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This chapter sets the stage for the first half of the book, the principles section. It outlines possible objectives of a system, followed by key steps in system development, data collection, data management, analyzing and interpreting data, disseminating and communicating information, and evaluating the surveillance system. Each step requires attention to a number of important details, which are introduced and addressed in detail throughout the first section of the book. Application of the principles is illustrated through an example using the National Notifiable Diseases Surveillance System in the United States.

This chapter describes two types of data collection that are critical for monitoring the population's health and generating health statistics: notifications and registrations. Notifications are reports of one or more health-related events that typically require close monitoring by health or other agencies to ensure that they are controlled and do not spread to, or adversely affect, others. Registrations are similar to notifications in that a specific event is the subject of a registration system, but the registration of events is not usually for the immediate control of a specific health problem or hazardous condition. Rather, it is for documenting and tracking events or persons for administrative, legal (e.g., registration of births and marriages), scientific (e.g., to facilitate the identification of a cohort exposed to a hazardous substance for future study), or statistical purposes. The first part of the chapter provides a brief overview of notifications and a detailed description of one notification system—the U.S. National Notifiable Disease Surveillance System—to illustrate the history, practice, and uses of one important example of these systems. The second part of the chapter provides a brief overview of registration systems and then presents detailed descriptions of two registration systems—the U.S. national vital statistics system and the U.S. system of cancer registries—to illustrate the history, practice, and use of registration systems.

This chapter deals with the development and use of statistical methods for geographic disease surveillance. The second section discusses some ideas that are commonly used in statistical process control (SPC) and considers their relevance to disease surveillance. The third section addresses the three areas to which the study of the distribution of disease can be applied: disease mapping, disease clustering, and ecological analysis. The fourth section presents models for spatial surveillance of disease maps and considers disease clustering. The fifth section describes monitoring in a fixed time period and in an evolving time frame. The sixth section reviews disease surveillance modeling and presents a simple example of a spatial temporal disease map analysis. Finally the software available for spatial temporal map surveillance is described.

This chapter considers the effect of the incubation period of disease on temporal patterns in disease surveillance, focusing on three diseases with widely differing incubation periods: HIV/AIDS, bovine spongiform encephalopathy, and anthrax. It identifies some factors that can affect time trends in surveillance data. It describes quantitative methods of monitoring common source and continuous exposure epidemics, and presents simple mathematical models for describing the transmission of diseases that are spread from person to person.

‘Infectious Disease Control’ examines the historical development of approaches to the geographical control, elimination, and eradication of infectious diseases. It begins at a local spatial scale, seven centuries ago, among the plague-ridden lazarettos of Venice. It ends at the global scale with twenty-first-century developments in the Internet-based monitoring and surveillance of infectious diseases. Basic spatial strategies for the control of infectious diseases (defensive isolation and offensive containment) are outlined, their historical development and application in the form of such measures as cordons sanitaires, isolation, and quarantine are reviewed, and their present-day forms highlighted. Vaccines and vaccination are reviewed as a second approach to disease control, alongside initiatives for the global eradication of infectious diseases such as smallpox and poliomyelitis. Disease surveillance continues to form a cornerstone of spatially focused control activities and, so, the chapter ends with a review of the evolution of disease intelligence systems down the centuries.

This chapter examines a diverse set of literatures from behavioral economics and global health to see what changes have taken place in foundational agreements about policy regarding the poor. Since disease surveillance has appeared as a major concern in global health, the impetus toward generation of data on global disease prevalence through statistical models has gained considerable prominence. The hope is for rational decision making through which global interventions can be made in setting priorities for different countries. The chapter explores how health is imagined in the context of ambitions for standardized ways of tackling the health problems of low-income countries through global programming. It considers how the emergence of ideas of global public goods, demands for greater precision in measuring outcomes of health interventions, and the pressures for standardization has changed what is regarded as “common sense” about the behavior of the poor. It also looks at theories embedded in the everyday experiences of patients and healers, and how they might be made to speak critically to the expert discourses of global health.

This chapter examines the role of maps as graphic propaganda for public health: from John Snow’s map of the infamous Broad (now Broadwick) Street pump in London’s Soho, first created during the cholera epidemic of 1854, to epidemiological maps used by government agencies in the early twenty-first century. It argues that Snow’s map was largely buried in the epidemiological literature until the 1930s when Johns Hopkins University epidemiologist Wade Hampton Frost touted it as a prototype of bacteriological thinking as well as an emblem of medical geography. It considers the dual role of maps ostensibly intended to describe public health facilities or summarize programs of disease surveillance. It also suggests that maps are inherently more effective, if not more common, as persuasive graphics than as research tools. Indeed, any graphic that attracts viewers’ attention to a threat or campaign is propaganda insofar as it contributes to heightened concern or increased resolve.

