From surveys to surveillance

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Abstract
Surveillance of noncommunicable diseases (NCDs) has been neglected in modern epidemiology and public health. Silva et al. are to be congratu-lated for their willingness to work towards improving surveys as poten-tial tools for surveillance purposes, as evidenced by their article on this subject last month in this journal (1) and by their follow-up case study in this issue (2). Such efforts are crucial in the context of the emerging NCD disease burden in developing or newly industrialized countries, which will have significant social and economic consequences for governments and health systems. Preventive programs are needed to halt the rapid rise in risk factor levels responsible for increasing disease burdens. Such pre-ventive programs require information on the distribution of major risk factors in populations and regular, ongoing data collection to evaluate and refine interventions. Surveillance has been defined as the systematic collection, analy-sis, and interpretation of health data and the timely dissemination of such data to policymakers and others. While this definition has been modeled on the body of science related specifically to surveillance of infectious dis-eases, it is equally relevant to surveillance of NCDs. In particular, surveil-lance provides the knowledge to support health promotion and disease prevention, and it should take place in the context of efforts to improve population health. In contrast, surveys are often done only once, to determine the distri-bution of risk factors in a population at a point in time. In many developed countries, surveillance of major NCD risk factors is already quite advanced. Often an appropriate first step towards initiating surveillance is to conduct a baseline survey of sufficient sample size to have the power to detect mean-ingful changes over time. If well conducted, such a survey can provide im-portant information for determining priorities for intervention, and for raising public and political awareness of the extent of public health problems. Nonetheless, a baseline survey is only the first step in what ideally should be-come an ongoing surveillance system that builds on multiple sources of health information. The World Health Organization (WHO) is pursuing surveillance as part of a global strategy for preventing and controlling NCDs and the major risk factors that predict them. The WHO's "STEPwise" approach to surveil-lance for NCD risk factors is based on standardized data collection and a methodology that can be adapted to a variety of country settings. The STEP-wise approach encourages the development of an increasingly comprehensive surveillance system that meets local needs. Moreover, for sustainable surveil-lance, the STEPwise approach emphasizes small amounts of good quality data over large amounts of poor quality data.

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