Introduction

James W. Buehler, MD

Acting Director, Public Health Surveillance and Informatics Program Office (proposed)

Office of Surveillance, Epidemiology, and Laboratory Services, CDC

This MMWR supplement summarizes the deliberations of CDC/ATSDR scientists and managers who met in September 2009 in Atlanta as part of the 2009 Consultation on CDC/ATSDR's Vision for Public Health Surveillance in the 21st Century. The meeting was convened to reflect on domestic and global public health surveillance practice and to recommend a strategic framework to advance public health surveillance to meet continuing and new challenges. The first report is an adaptation of the keynote address for the meeting, which summarized the history of public health surveillance, the need to reassess its usefulness, the rationale for topics selected for discussion, and the charge to participants. Subsequent reports summarize the discussions of workgroups that addressed specific topics in surveillance science and practices.

Public health surveillance in the United States has evolved from monitoring infectious diseases to tracking the occurrence of many noninfectious conditions, such as injuries, birth defects, chronic conditions, mental illness, illicit drug use, environmental, and occupational exposures to health risks. In 2001, the intentional dissemination of Bacillus anthracis spores and subsequent cases of anthrax in the United States provided an impetus for automating surveillance to enable early detection, rapid characterization, and timely continuous monitoring of urgent public health threats.

As the topics of surveillance have evolved, so have the methods of surveillance, spurred by rapid advances in information technology. With the impending mass adoption of electronic health records, procedures for conducting surveillance are taking another turn, and new opportunities for strengthening surveillance capacities are emerging. Electronic health records offer an opportunity to improve links between health-care providers and public health departments, making surveillance more effective and timely, although fulfilling that promise poses substantial challenges.

Despite these changes in scope and methods, the fundamental premise of public health surveillance remains constant. It should provide information to the public health community regarding the health of the populations served. Stewards of public health surveillance have a responsibility to ensure that the information is used to advance public health and to safeguard the confidentiality of persons who are represented in the data.

To begin the process of assessing the state of public health surveillance, CDC/ATSDR leadership conducted a survey of the opinions of CDC/ATSDR scientists and managers. The survey responses identified six major concerns that must be addressed by the public health community to advance public health surveillance in the 21st century:

• Lexicon, definitions, and conceptual framework for public health surveillance;
• Global health surveillance;
• Roles of information sciences and technological advances in public health surveillance;
• Public health surveillance work force of the future;
• Accessing and using data for public health surveillance: legal, policy, ethical, regulatory, and practical concerns related to data sharing; and
• Analytical challenges for emerging public health surveillance.

Each CDC Center/Institute/Office (CIO) identified five public health surveillance scientists or senior scientists to participate in the meeting. Other participants included the planning committee members and invited workgroup leads, including representatives from the CDC's Surveillance Science Advisory Group (SurvSAG) — a CDC/ATSDR employee organization dedicated to advancing surveillance practice. Although representatives from organizations representing state and local health departments were invited as observers and reviewed drafts of the papers in this MMWR supplement, the meeting was intended to generate ideas from within CDC/ATSDR and to stimulate further discussion with partners. Participation in the meeting was constrained in part because it occurred during the midst of the fall 2009 upswing in cases of H1N1 pandemic influenza, and several persons from both CDC/ATSDR and health departments were unable to attend because of their involvement in the response to the pandemic. Altogether, approximately 100 surveillance specialists from across CDC/ATSDR participated in the one and a half day meeting. Participants were divided into six workgroups that were charged to describe challenges and opportunities for each of the topic areas identified above and to propose a vision for addressing those challenges and opportunities.

The 2009 meeting was planned and convened before the 2010 CDC/ATSDR reorganization created an office devoted to surveillance science and practice, the Public Health Surveillance Program Office, located within a new umbrella organization called the Office of Surveillance, Epidemiology, and Laboratory Services (OSELS). This program office has since been merged functionally with another program in OSELS focused on public health informatics to create the Public Health Surveillance and Informatics Program Office (proposed), reflecting the interdependence between surveillance and informatics. This new office provides the CDC/ATSDR nexus for addressing common concerns in surveillance and informatics. It manages three cross-cutting surveillance systems: BioSense, the Behavioral Risk Factor Surveillance System, and the National Notifiable Diseases Surveillance System. Beyond these systems, the majority of CDC/ATSDR surveillance systems are managed by programs across multiple CDC/ATSDR centers and offices and one institute.

In addition, the program office provides the focal point at CDC/ATSDR for addressing shared concerns in informatics, including those shaping surveillance practice, most notably opportunities arising for public health from Federal investments aimed at supporting the "meaningful use" of electronic health records to improve health care and population health.

The reports in this supplement arose from the 2009 meeting deliberations. While the reports do not reflect the insight and experience gained from surveillance practice since the 2009 meeting, the issues identified by the workshop remain relevant to surveillance practice. With the publication of this supplement, CDC/ATSDR will add to conversations about the future of public health surveillance.