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ANNUALREVIEWS Further
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Public Health Surveillance
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Systems: Recent Advances
in Their Use and Evaluation
Annu. Rev. Public Health 2017.38:57-79. Downloaded from www.annualreviews.org
Access provided by 160.119.208.238 on 05/08/21. See copyright for approved use.
Samuel L. Groseclose1 and David L. Buckeridge2
1
Office of Public Health Preparedness and Response, Centers for Disease Control and
Prevention, Atlanta, Georgia 30329; email: sgroseclose@cdc.gov
2
Surveillance Lab, McGill Clinical and Health Informatics, Department of Epidemiology,
Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada H3A
1A3; email: david.buckeridge@mcgill.ca
Annu. Rev. Public Health 2017. 38:57–79 Keywords
First published online as a Review in Advance on public health surveillance, public health surveillance systems, surveillance
December 15, 2016
evaluation, surveillance indicators, surveillance objectives, surveillance
The Annual Review of Public Health is online at system monitoring
publhealth.annualreviews.org
https://doi.org/10.1146/annurev-publhealth- Abstract
031816-044348
Surveillance is critical for improving population health. Public health surveil-
Copyright c 2017 Annual Reviews. This work is lance systems generate information that drives action, and the data must be
licensed under a Creative Commons Attribution-
ShareAlike 4.0 (CC-BY-SA) International License, of sufficient quality and with a resolution and timeliness that matches ob-
which permits unrestricted use, distribution, and jectives. In the context of scientific advances in public health surveillance,
reproduction in any medium and any derivative changing health care and public health environments, and rapidly evolving
work is made available under the same, similar, or
a compatible license. See credit lines of images or technologies, the aim of this article is to review public health surveillance
other third-party material in this article for license systems. We consider their current use to increase the efficiency and effec-
information. tiveness of the public health system, the role of system stakeholders, the anal-
ysis and interpretation of surveillance data, approaches to system monitoring
and evaluation, and opportunities for future advances in terms of increased
scientific rigor, outcomes-focused research, and health informatics.
57
, INTRODUCTION
Public health surveillance, and by extension the systems used to enable surveillance, is central to
the practice of modern public health. Public health surveillance contributes data and information
to assess and characterize the burden and distribution of adverse health events, prioritize public
health actions, monitor the impact of control measures, and identify emerging health conditions
that may have a significant impact upon population health. The core role of surveillance systems
within public health practice, and their concomitant capacity to greatly influence the efficiency and
effectiveness of the public health system, has stimulated research to strengthen the scientific basis
of public health surveillance. In 1970, only 7% of PubMed articles about surveillance (20/277)
focused on methods, but that proportion rose to 60% by 2015 (7,400/12,400).
In the context of scientific advances in public health surveillance, changing health care and
public health environments, and rapidly evolving technologies, the aim of this article is to review
public health surveillance systems, including their current role, recent advances, and opportunities
Annu. Rev. Public Health 2017.38:57-79. Downloaded from www.annualreviews.org
Access provided by 160.119.208.238 on 05/08/21. See copyright for approved use.
for future advances. This review is divided into three sections. In the first two sections, we review
the contemporary use and evaluation of surveillance systems in public health practice and highlight
some notable recent advances in their use and evaluation through case studies and other examples.
In the third section, we discuss some promising opportunities for advancing surveillance systems
in the future and highlight notable research activities.
THE USE OF SURVEILLANCE SYSTEMS
The Concept of a Surveillance System
Surveillance, a core function of public health practice, is defined as “the ongoing, systematic col-
lection, analysis, and interpretation of health data essential to the planning, implementation, and
evaluation of public health practice, closely integrated with the timely dissemination of [this in-
formation] to those who need to know” and act upon that information (84, p. 164). A surveillance
system, in turn, is a collection of processes and components that enable public health practitioners
to conduct surveillance. Surveillance processes include data collection, data quality monitoring,
data management, data analysis, interpretation of analytical results, information dissemination, and
application of the information to public health programs. The enabling components of surveillance
systems may include laboratory diagnostics to detect or confirm health conditions; information
technologies to support the surveillance processes of data collection, analysis, and dissemination;
clinician consultation and reporting; clinician, public health, and laboratory worker education and
training; legislation, regulations, and policies that support the conduct of surveillance; systems
and directories for disseminating alerts, bulletins, clinical guidelines, and prevention recommen-
dations; program administration and management; and human factors (e.g., multisector commu-
nications and relationships) (54). Ultimately, public health surveillance systems should produce
information to guide public health decisions in many areas, including disease prevention, preven-
tion program planning and management, health promotion, quality improvement, and resource
allocation.
