American Journal of Epidemiology Vol. 154, No. 4 : 385-386
Copyright © 2001 by The Johns Hopkins University School of Hygiene and Public Health
BOOK REVIEWS |
Principles and Practices of Public Health Surveillance, Second Edition
1 Department of Epidemiology and Biostatistics University of California, San Francisco, CA 94105-3444
In 1963 Alexander Langmuir defined surveillance as "the systematic collection, consolidation, analysis and dissemination" of data in public health practice (1
, p. 182). Central to Langmuir's conceptualization of surveillance was that surveillance data would be used to trigger public health actions. This definition had its roots in the vital statistics movement, especially the efforts of William Farr in the United Kingdom in the 19th century and in state laws mandating the systematic reporting of communicable diseases of public health significance, first begun in the United States in Massachusetts in 1874. Before Langmuir, the term "surveillance" had been used to refer to the monitoring of persons who had been exposed to communicable diseases and who might need to be quarantined by public health departments. As late as 1966 the term "surveillance" was used by the World Health Organization to include "the epidemiological study of disease as a dynamic process" and a variety of disease control activities (2, p. 315). However, by the late 1960s, a working paper, coauthored by Langmuir and Karel Raska, the director of the World Health Organization's Division of Communicable Diseases, laid out the main features of surveillance much along the lines Langmuir had described in 1963 and was endorsed by the World Health Assembly as official World Health Organization policy.
The Centers for Disease Control and Prevention officially describe 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 health practice" (3, p. 165). While clearly routed in communicable disease reporting and vital statistics, surveillance activities undertaken by the Centers for Disease Control and Prevention and by state and local public health departments have grown over the past three decades to include chronic, environmental, and occupational diseases and outcomes of pregnancy and childbirth. However, the concept of public health surveillance is even broader still. It can be viewed as extending far beyond the narrow confines of disease reporting and registers to include surveillance of behavioral risk factors, of health care utilization and quality, of adverse events from drugs and medical devices, and of knowledge, attitudes, and beliefs concerning health.
The second edition of Teutsch and Churchill's Principles and Practices of Public Health Surveillance is an outstanding treatment of the breadth and depth of public health surveillance activities while at the same time maintaining the practical "nuts-and-bolts" character of its first edition (4). The book contains 16 chapters by different authors, mostly either currently or historically affiliated with the Centers for Disease Control and Prevention, on a broad variety of topics related to public health surveillance. The first several chapters deal with the practical issues of surveillance: planning a surveillance system, finding health information, management and quality control of surveillance data, analyzing and interpreting surveillance data, evaluating surveillance systems, the legal basis for disease reporting and surveillance, and an overview of surveillance programs at the state and local public health department levels. These are especially worthwhile for public health students learning about surveillance for the first time. For epidemiologists used to working with analytical or experimental studies, surveillance data—largely descriptive data—may seem not worth the trouble. A chapter by Janes and colleagues provides an excellent overview of analytical methods useful for surveillance data, ranging from general approaches to more advanced interpretive techniques such as cluster analysis, and in the first chapter Thacker lays out a variety of uses of surveillance data, many of which, such as identification of cases for case-control studies, have long been used by academic researchers.
The landscape of what constitutes public health surveillance and how it is practiced has changed since the first edition in 1994. New chapters on the health care information infrastructure, surveillance of quality in health care, and post-market safety surveillance for pharmaceuticals explore these emerging sources of and uses for surveillance data. Administrative and clinical data sets from managed care organizations may be to surveillance in this decade what laboratory-based surveillance was in the 1990s—a chance for much more complete ascertainment of cases (5). How best to assess and audit quality of health care is an especially important topic since the Institute of Medicine's report on medical quality in 2000 (6), and solutions have been proposed to use everything from a public health surveillance-style system to something more akin to failure analysis, used in engineering and most publicly by the Federal Aviation Administration to investigate aircraft accidents. Similarly timely is the chapter on surveillance for post-market surveillance. It was just such a system, the Vaccine Adverse Events Reporting System, that identified the association between rotavirus vaccine and intussusception in vaccine recipients (7).
Not only has the breadth of public health surveillance expanded, the information technology that supports it has grown much more sophisticated and powerful since the first edition. Updated chapters on management of surveillance information systems by Groseclose and colleagues and computerizing surveillance systems by Dean provide in-depth discussions of efforts in system integration, such as the American National Standards Institute's electronic data interchange protocols, and newer Internet-based tools. Additionally in other chapters there is in-depth discussion of the potential impact of the Health Insurance Portability and Accountability Act of 1996 on public health surveillance.
Principles and Practices of Public Health Surveillance is a wonderful source of information on this underappreciated topic. It has two strengths in particular. First, it is by and large written by people who deal with public health surveillance systems and data on a daily basis and are intimately acquainted with their strengths and weaknesses. Second, the book is a one-stop source on public health surveillance and provides a single source reference on all aspects of surveillance in a straightforward, well-referenced, and readable manner. Like all books written by multiple authors, there is a little overlap between chapters, but it is not detracting. Also, like all books, it represents the state-of-the-art at the moment in time it was written; surveillance concepts and practices will continue to evolve, especially in the area of information technology. Nonetheless, this is and will continue to be for the foreseeable future the single best source on public health surveillance. I recommend it for public health practitioners, for public health students, and for researchers interested in further exploring this treasure trove of data.
NOTES
Edited by Stephen M. Teutsch and R. Elliott Churchill
ISBN 0195138279, Oxford University Press, New York, New York (Telephone: 800-451-7556, Fax: 919-677-1303, Web: www.oup-usa.org), 2000, 424 pp., $57.75
REFERENCES
- Langmuir AD. The surveillance of communicable diseases of national importance. N Engl J Med 1963;268:182–92.
- Raska K. National and international surveillance of communicable diseases. WHO Chron 1966;20:315–21.[Web of Science][Medline]
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Thacker SB, Berkelman RL. Public health surveillance in the United States. Epidemiol Rev 1988;10:164–90.
[Free Full Text] - Teutsch SM, Churchill RE, eds. Principles and practices of public health surveillance. 2nd ed. New York, NY: Oxford University Press, 2000.
- Rutherford GW. Public health, communicable diseases, and managed care: will managed care improve or weaken communicable disease control? Am J Prev Med 1988;14(suppl):53–9.
- Kohn LT, Corrigan JM, Donaldson MS, eds. To err is human. Building a safer health system. Washington, DC: National Academy Press, 2000.
- Intussusception among recipients of rotavirus vaccine—United States, 1998–1999. MMWR Morb Mortal Wkly Rep 1999;48:577–81.
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