Multinational collaborations on international outbreak investigations and response have a long history. Development of the World Health Organization (WHO) in 1948 was closely linked to efforts by the global community to prevent, detect, and respond to outbreaks of international concern. Through the International Health Regulations (IHR) of 2005, a legally binding instrument requiring countries to report certain outbreaks and public health events, WHO outlined a strategy for disease threat response. Efforts by global partners to strengthen cooperation have evolved over the years, including roles and responsibilities of WHO, its Member States, and other partners. Among the challenges faced by Member State and WHO in implementing the IHRs are limited funding to support staffing and operational support as well as sometimes conflicting multijurisdictional decision-making. The response to recent outbreaks provides evidence that much work remains to be done to strengthen IHR mechanisms.

Quality data are necessary to make good decisions in health delivery for both individuals and populations. Data can be used to improve care and achieve equity. However, systems for health data management were historically weak in most impoverished countries. Health data are not uncommonly compiled in stacks of poorly organized paper records. Efforts to streamline and improve health information discussed in this chapter include patient-held booklets, demographic health surveys, and the use of common indicators. This chapter also focuses on the evolution of medical records, including electronic systems. The use of data for monitoring, evaluation, and quality improvement is explained. Finally, this chapter reviews the use of frameworks—such as logic models and log frames—for program planning, evaluation, and improvement.

This concluding chapter explores what the future holds for emerging viruses. Clearly, emerging viruses are on the rise, so we urgently need to find out why they are emerging so frequently and how to stop them. We know that they are generally zoonotic, having jumped to us from an animal source. Broadly speaking, the reason for the rise in these spillover events and subsequent spread is twofold: human population growth and increased international travel. The World Health Organization (WHO) regularly publishes a list of potential emerging diseases investigation into which requires urgent research and development. Presently this includes COVID-19, Ebola and related Marburg virus diseases, Lassa fever, MERS, SARS, Nipah and related henipaviral diseases, Rift Valley fever, Crimean–Congo haemorrhagic fever, Zika, and Disease X (the latter meaning a hitherto unknown disease). But while most would agree that it is sensible to encourage research into these potential epidemic viruses, the most likely candidate to cause the next epidemic or pandemic is Virus X—a ‘new’ virus causing Disease X. The chapter then briefly mentions the founding of the Global Alliance Vaccine Initiative (GAVI) and the Coalition for Epidemic Preparedness Innovations (CEPI), both of which aim to prepare vaccines against emerging infections and to enable equitable access to them.

In chapter 1, Anthony S. Fauci, Director of the National Institute for Allergy and Infectious Diseases, US National Institutes of Health, provides an overview of the complex challenges that led the Ebola outbreak to go relatively undetected and, even after it was better understood, to cause problems for the global response. He attributes the rapid spread of the disease to a “perfect storm” of converging and compounding factors: poor countries with histories of conflict, political unrest, and resultant mistrust of government; densely populated cities; severely limited healthcare infrastructure; and long-standing cultural practices that enhanced the potential for contact with infectious bodily fluids. The chapter then assesses the factors facilitating the spread of Ebola from Guinea to Liberia and Sierra Leone, and then elsewhere. The chapter concludes by analyzing the lessons the outbreak teaches about management of the inevitable future emergences of infectious diseases.

Climate change will introduce new stresses to human health, and not only from the geographical expansion of vector-borne diseases. Because climate change affects basic elements central to human survival—air, food, and water—more people in more places will face public health threats. Despite the clear and present danger climate change poses to public health, the efforts of the medical profession and public health authorities to date have not matched the urgency of the problem and remain too reactive. This chapter focuses on a relatively narrow but important element of the response—the reliability and effectiveness of the systems for delivering medical services. Communities, governments, and global institutions must develop ways to provide health care in a changing climate. It will be important to harden the infrastructure supporting the health care system so it can withstand climate impacts and still deliver services. Health care systems must also be made smarter, which means training health care providers about climate-exacerbated conditions, putting in place predictive and early-warning systems, and finding more effective ways to protect and attend to the most vulnerable people.