Using Surveillance Systems to Meet Public Health Objectives
From a societal perspective, public health surveillance systems should increase the efficiency and
effectiveness of the public health system, which is a primary determinant of population health. A
surveillance system affects population health by capturing data and generating information that
58 Groseclose · Buckeridge
, public health practitioners and stakeholders can use to improve the quality of their decisions and
the effectiveness of their actions. From the perspective of the public health system, surveillance
systems support all three essential functions of public health—assurance, assessment, and policy
development (39). For a specific surveillance system, however, the objectives should be defined
more precisely (Table 1) (see also Supplemental Case Studies 1, 2, and 3; follow the Supple- Supplemental Material
mental Material link in the online version of this article or at http://www.annualreviews.org/).
These objectives should be tailored to the outcomes under surveillance, the intended uses of the
information generated by the system, and the level (e.g., local, regional, national) of the public
health system at which the surveillance system is functioning. The processes and components of a
public health surveillance system should in turn be aligned with the objectives of the surveillance
system to ensure that valid information can be derived and applied to practice, to promote oper-
ational efficiency, and to ensure that the activities are within the legal or regulatory mandate of
the public health system.
Annu. Rev. Public Health 2017.38:57-79. Downloaded from www.annualreviews.org
Explicitly documented objectives for the surveillance system are also important for planning the
Access provided by 160.119.208.238 on 05/08/21. See copyright for approved use.
system, evaluating system performance, and enabling continuous improvement of data and system
quality. Surveillance objectives and budget should determine the number and type of data variables
to be collected (e.g., demographic or behavioral data variables), including the required level of
resolution of the data, the population under surveillance, the required timeliness of information for
effective action or response, the frequency of data analysis and interpretation, and the resources
required to support the surveillance system. Similarly, surveillance objectives should influence
decisions about data collection, management, analysis, integration, dissemination, security, and
privacy. It is best to identify inconsistencies between the objectives (and their implications for
system design and performance) and resources at the planning stage so that one or the other can
be adjusted accordingly.
Ultimately, a public health surveillance system’s objectives indicate how the data are intended
to be used for public health action. Over 40 years ago, Dr. William Foege wrote,
The reason for collecting, analyzing and disseminating information on a disease is to control that
disease. Collection and analysis should not be allowed to consume resources if action does not follow.
Appropriate action, therefore, becomes the ultimate goal and the final assessment of the earlier steps
of a surveillance system. (28, p. 30)
Surveillance data have been used to guide a range of public health actions. Table 1 presents
examples of surveillance data use by surveillance system objective to illustrate the range of public
health actions that can be informed by public health surveillance data.
The Expanding Use of Surveillance Systems
The initial focus of public health surveillance principles and practices was on infectious diseases, but
today public health surveillance systems are used to monitor and forecast a broad range of health
determinants (e.g., risk behaviors, health care services, and socioeconomic factors) and outcomes
relevant to infectious diseases, injuries, chronic diseases, mental health, and occupational and
environmental health. The case studies on the Major League Baseball Health and Injury Tracking
System (MLB HITS) and active transportation surveillance are examples of surveillance systems
focused on noninfectious diseases (see Supplemental Case Studies 1 and 3). In particular, in
the case of the MLB HITS, two non–public health entities, an industry (MLB) and its worker
association, established a surveillance system to identify and monitor work-related injuries and
associated risk factors and to assure the effectiveness of the intervention (64).
www.annualreviews.org • Public Health Surveillance Systems 59
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