist can play a vital role in many other types of health emergencies and further threats to public health by examining a number of diverse crimes ranging from environmental to foodborne offenses. Some examples include the following:

Forensic epidemiologists are employed in ME/C’s offices, local or state health departments, public health sectors, schools of public health, private organizations (as private consultants), and as expert witnesses (Wecht, 2004).

Forensic epidemiologists use data collected from various sources, including the death scene investigations, police reports, autopsies, toxicology results, death certificates, and medical records. This information is used to present everything from a general overview of the death to detailed characteristics of various types of death. Types of death include suicide, homicide, motor vehicle accidents (MVAs), drug overdoses, industrial accidents, falls, fires, and medical misadventures. The following are some examples of the types of investigation generated by the data analysis conducted by forensic epidemiologists.