THE ROLE OF SURVEILLANCE IN THE HIERARCHY OF PREVENTION

Surveillance is the collection, analysis, and dissemination of results for the purpose of prevention. Surveillance tells us what our problem s are, how big they are, where the solutions should be directed, how w ell (or poorly) our solutions have worked and if over time, there is i mprovement or deterioration. Surveillance is essential to successful s ustained public health intervention for the purposes of prevention. Su rveillance systems must be tailored to the specific disease or injury that is to be prevented. Surveillance should not be limited to the occ urrence of death, disease, or disability. Public health is a multileve l cascade of activities involving recognition, evaluation, and interve ntion Public health should include elements of experimentation as well as field implementation with evaluation. Surveillance is the mechanis m to modify any element in the cascade based upon that element's contr ibution to prevention or lack thereof. Any element in the causal or in tervention pathway is appropriate for surveillance as long as the moni toring of the element is useful in improving the prevention system. Th ese elements include the occurrence of hazard and intervention as well as disease, death, or disability. Examples will be provided that demo nstrate the roles of surveillance in the recognition of new diseases, the evaluation of the persistence of recognized problems, the estimati on of the magnitude and trends of public health problems, and the prov ision of information to motivate intervention. (C) 1996 Wiley-Liss, In c.