Dr. David MowatJune 22, 2005

Federal, Provincial & Local RolesFederal, Provincial & Local RolesSurveillance of Risk Factors and Determinants of Chronic DiseasesSurveillance of Risk Factors and Determinants of Chronic Diseases

• surveillance in theory

• the Task Group– context– work– recommendations– next steps

• P/T and local roles

Health Surveillance

• The tracking and forecasting of any health event or health determinant

• through the continuous collection of high-quality data,

• the integration, analysis and interpretation of those data into surveillance products (such as reports, advisories, warnings)

• and the dissemination of those surveillance products to those who need to know.

• Surveillance products are produced for a specific public health purpose or policy objective.

Surveillance is not:– research– evaluation

Principles

• Surveillance is a foundation for essential public health functions

• National, P/T and regional/local levels must work together – National surveillance depends upon local capacity

• Should take place within an integrated chronic disease approach

• Influence of factors at the community level

Uses of Surveillance

• monitor trends & geographic variation• improve understanding and facilitating research• identifying outbreaks, clusters and emerging

issues• planning programs and policies• identifying areas and groups needing service• helping with evaluation• motivating for action• accountability

HEALTH

OUTCOMES

KnowledgeSynthesis

andDecisionMaking

Actionslegislationprograms

interventionspolicy

Legislation & Regulation

Coordination

Management

Inputs Outputs

Information Management

REQUIREMENTS

Health Surveillance

SurveillanceProducts &

Dissemination

Analysis &Interpretation

Integration

Data Collection

Basic Research

Public, Professional &

Stakeholder Input

Applied Research &

Epidemiological Studies

Other Considerations

Social &Economic

Considerations

Figure 1 Contribution of Health Surveillance to Evidence-based Decision Making

Desirable Characteristics of Surveillance Systems

• acceptability

• simplicity

• flexibility

• validity

• sensitivity and specificity

• representiveness

• timeliness

• stability

• compliance

System Performance Characteristics

• effectiveness

• efficiency

• usefulness

Data Sources

• Administrative

• Clinical

• Special purpose– surveys– sentinel systems– research studies

• Pre-contact/syndromic

• Intelligence

Data Collection Strategies

• Collect once, use many times

• legal requirements

• provide tools

• “transactional”

• return results

Data Access

• privacy and other legal issues– lack of agreements

• academic interests

Surveys – Issues

• sample size

• quality control

• environmental measures

• respondent fatigue

• continuity

Other Data Issues

• representativeness

• standardization

• metadata

• Coronary heart disease

• Stroke• Peripheral vascular

disease• Several cancers• COPD/emphysema

EndpointsIntermediateRisk Factors

•Hypertension

•Blood lipids

•Obesity / Overweight

• Diabetes

• Tobacco• Diet • Alcohol• Physical Activity

BehaviouralRisk Factors

Non-modifiableRisk Factors

•Age•Sex

•Genes

Socio-economic, Cultural & EnvironmentalConditions

Figure 4 Example of Major Selected Non-Communicable Disease (NCD) Risk Factors and Determinants

Source: World Health Organization (WHO)

Context

• Enhancing surveillance of chronic diseases – a priority

• health goal with objectives and targets.

• reporting on the health of Canadians.

• Pan-Canadian initiatives such as Healthy Living and Diabetes

• Public health units and community coalitions

Context (2)

• Naylor and Kirby Reports

• CDMH– STFPH Pan-Canadian Public Health

Network– SPHSITG– PHHRJTG– SSCDRFTG

Mandate of Task Group

To develop a strategy to strengthen Canada’s capacity at all levels to coordinate and conduct surveillance for chronic disease risk factors and determinants to support evidence-based decision-making and monitor progress for initiatives such as the pan-Canadian Healthy Living Strategy.

