It might be difficult to believe that France was the pioneer in public health and epidemiology publishing, considering the abundance of such literature published in English today. Nevertheless, it was. The first journal of public health in any language was founded by French physicians in 1829 and was published in French. The Annales d'hygiène publique et de médecine légale has been the leader in this field for a long time 5. Fifty years later, with the creation of the first two national public health organisations in 1877, three new journals focusing on public health and hygiene were created, namely the Journal d'hygiène, the Bulletin de la Société de Médecine Publique and the Revue d'hygiène et de police sanitaire 5.

France is recognised as the country that created the first model of public health as a complete and coherent discipline in the 19^th century, albeit through more academic means rather than a discipline in and of itself 25. Even though health has been proclaimed as a right for every citizen in a modern democracy after the French Revolution (1789–1799), preventive medicine continued to be applied through local initiatives in villages and cities instead of through a larger, recognised movement. Contrary to England, France considered disease prevention as an intellectual and academic science, and this fact delayed the construction of disease prevention as a (practical) discipline until the end of the 19^th century 2.

However, this trend gradually changed with Louis Pasteur's discoveries related to bacteriology and microbiology. As a chemist, Pasteur discovered that organisms such as bacteria were responsible of the change of taste in beer and wine as well as milk. He demonstrated that bacteria could be removed by heating the liquid (pasteurisation) of each beverage 12. He also created the first vaccine against rabies, and on the whole his work served to improve epidemiology and public health. In 1888, the "Institut Pasteur" opened its doors in Paris 13.

In Canada, the emergence of public health began late in the 19^th century with the birth of the Confederation in 1867, after which the provinces were not under the control of England anymore 14. The creation in 1882 of the first Provincial Board of Health in Ontario marked the beginning of a recognised public hygiene movement. The only French province in Canada, Québec, followed four years later with the "Conseil d'hygiène de la Province de Québec". After the establishment of the Confederation, England continued to have a strong influence on Canada's decisions – e.g., its 1875 public health laws have strongly influenced Canada's general public health policies 14.

It is well known that Canada is divided linguistically into two communities with two official languages: English and French. The first recorded specialised journal on public health, Public Health Journal, began in 1910 and was published in both languages 15. Between 1880 and 1910, a group of Québécois physicians created the first sanitary education journal (Journal d'hygiène populaire), whose mission was to educate to the population of Québec on proper tools for hygiene 16.

In the first decade of the 20^th century, Québec and the nine other Canadian provinces developed parallel health care systems. The particular linguistic profile of Canada probably encouraged and influenced Québec to develop its own competences as well as to take its own actions in public health. In addition, constant tensions between French and English-speaking Canadians within medical and public health communities also enabled Québec to develop this emergent science independently 15. The creation of the first French-speaking hygiene school (University of Montréal) in North America in 1946 is one of the best examples of this dynamism 16.

In France, there exists a notably larger network of epidemiologists and public health practitioners; for example, the French Language Epidemiologists Association founded in 1976 17 includes epidemiologists from everywhere in France. This larger network and the history of France in the development of preventive medicine might explain the greater number of publications from France than those from Canada, as it is noticeable in Table 1. France obviously has more publications than either Canada or Africa, but unlike Canada, journals published in France are unilingual (except for the Revue d'épidémiologie et de santé publique). In addition, France also has an online public health database containing 28,047 accessible documents, as of December 5^th, 2007 18.

As shown in Table 1, there are only three Canadian journals covering the field of epidemiology and public health and they are bilingual. As in other non-English-speaking countries, francophone journals including those in France, Switzerland and Africa are struggling to survive considering the fact that English is currently the primary language in the scientific world (Personal communication, Dr. Benoit Gaumer, Associate Professor, Department of Health Administration, University of Montréal). For researchers in Québec and in francophone countries, it is more rewarding to publish their results in English and this tendency is difficult to reverse. One of the consequences of the current situation is the transformation of French journals into bilingual publications. This is the case for the journal Ruptures, previously published by the Department of Public Health of the University of Montréal, which ceased publication in May 2007 due to a lack of human and financial resources 19. Now, Ruptures has become Healthcare Policy/Politiques de Santé under a more prestigious publishing house, Longwoods (Personal communication, Ms. Saul-Cohen, Department of Health Administration, University of Montréal).

In Africa, there are several French journals available as well as one publication that publishes articles in both English and French (Table 1). Senegal, Madagascar, Mali, Tunisia, Côte d'Ivoire and Nigeria are currently the only African countries that publish epidemiology or public health journals in French. However, one can retrieve (via PubMed) a few other journals from these countries that only offer articles in English or in their native languages.

