What is health surveillance and health intelligence?
Health surveillance and health intelligence are critical components of modern health systems, but they are particularly useful in bioterrorism and biosecurity.
Health surveillance refers to the deliberate process of collecting epidemiological and other data of relevance from health systems, populations, media and various other informal sources. Health intelligence is the interpretation, analysis, processing and generation of useful products that assist individuals such as public health practitioners, clinicians, responders, decision and policy makers and wider stakeholders in making sense of a health surveillance data, and using it to better achieve goals.
Health surveillance is conducted in a systematic way, according to a well-defined plan linked with a clear need to collect the data in question. It can rely on automated systems for data collection, or be reliant on meticulous collection by individuals and involve significant expenditure of resources.
Traditional data-points collected by health surveillance activities are:
- The number of cases of disease meeting a diagnostic case definition
- The number of individuals who have received certain interventions
- The types and numbers of health resources being utilised, including their depletion
- The occurrence of various sentinel or critical clinical events
- The occurrence of certain clinical complications
- The number of, and details of, deaths related to a particular disease
- The time course and geographic distribution of collected data
For example syndromic surveillance is a form of health surveillance that uses loose case definitions of disease – such as upper-respiratory tract symptoms occurring with fever and other signs – to identify cases of concern or interest.
Health intelligence uses health surveillance data to add value and meaning. Health intelligence, like any other intelligence product, is developed through a systematic process that involves cyclic review of critical information rather than the production of “one off” or standalone pieces of information. This process is called the intelligence cycle.
The key steps of the intelligence cycle are:
- 1. Planning and direction
- 2. Collection
- 3. Processing
- 4. Analysis and production
- 5. Dissemination
While collection of health surveillance data generally involves the combined work of many hundreds and potentially thousands of individuals, the generation of health intelligence product is usually conducted by a smaller group of subject matter experts. This allows individuals with specialised knowledge to make a determination on the quality, veracity and certainty of the health surveillance information.
Processing and analysis of health surveillance data is a specialised task undertaken across a wide range of organisations. Health intelligence activities in a military organisation may, for example, be focussed on the assessment of the risks to deploying personnel to a remote or tropical location. Health intelligence activities in a major corporation may develop and use health intelligence products to assist in planning and building a major risk facility such as a power station, chemical plant or mine. Health intelligence activities in a state health department may be focussed on assessing the emergence of epidemic diseases, unusual diseases and the day to day operation of a health system. Health intelligence experts, depending on the roles they are undertaking, develop specific expertise in specialised areas as outlined in the examples above and work closely with decision and policy makers to continuously redesign and refine the health surveillance and intelligence structure to improve operation.
Dissemination of health surveillance and health intelligence product is the final but essential component of the health intelligence cycle. Communication of health intelligence product is at times challenging. Certain organisations – such as state or federal health departments – are mandated to collect, process and analyse health information as a part of their support to a population. Communicating unexpected or difficult information to leaders and decision makers is a specialised and important skill, particularly where uncertainties, unknowns and data gaps exist. In communicating health intelligence information to decision makers, the analyst must balance the need to remain impartial and unbiased, with an occasional need to underline the significance of important findings. Triggers for further action – such as a detailed review, or further investigation - are often incorporated into the health intelligence cycle during the initial planning and review phases.
Health surveillance and health intelligence are systematic activities that are an essential component of the wider health systems in place to manage public health. They are particularly important in bioterrorism and biosecurity where they are essential components of early warning systems to correctly identify high risk biological events at a point in time where intervention will be effective and harm minimised.
After reading this article, discuss your answer to the following question in the comments section below:
Review some of the health intelligence resources available to public health clinicians online and provided here in the related links section.
What do you think some of the difficulties might be in detecting bioterrorism and biosafety events using health intelligence systems?
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