Methodology

• Review of previous FPT reports

• Review of literature

• Survey of innovative practices

• Commissioned papers

• Cross-Canada consultation

• Meetings with innovative programs

• Presentation at CDPAC

Strengths (Varies across country)• Surveillance recognized as a core public health function• Components for effective surveillance• Key indicators being developed• On-going population-based databases • Administrative databases• Regional Health Survey (NAHO)• Staff training and development • Dissemination approaches• Surveillance used to shape policies• Standards • Data across sectors• Resource function

Weaknesses (varies across country)

• Staff, knowledge, skills and resources • Inadequate surveillance planning with links to

program needs• Major gaps in data – type and for all levels• Analytical and interpretation capacity • Inadequate use of surveillance in policy and

program decision-making• Gaps in overall coordination • Lack of comprehensive Aboriginal People

surveillance

Vision

Canadians have reduced burden of chronic disease as a result of changes in policy, programs and services based on timely surveillance.

Goal

To improve capacity in Canada for surveillance of chronic disease risk factors and determinants.

Outcomes

• Public health organizations conduct surveillance using data from existing population databases, and use the information in decision-making.

• Public health organizations have access to surveillance data collection systems that are timely, rapid and flexible to meet their information needs, and use this information in decision-making.

• Administrative and clinical databases are used effectively for surveillance purposes.

Outcomes (continued)

• Data users and data owners from health and other related sectors, such as recreation, education, transportation and social services, work collaboratively to increase data availability and its use for chronic disease risk factor and determinants surveillance.

• The public health environment encourages the use of surveillance information in decision-making.

• Coordination of surveillance supports public health organizations surveillance activity.

Recommendations• #1 Enhance Federal, P/T and local/regional

capacity to analyse, interpret and use surveillance data.

• #2 Expand data sources to fill gaps in knowledge.

• #3 Enhance collaboration, planning and evaluation among all stakeholders.

• #4 Build capacity across jurisdictions for congruent public health legislation supportive of chronic disease surveillance.

Data Access, Analysis & Interpretation

• published data tables

• free access to date

• interactive data tables

• web-based data dissemination

• public health observatories

• tools

• portal

#1 Enhance Federal, P/T and local/regional capacity to analyse, interpret and use surveillance data.

• Surveillance planning linked to programs.

• Central coordinating function for resources.

• Access to existing surveys and databases.

• E-learning, conferences, and workshops

• Public health human resource strategy

#2 Expand data sources to fill gaps in data.

– Establish local/regionally coordinated on-going flexible data collection systems.

– Build on existing data sources to fill gaps in data.• Monitoring of physical activity

• Student-based school surveys and other setting-based tools and methods.

• Physical Measures Survey.

• Databases from other sectors and settings

• Health administrative databases

• Electronic health records

• Primary care research networks

• Data collection systems for Aboriginal Peoples

#3 Enhance collaboration, planning and evaluation among all the stakeholders.

• Pan-Canadian Issue Group for Surveillance of Chronic Disease within the Pan-Canadian Public Health Network linked to the Surveillance and Chronic Disease Expert Groups

• Coordinating function - PHAC

Stakeholders

• federal government

• database managers

• NGOs

• universities and research bodies

• P/T governments

• regional/local health agencies

Coordination

• establish common orientations & priorities

• facilitate development of, and success to, data

• develop common tools, methods and standards

• improve capacity

• obtain specialized support

#4 Support the public health mandate for surveillance through legislation.

– Model public health legislation– Jurisdictions to consider the model legislation

when reviewing and revising their health legislation.

– Creation of a centre of expertise in public health law within the Public Health Agency of Canada, and a national interest group in public health law linked to the Public Health.

Provincial/Territorial Role

• coordination

• legislation and agreements

• support regional/local public health

• contribute data to national surveillance

• participate in national surveys

• analyse and interpret data, disseminate, use in decision-making

Local/Regional Role

• analyse and interpret regional/local data, disseminate and use in decision-making

• contribute data to P/T government surveillance

• collect data

“The most serious gap in dissemination of surveillance information is its lack of use in policy and program decision-making.”