One of the most extensive bibliographic databases in French is CAT.INIST, which provides access to 15 million references 20. This database contains documents covering research in Sciences, Technology, Medicine, Humanity and Social Sciences across the world from 1973 to today. CAT.INIST combines documents from The Institute for Scientific and Technical Information (INIST) 21 (English website: 22) and the Centre national de la recherche scientifique (CNRS) 23 (English website: 24). Other relevant databases include Base de données Santé Publique (Public Health Database), France 25, Institut national de santé publique (National Public Health Institute), Québec (Canada) 26 and Masson, Éditeur médical et paramédical (Masson, Medical and Paramedical Editor), France 27.

Today, France offers post-graduate training through the École nationale de la Santé Publique 28, the Institut de Veille Sanitaire 29 and the Institut Pasteur 13. In Québec, epidemiology and public health are taught in graduate and post-graduate programmes at the University of Montréal (in French) 30, at Laval University (in French) 31 and McGill University (in English) 32. Basic epidemiology and public health training is also offered in other universities such as the University of Sherbrooke 33 and University of Québec at Chicoutimi 34. The Québec National Public Health Institute provides training sessions for practitioners and public health researchers 35. Through universities and specialist institutes, postgraduate epidemiology and public health courses are also offered in French in Belgium (e.g. Prince Leopold Institute of Tropical Medicine, Antwerp 36) and Switzerland (cf. Swiss School of Public Health plus 37, a foundation jointly founded by the Universities of Basel, Bern, Geneva, Lausanne, Lugano and Zurich) as well as in francophone Africa (cf. 38 and 39 in which north African countries were classified in a separate category): Algeria (e.g. École National de Santé Publique 40), Benin (Institut Regional de Santé Publique de Ouidah), Cameroon (University of Yaounde 1), Côte d'Ivoire (UFR des Sciences Medicales de l'Université de Cocody-Abidjan), Democratic Republic of Congo (e.g. Kinshasha School of Public Health), Morocco (Institut National de l'Administration Sanitaire 41), Senegal (Institut de Santé et Développement 42) and Tunisia (e.g. Institut National de la Santé Publique). However, there are still 18 francophone African countries without any advanced public health education programmes 38.

In conclusion, there is no doubt that the epidemiology and public health journals of francophone countries and Québec are struggling against the dominance of those in English-speaking countries such as the United Kingdom and the United States of America. The fact that English-speaking countries have been dominant in the history, literature and academic field of epidemiology for many years certainly influenced the current scene in francophone countries. French-speaking researchers and practitioners do not have a choice but to refer to English epidemiology and public health journals for their work as they offer more complete and accurate information at the international level.

This fact is ironic considering that France, Québec and francophone Africa are actively providing training in epidemiology and public health in French. Employment opportunities for French researchers and practitioners are flourishing within health care, administration, and academia due to the increase of chronic and infectious diseases. It is possible that partnerships between French-speaking countries and Québec, such as the Observatoire franco-québécois de la santé et de la solidarité (OFQSS) 43 created in 2002 in order to enable Québec and France to distribute their work in the social and sanitary field, will promote better development and visibility of research published in French publications.

Today, German epidemiologists tend to publish major results and methodological aspects of their studies in English language journals (European or American), followed by papers on selective aspects of the study or overviews in German in German journals. For example, a team who conducted a retrospective cohort study of ethnic German migrants in Germany published innovative aspects of the methodology and major findings in English in the European Journal of Epidemiology 44, BMC Public Health 45 and European Journal of Cancer 46, respectively. Thereafter, a summary of the major epidemiological findings appeared in German in the German medical journal Deutsches Ärzteblatt (including an English translation, see footnote 3 in Table 2) 47.

In other words, when German epidemiologists wish to retrieve findings of studies conducted in Germany, they have to access the international epidemiological and public health literature. At the same time, German public health practitioners, who often do not routinely access English-language journals, receive information on German studies belatedly and only in the form of summary papers. What is the history behind this situation?

German used to be a major language of science in the 19th and early 20th century. This also applied to social medicine (the precursor of epidemiology and public health) 48. For example, Robert Koch published almost exclusively in German 49. Thus, German scientists used to communicate in German in the past. This tradition still exists in Germany even today, especially in the social sciences but also in medicine 50. However, after World War I and II, the German language lost some of its dominance in many core areas of science. The reason for this was, among other things, anti-German sentiment related to the atrocities committed during the Nazi regime, as well as the economic and cultural influence of the United States combined with the prestige associated with the English language 48.

After World War II, social medicine was discredited in Germany because of its misuse by the Nazis (e.g. in the field of eugenics) 51. A renaissance started only in the 1980s and especially the 1990s 52. German-language medical and medical research journals started to recover earlier, but initially followed a "German", rather than international approach: a tendency to focus on experience, rather than evidence, persisted much longer in the German literature than in that of the United Kingdom and the United States. For example, evidence from randomised, controlled trials was introduced in a systematic way only much later in German-language journals 53.

