Review Article

The Past, Present, and Future of Public Health Surveillance

Table 5

The historical evolvement of the definitions of public health surveillance.

YearAuthorDefinitionRemarks

1662John GrauntNow having engaged my thoughts upon the Bills of Mortality, and so far succeeded therein, as to have reduced several great confused Volumes into a few perspicuous Tables, and abridged such Observations as naturally flowed from them, into a few succinct Paragraphs … I hoped … to see unto how much profit that one Talent might be improved, beside the many curiosities concerning the waxing and waning of Diseases” [29].Surveillance is based upon successful analysis of population-based, on-going data (e.g., death records). There are several basic principles of data analysis: reduce volumes of data to a few easy-to-understand tables, then interpret them, and prepare a few brief and precise paragraphs, so as to gain profit from the data analysis, in order to understand the increase and decrease of diseases [7].
1687Sir William PettyPolitical Arithmetic” [66]. Much of the data manipulation that epidemiologists do requires a fourth grade education in arithmetic. However, the wisdom as to the validity of the data and the conservatism of interpretation requires persons with a keen political sense” [46].
1963Alexander
Langmuir
Surveillance, when applied to a disease, means the continued watchfulness over the distribution and trends of incidence through the systematic collection, consolidation and evaluation of morbidity and mortality reports and other relevant data. Intrinsic in the concept is the regular dissemination of the basic data and interpretations to all who have contributed and to all others who need to know” [67].Langmuir was careful to distinguish surveillance both from direct responsibility for control activities and from epidemiologic research, although he recognized the important interplay among epidemiologic studies, surveillance, and control activities” [30]. “Langmuir stated on more than one occasion that the concept of surveillance did not encompass direct responsibility for control activities” [27], and that “the surveillance officer should be the alert eyes and ears of the health officer and he should advise regarding control measures needed, but the decision and the performance of the actual control operations must remain with the properly constituted health authority" [68].
1968World Health OrganizationSurveillance is the “systematic collection and use of epidemiologic information for the planning, implementation, and assessment of disease control” [69].In the sense of the 1968 definition, surveillance implies “information for action” [70].
1986Centers for Disease ControlEpidemiologic surveillance is the ongoing systematic collection, analysis, and interpretation of health data essential to the planning, implementation, and evaluation of public health practice, closely integrated with the timely dissemination of these data to those who need to know. The final link in the surveillance chain is the application of these data to prevention and control” [71].A critical word in this definition is “ongoing”; one-time surveys or sporadic studies do not constitute surveillance. An ongoing system of data collection and collation is also not sufficient to constitute public health surveillance, because to be useful the data must be integrated into the conduct and evaluation of specific public health programs, which may include epidemiologic research leading to prevention” [30]. “The 1986 CDC definition of surveillance reflects Langmuir’s 1963 view and avoids the use of the term surveillance for control activities, although it states that the final link in the surveillance chain is the application of these data to prevention and control” [27]. “The 1986 CDC concept of surveillance differentiates surveillance from occasional surveys and from planned comprehensive research programs” [72].
1988Thacker and BerkelmanPublic health surveillance is the ongoing systematic collection, analysis, and interpretation of outcome-specific data, closely integrated with the timely dissemination of these data to those responsible for preventing and controlling disease or injury” [30].This definition, however, contains two very different activities. Case surveillance focuses on individuals, to identify those with certain diseases and take action. Statistical surveillance, on the other hand, focuses on populations, to identify differentials and trends that can inform public health policymaking, including the allocation of resources” [73].
1998Bernard ChoiA surveillance system is … a systematic, ongoing and population-based system for the collection, analysis, and interpretation of data on health outcomes, risk factors, and intervention strategies, for the monitoring and early warning of health events, and for the development and evaluation of public health interventions and programmes, closely integrated with the timely dissemination of the information to those who need to know” [7, 74].Based on 12 lessons learned from the past 5000 years of the history of epidemics, a surveillance system should have twelve desirable features, including (1) evolving, (2) ongoing, (3) systematic, (4) population-based, (5) comprehensive, (6) analytic, (7) hypothesis generating, (8) early warning, (9) informing programs and interventions, (10) evaluative, (11) effective in information dissemination, and (12) equitable [7].
2001US Centers for Disease Control and PreventionPublic health surveillance is the ongoing, systematic collection, analysis, interpretation, and dissemination of data regarding a health-related event for use in public health action to reduce morbidity and mortality and to improve health” [75].Historically, surveillance focused on infectious disease, then broadened to other topics, including chronic diseases” [76].
2006Public Health Agency of Canada, Public Health Research, Education and Development, Canadian Public Health AssociationHealth surveillance is the ongoing, systematic use of routinely collected health data to guide public health action in a timely fashion” [77].
2012World Health OrganizationSurveillance is systematic ongoing collection, collation and analysis of data and the timely dissemination of information to those who need to know so that action can be taken” [78].
2012World Health OrganizationPublic health surveillance is an ongoing, systematic collection, analysis and interpretation of health-related data essential to the planning, implementation, and evaluation of public health practice” [79].
2012World Health OrganizationPublic health surveillance is the continuous, systematic collection, analysis and interpretation of health-related data needed for the planning, implementation, and evaluation of public health practice” [80].