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Topic:
Surveillance
Presenter:
Dr. Ann Marie Kimball
What kinds of surveillance are there in the world? To understand international surveillance, you have to be familiar with surveillance in the United States. It is every bit as diverse and probably more so than international surveillance. Most people in the U.S. think that the Centers for Disease Control are in charge of surveillance. They are not. The States are responsible for surveillance. Within the States, the final responsibility for the health and welfare is often at the county health office level. In Washington State that's 39 different individuals in 39 county health districts responsible for the population.
How disease surveillance works.
The States decide which diseases are reportable in that State. Hemolytic uremic syndrome, the E.coli disease, was not reportable in most states including Washington when the first large outbreak occurred. The State Board of Health, a body appointed by the Governor, must take action to make a disease reportable. It's a very political process because information costs money. States make their decisions based on guidelines offered by the Centers for Disease Control. Generally a uniform set of diseases are universally reportable across the 50 states. However there are also big gaps that you'll run into when you talk about emerging infections and new syndromes.
Limits to surveillance
Surveillance is imperfect information, even in this country. Parts of Europe such as the Scandinavian countries have more exact surveillance than the U.S. They have excellent lab-based reporting, they have a very tight network of providers and much more accountability because they have a lot smaller population. They also are generally more organized in the social sector than the U.S. The United Kingdom may also have better surveillance data than the U.S. They have long-standing data sets and pretty good surveillance. But even though the United States has generally good reporting for surveillance, by studying our system you begin to see the cracks and problems and appreciate why surveillance information in developing countries is even more imperfect.
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