Dr. David Mowat June 22, 2005 Federal, Provincial & Local Roles Surveillance 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

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

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.”