As will be seen in the following, the historical development of epidemiology also finds expression in the publication behaviour of epidemiologists and the current role of German-language epidemiology and public health publications.

In Germany, epidemiology is considered to be one of the constitutional or core sciences of public health 52. Hence, the findings of non-clinical epidemiological studies are published in public health journals as well as in epidemiological journals. Naturally, the former cover a broad range of topics, of which epidemiology is only one.

In Table 2, journals publishing epidemiological papers with a public health focus are grouped in category A. The majority of these journals are published in German, with abstracts in both German and English. Some of these journals are increasingly accepting and publishing English language articles. One example is the International Journal of Public Health, formerly Sozial- und Präventivmedizin. This journal is in the process of completely switching over to English language, an aim which the Journal of Public Health (formerly Zeitschrift für Gesundheitswissenschaften) has already achieved.

Clinical epidemiological research is occasionally published in general medical journals. Examples are listed under category B in Table 2. These journals are almost exclusively in German. Findings from clinical epidemiology can also be found in journals dedicated to subfields of medicine such as occupational health (see category C in Table 2 for some such examples). Some of these journals accept papers in English, e.g. the journal with the German title Dermatologie in Beruf und Umwelt (Dermatology in the Workplace and Environment).

Besides the actual subject matter, epidemiological studies often comprise innovative methodological aspects, which are usually covered by more specialized epidemiological journals. Only one such journal, German Medical Science (GMS) Medizinische Informatik, Biometrie und Epidemiologie (see category D in Table 2) is published in the German language. Incidentally, this journal is the only journal in the table featuring "epidemiology" in its (sub-)title. However, this journal is published only three times a year and contains only a few articles per issue.

In addition, there is a tendency in Germany today to assume that excellence in science is reflected by publications in English, rather than in German. This could be due to the higher impact factors of English language journals and the higher "international visibility" of English-language publications. This phenomenon can be evidenced in the so-called "Exzellenzinitiative" in which German universities competed for government funding – "international visibility" was a crucial criterion in the evaluation of applications 54. Clearly, English-language publications ensure a higher international visibility than German-language ones.

In public health, however, many scientists still write in German. It is striking to observe to what a low extent English language public health papers – even those in high impact journals – are read and discussed in Germany, compared to German language publications in journals that are not even listed in Medline. This has a peculiar side effect: public health specialists and epidemiologists in Germany who publish mainly in English are sometimes better known in neighbouring European countries than they are in Germany itself. They only become more widely known and acknowledged in their home country and language after publishing overview articles in widely read German journals (as in the example above).

As is the case for Italian and French, there are also various web-based bibliographic databases in German speaking countries that also cover literature relevant to public health and epidemiology. Aside from general catalogues offered by national and university libraries in Austria, Switzerland, and Germany, some examples that focus on medicine, social and health sciences in particular include (topics covered are given in brackets): SOMED (social medicine) 55, Archido (publications and information related to drugs and addiction) 56, BELIT (Bioethics) 57, ETHMED (Ethics in medicine) 58, GeroLit (Gerontology) 59, resources offered by the Federal Centre for Health Education (Bundeszentrale für gesundheitliche Aufklärung, BZgA) (portal for different databases relevant to prevention and health promotion) 60, Zeitschriften-Dokumentation Sozialwesen/Pflege (social services, nursing) 61. Additionally, some services offer meta-search in different databases. Two examples are the search engines offered by the German Institute of Medical Documentation and Information (DIMDI) 62 and MedPilot 63, a service offered by a cooperation of different institutions. Most of the databases mentioned above are not limited to German language publications but also cover international literature. Apart from these bibliographic collections, web-based surveillance information systems and other web-based resources relevant to health reporting are available in all three countries.

Until the late 1990s, there were no postgraduate epidemiology training courses in Germany. The first MSE (Master of Science in Epidemiology) course only started in 2001. In the early- to mid-1990s there was a special programme ("Sonderprogramm Epidemiologie") funded by the government to send young German scientists to the United Kingdom or the United States for training in epidemiology. Many of those who graduated from international courses later took up leadership positions in German academia (e.g. chairs in epidemiology) and routinely write their major epidemiological papers in English. Thus, the "Sonderprogramm" contributed to the trend among German epidemiologists to publish mainly in English.

Due to a similar influence of National Socialism, the historic development of public health in Austria bears a similar pattern to that of Germany. Hence, public health in Austria also has a rather short tradition. Before the establishment of public health courses in recent years, public health education took place abroad and was supported by scholarship programs. The oldest German-language School of Public Health is located in Austria and was founded in 1986 64.

In Switzerland, however, the development of public health started a bit earlier. In the 1950s and 1960s, some Swiss physicians took epidemiology and public health courses in the United States and the United Kingdom, mostly at their own expense. Later, further education in public health was financed through scholarships via a national fund. Public health courses have been available in Switzerland since 1990 65.

