Am J Epidemiol 2004; 159:818.
Copyright © 2004 by the Johns
Hopkins Bloomberg School of Public Health
BOOK REVIEW |
Global Behavioural Risk Factor Surveillance
Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205
Edited by David McQueen and Pekka Puska
ISBN 0-306-47777-7, Kluwer Academic/Plenum Publishers, New York, New York (Telephone: 212-620-8000, Website: http://www.kluweronline.com/), 2003, 262 pp., $65 (hardcover)
The now virtually global epidemiologic transition to chronic diseases (noninfectious diseases) accounting for the majority of deaths has generated interest worldwide in measuring, tracking, and addressing chronic disease risk factors (1). The transition to awareness of the importance of chronic disease risk factors has now moved from the industrialized to developing nations and from three continents to six. As global mortality measures already, risk factors are on their way to being universally collected and continuously improved for country-to-country comparability and reporting (2).
Assembling an experienced and knowledgeable cadre of contributors first in a conference meeting and now in book format, the editors of Global Behavioural Risk Factor Surveillance hope to provide "global leadership in risk factor surveillance" (3, p. 1). Importantly, they have taken the first step in surveillance: to define the problem of noninfectious disease and to measure the most useful factors in worldwide behavioral risk surveillance. As a whole, the text covers the spectrum of considerations involved in developing a tracking system that will depend entirely upon individual countries subscribing to standardized risk factor surveillance. The authors’ experiences are evidenced throughout with examples of priority development (e.g., which risk factors to assess and survey periodicity), creation of surveillance tools (e.g., questionnaires, sampling strategies, and statistical methods), analysis (e.g., data harmonization, local level measures, indices creation, and trend estimation), and dissemination (e.g., salience, audiences, and uses). Experiences with infectious disease surveillance, current national infrastructures, and successful surveys (e.g., the Chinese Behavioral Risk Factor Surveillance System, the European Information Campaign on Diet and Nutrition (EURALIM), the European Physical Activity Surveillance System (EUPASS), the Mega Country Health Promotion Network Surveillance Initiative, the Pan American Health Organization (PAHO)’s risk factor survey evaluation criteria, the South Australia omnibus surveys, and the US Behavioral Risk Factor Surveillance System (BRFSS)) inform the reader about various approaches to this new frontier.
Notably, the authors are neither prescriptive about global surveillance of noninfectious diseases nor US-centric. For example, they suggest that readers use as a planning tool, STEPS, the World Health Organization Stepwise Approach to Surveillance. The epidemiologist looking for a short list of lessons learned to date will be disappointed; they are not inventoried here. A more synthetic approach might have exploited the shortcomings to move this multinational effort forward; perhaps the domestic and global public health world is not quite ready. In addition, actual prevalence measures are few and links to global goals were not made (4). Remarkably, the importance of cultural sensitivity is addressed only tangentially and would have made a significant contribution to the deliberations surrounding such surveillance systems in any country.
Nevertheless, many of the presentations and lessons learned are pertinent to even the most mature surveillance systems, such as the US BRFSS. For example, the chapter entitled, "Did they use it? Beyond the collection of surveillance information," delves into the topics and issues surrounding the use and dissemination of the health information amassed, a conversation well worthwhile. Further, this text offers an overview of issues that the reader must tailor to the policies and decisions of his/her own public health purview. Certainly many of the issues presented go beyond the display of options and portend the next set of global behavioral surveillance issues, such as moving from a single survey to a surveillance system, extracting maximum use of the data collected, achieving comparability, validity, and so on. In all, the desired outcomes of a well-functioning surveillance system are covered—public health policy and program-planning information, including important topics of trend data availability and comparability with other surveys (2). To my knowledge, this is the only volume available to address worldwide surveillance, and indeed it may be used immediately by those working internationally with such agencies as the World Bank, US Agency for International Development (USAID), foundations, and others (1).
REFERENCES
- Commission on Macroeconomics and Health, World Health Organization. Macroeconomics and health: investing in health for economic development. Geneva, Switzerland: World Health Organization, November 2001. (http://www3.who.int/whosis/menu.cfm?path=whosis,cmh&language=english). (Accessed December 30, 2003).
- Updated guidelines for evaluating public health surveillance systems: recommendations from the Guidelines Working Group. MMWR Recomm Rep 2001;50(RR-13):1–35.
- McQueen D, Puska P, eds. Global behavioural risk factor surveillance. New York, NY: Kluwer Academic/Plenum Publishers, 2003.
- World Health Organization. Millenium development goals (MDGs). New York, NY: United Nations, September 2000. (http://www.who.int/mdg/en/). (Accessed December 30, 2003).
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