Definition of Surveillance System

by Carolina on December 13, 2009

Author: Dr. Arana

Historically, public health surveillance has combined two different activities: case and statistical surveillances. Case surveillance, which is focuses on individuals, or sometimes small groups of individuals, has been used for communicable diseases capable of causing great harm to the entire population if allowed to spread. In contrast, statistical surveillance uses populations to identify differentials and trends that can inform public health policymaking, including the allocation of resources (Stoto 2008). Both case and statistical surveillance approaches have roots going back centuries, but it was not until 1963 that Alexander Langmuir of the Communicable Disease Center (now the Centers for Disease Control and Prevention, or CDC) combined them in his classic definition of public health surveillance, the basis for the CDC’s definition.

In 1963 the term surveillance was defined by Alexander Langmuir as “the systematic collection, consolidation, analysis and dissemination of data on specific disease” in public health practice (Langmuir 1963). Prior to that definition, surveillance had been used in public health practice to refer the monitoring of persons who had been exposed to communicable diseases and who might need to be quarantined by public health departments.

In United States a broader, population-based approach of surveillance gained importance following the Francis Field Trial of poliomyelitis vaccine in 1955 ( Markel 1955), where having in place the notifiable-disease reporting system to state and local health departments led to an epidemiologic investigation remarkable in the public health field. This evolution of “surveillance” from personal to public health surveillance developed and highlighted what currently are considered its main principles – data collection, data analysis , data interpretation , and dissemination of that data in a timely manner at the lowest possible cost for public health action.

In 1965, the Director General of the World Health Organization (WHO) established the epidemiological surveillance unit in WHO’s Division of Communicable Diseases and defined surveillance much more broadly than Langmuir including “the epidemiological study of disease as a dynamic process.” In 1968, the 21st World Health Assembly, through the leadership of Alexander Langmuir and Karel Raska, the director of the World Health Organization’s Division of Communicable Diseases, affirmed the three main features of surveillance: a) systematic collection of data, b) analysis and evaluation of data, and c) dissemination of data regarding a health-related event for use in public health action to reduce morbidity, mortality and to improve health ( Raska 1966) (World Health Organization 1968).

In recent years, surveillance constitutes a critical part of public health practice. The Center for Disease Control and Prevention (CDC) officially describes public health surveillance as “the ongoing and systematic collection, analysis, and interpretation of outcome-specific data for use in the planning, implementation, and evaluation of public healthpractice” (Thacker, Berkelman 1988). By definition, surveillance systems include the capacity for data collection and analysis, as well as the timely dissemination of information to persons or group of persons who can undertake effective prevention and control interventions related to specific health outcomes.

Over the years the concept of surveillance has been changed. However, this system will always have a practical value as it can be used in designing new surveillance systems as well as understanding or evaluating currently operating ones. Current concepts of surveillance systems evolve from public health actions to control disease outbreaks in the population. Nowadays, surveillance extends far beyond the narrow confines of communicable disease reporting and vital statistics to include surveillance of chronic diseases, environmental factors, behavioral risk factors, health care quality and utilization, adverse events from drugs and medical devices, knowledge, attitudes, and beliefs concerning health, occupational diseases and outcomes of pregnancy and childbirth. Surveillance systems are extending its services to the entire population in a more public health context including collection and analysis of surveillance data to assess public health status, identifying priorities, evaluating and monitoring programs, and conducting research. In addition, surveillance system is being useful in detecting epidemics and changes in health practice, documenting the distribution and spread of a health event, estimating the magnitude of a health problem, and delineating the natural history of disease.

Furthermore, several activities are expected to contribute to the evolution of public health surveillance. For example, the use of technology revolutionized the practice of public health surveillance. In U.S., the National Electronic Telecommunications System for Surveillance (NETSS) connects all the state health departments electronically for collection, analysis, and dissemination of information on notifiable health conditions. States, counties and health-care providers are electronically linked for routine surveillance, using this coordinated, timely, and useful integral multisource of public health surveillance readily developed. Technology, electronic media, and all other communication’s tools should facilitate the use of surveillance data for public health action.

In addition to the definition, uses and principles of surveillance systems, it is important to understand some terms related to these systems such as Indicators – a measurable factor used to estimate the size of a health event and monitor the processes or the effect of an intervention on the population; Active surveillance – dynamic process of contacting health care providers or population to seek information about health conditions. This is the most accurate and timely information, but it is also expensive; Passive surveillance- a system by which a health jurisdiction receives reports submitted from hospitals, clinics, public health units, and other sources. It is a relatively inexpensive strategy to cover large areas, and provides critical information for monitoring a community’s health. However, data quality and timeliness are difficult to control ( Losos 1996). Among these surveillance definitions there are also different types of surveillance systems available to specific diseases and health risks such as syndromic surveillance, categorical and integrated surveillance systems, and BRFSS.

It is important to notice that in order to establish and maintain a surveillance system, it is necessary to establish the goals of the system, develop case definitions, select appropriate personnel, and acquire tools and clearances for collection, analysis, and dissemination; then  the surveillance system can be implemented and evaluated (Thacker, Stroup 1998). Following these steps will ensure the sustainability and establishing of the systems since they must adapt constantly to changes in the population and the physical and social environment.

Generally speaking, public health surveillance is considered as the systematic, ongoing assessment of health risks related to the community based on the collection, interpretation, analysis, and dissemination of information. Its purpose is to empower decision makers to lead and manage more effectively by providing timely, useful evidence. Therefore, surveillance data is necessary to guide public health planning, developing, implementing, and decision making. It is crucial not only to improve the quality and effectiveness of collection, analysis, interpretation and display of data, but also to listen to persons who are empowered to set policy in order to understand and stimulate policymakers’ interests and actions. Public health action is based on its majority to an effective, timely and reliable surveillance system.

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