In Italy, before the unification in 1861, epidemiology developed within the context of public health 66. In particular, based on either the miasmatic or the epidemiological-materialistic paradigm of epidemics, scientists developed theories to interpret the cholera outbreaks periodically striking the Italian peninsula 676869. These efforts contributed to the identification of the Vibrio cholerae bacillus in Florence by Filippo Pacini in 1854 70.

Following the unification, epidemiology strongly contributed to the major public health efforts devoted to control malaria which affected most of the country. Within this context descriptive and analytical epidemiological methods were adopted to assess the local burden of malaria, to design and test the efficacy and impact of both preventive and curative measures, and finally to evaluate the results of extensive campaigns against malaria in rural settings. Eventually, Italy was declared malaria-free in 1962 71.

After the Second World War, the focus progressively shifted towards non-communicable diseases; in particular, major efforts were devoted to occupational, environmental and cancer epidemiology. The contribution of Italian epidemiology at an international level has become increasingly relevant. As an example we would like to recall the key role played by Lorenzo Tomatis (1929–2007), director of the International Agency for Research on Cancer (IARC) between 1982 and 1993, in setting up the IARC Monographs on the Evaluation of Carcinogenic Risks to Humans programme, which seeks to identify the causes of human cancer 72.

During the last few decades, epidemiology has become increasingly relevant in Italy as a driving force of the National Health Service. Epidemiological resources and activities are currently present both at the central level, in particular within the National Health Institute (Istituto Superiore di Sanità or ISS) 73, and at a peripheral level, in particular within agencies and observatories present in the twenty Italian regions. These central and peripheral epidemiological and public health activities are coordinated by the National Center for Disease Control (CCM) 74. Furthermore, since the Italian National Health Service is largely run at a regional level, a substantial amount of epidemiological activity is also carried out at smaller – e.g. Local Health Unit – levels. A typical example is given by the 21 population-based cancer registries active mainly in Northern and Central Italy 75, covering about the 25% of total Italian population 76.

Similar to what happens in other non-English speaking countries, Italian epidemiologists aim to publish major results 77 and methodological aspects of their investigations in international journals 78, whereas selected reviews and studies with a predominant local interest are published in Italian journals. As shown in Table 3, a number of Italian epidemiological and public health journals are indexed in Medline with abstracts available in English. In particular, the journal Epidemiologia & Prevenzione regularly publishes monothematic supplements on selected topics such as health consequences of air pollution, cancer statistics and screening program management. Recently, the tendency to publish (or translate) selected articles in English has emerged, while two new public health journals have adopted English as their official language.

While there is no widely circulated Italian medical journal addressing topics relevant to general medicine, many specialty journals often publish epidemiological papers relevant to their domain of interest. The topics addressed by these journals encompass most of the medical specialties such as mental health, occupational health, nosocomial infections, oncology and clinical pharmacology.

One major weakness of Italian epidemiological and public health journals arises from their limited local readership. In particular, these journals are read by a small proportion of public health practitioners, while they are largely ignored by physicians and other medical practitioners. The lack of a common methodological approach, conflicting research interests, and the inability to ensure dissemination of epidemiological data at the local level results in poor communication between public health services, the academic sector, and experts involved in clinical epidemiology. The inability to reach a suitable audience challenges the reason for keeping Italian as the main publishing language: if a relevant proportion of public health practitioners do not access local publications, these become non-relevant to the health care development process.

Although no comprehensive bibliographic database is available in Italian, many databases relevant to epidemiology and public health are accessible on the web. Without claiming any completeness, the following websites can be cited: a registry of clinical (drug) trials conducted in Italy 79; an overview of epidemiological activities (studies, meeting, resources) throughout the country 80; data on health care delivery (including hospital discharges by primary diagnosis and intervention, and infectious diseases with mandatory notification) 81; general country statistics (demography, socio-economic indicators, mortality); an Italian version of the Health for All Database 82; and incidence, mortality and survival from the Italian cancer registries 75. Finally, information from the Italian Environmental Protection Agency is accessible at its own website 83.

At the academic level, epidemiology is regularly taught in under- and post-graduate courses as part of the core scientific syllabus. Moreover, basic epidemiological training is often required to write and defend the thesis concluding health-related academic courses. It is worth noting that the intensive summer school "European Educational Programme in Epidemiology" (EEPE) 84 has been held in Florence since 1988, and has been attended by several hundred students from European and extra-European countries 7. The first post-graduate course in Epidemiology, a Masters of Science (M.Sc.) in Epidemiology, was started in 1997 by the Italian Association of Epidemiology (AIE) 85, is now run by the University of Turin on a biennial basis, and is part of the network "European Master of Science in Epidemiology" (EU-MSE) 86. Currently, four additional M.Sc. programmes and several short courses are available through the country 8085.