Occupational sentinel health events: an up-dated list for physician recognition and public health surveillance

An occupational sentinel health event (SHE[O]) is a disease, disability, or untimely death, which is occupationally related and whose occurrence may: 1) provide the impetus for epidemiologic or industrial hygiene studies; or 2) serve as a warning signal that materials substitution, engineering control, personal protection, or medical care may be required. Following survey of scientific literature, a list of 50 disease conditions linked to the workplace was presented in 1983; these were codable within the framework of the International Classification of Diseases system (ICD-9). Three criteria were used for inclusion: documentation of associated agent(s), of involved industries, and of involved occupations. The up-dated list contains 64 diseases or conditions and a bibliography of literature citations. The list is useful for the practicing physician in occupational disease recognition, for occupational morbidity and mortality surveillance, and as a periodically up-dated database of occupationally related diseases.     

Epidemiological surveillance: a management tool for occupational health

Epidemiological surveillance represents a practical and intuitive approach to preventing occupational disease and injury, yet it is underutilized in health care management. Through the systematic analysis of employee occupational health data, the epidemiological surveillance approach allows prompt identification of potential workplace hazards, identifies high-risk groups for targeting preventive efforts and provides a mechanism for evaluating interventions. Often, epidemiological surveillance can utilize existing data resources, making it a cost-effective tool. Epidemiological surveillance should be valuable in supporting management decisions relating to health promotion and disease prevention programs, as well as basic clinical needs of employees.     

Health for all: a public health vision.

The approach of a millennial passage invites public health to a review of past performance and a preview of future prospects toward assuring a healthy public. Since the 1974 Canadian Lalonde report, the best national plans for health progress have emphasized disease prevention and health promotion. WHO's multinational Health for All by the Year 2000 promotes basic health services essential to leading a socially and economically productive life. Healthy People 2000, the latest US guide, establishes three goals: increase healthy life span, reduce health disparities, and achieve universal access to preventive services. Its objectives can be used to excite public understanding, equip program development, evaluate progress, and encourage public accountability for health initiatives. Needed is federal leadership in defining requisite action and securing necessary resources. Elsewhere a "new public health" emphasizes community life-style and multisectoral "healthy public policy." In the United States, a national health program is needed to achieve equity in access to personal health care. Even more essential is equitable sharing in basic health determinants in society--nutritious food, basic education, safe water, decent housing, secure employment, adequate income, and peace. Vital to such a future is able and active leadership now from governments and public health professionals.     

The new International Health Regulations: considerations for global public health surveillance

Global public health surveillance is critical for the identification and prevention of emerging and reemerging infectious diseases. The World Health Organization recently released revised International Health Regulations (IHR) that serve as global legislation and provide guidelines for surveillance systems. The IHR aim to identify and prevent spread of these infectious diseases; however, there are some practical challenges that limit the usability of these regulations. IHR requires Member States to build necessary infrastructure for global surveillance, which may not be possible in underdeveloped countries. A large degree of freedom is given to each individual government and therefore different levels of reporting are common, with substantial emphasis on passive reporting. The IHR need to be enforceable and enforced without impinging on government autonomy or human rights. Unstable governments and developing countries require increased assistance in setting up and maintaining surveillance systems. This article addresses some challenges and potential solutions to the ability of national governments to adhere to the global health surveillance requirements detailed in the IHR. The authors review some practical challenges such as inadequate surveillance and reporting infrastructure, and legal enforcement and maintenance of individual human rights.     

Sentinel areas: a monitoring strategy in public health

Available techniques for monitoring the health situation have proven insufficient, thus leading to a discussion of the need for their improvement based on new data collection strategies allowing for data use by local health systems. This article presents the methodological basis for a strategy to monitor health problems utilizing demarcated intra-urban spaces called "sentinel areas" to collect fundamental social, economic, behavioral, and biological data for public health that allow for a closer approach to the reality of complex social spaces. The authors present an experience that is being developed in Salvador, Bahia, Brazil, to evaluate the epidemiological impact of an environmental sanitation program. They discuss selection criteria for the areas and the potential uses of this strategy allowing for the rapid utilization of epidemiological resources by health services and the timely application of the results to reorient and enhance health intervention practices.     

The public health dashboard: a surveillance model for bioterrorism preparedness.

The City of Milwaukee Health Department piloted a short-term, near real-time syndromic surveillance and communication tool by using an existing secure regional Internet infrastructure. Voluntary, active syndromic case reporting by hospital Emergency Departments was combined with other data streams, including clinical laboratory reports of communicable disease, hospital emergency room diversions, ambulance runs, medical examiner reports of unusual or suspicious deaths, poison control and nursing hotline call volumes, and pharmacy over-the-counter sales. These data were aggregated into a "Surveillance Dashboard" format that was used to communicate community syndromic health trends to hospitals, Emergency Departments, and other providers using a secure Internet technology. Emergency Departments at 8 area hospitals reported a total of 314 cases meeting syndromic criteria from 26,888 patient encounters. Participants were satisfied with data entry and communications. All participating Emergency Departments received e-mail and text pager alerts sent by the Milwaukee Health Department. No unexplained findings or suggestions of an early outbreak were reported through syndrome surveillance for the 4-week duration of the project. Similar surveillance and communications systems could provide multiple benefits to Emergency Department workflow and management, as well as to public health and emergency response.     

Health and productivity: a role for occupational health professionals

The impressive economic gains achieved by many nations within the past decade have been attributed primarily to improvements in productivity from technological changes. The resultant low unemployment levels, however, emphasize the importance of human capital in the success of any enterprise. Concurrently, some economists have proposed an alternative economic view regarding the relationship between health and income, postulating that improvements in the health of the nation's population have a substantial effect on its economic viability. Such a view directly pertains to occupational health professionals, who are often charged with promoting the health of the worker. Although studies relating the beneficial impact of occupational health on productivity and human performance are limited, some efforts have shown impressive effects, as measured primarily by reduced absenteeism. The prompt, assertive management of occupational injuries and illnesses and their treatment have been well documented. Illnesses not considered traditional occupational ailments, such as migraine headaches, allergic disorders, infectious diseases, and depression, offer opportunities for occupational health professionals to ensure an accurate diagnosis and proper treatment for minimizing the impact on work performance. Considerable opportunities exist for occupational health professionals to demonstrate the importance of certain services to productivity.     

The public health physician and the provider.

A core strength of public health physicians is the ability to bring their skills to the integration of primary care, hospital medicine and local authority public health services. The current move towards a 'purchaser/provider split' is potentially damaging to this.     

Service-oriented training in public health: a model for enhancing public health surveillance in the Pacific

There is a need for a coordinated, sustainable, in-service, training programme in surveillance and other public health activities. This should be available for all levels of health personal throughout the Pacific. The model advocates continuing education and in-service training that immediately and directly enhances surveillance. Specific educational objectives for surveillance should be based on the needs of the work environment while the graduate degree training should include broader objectives integrated with established public health training courses. It is suggested that the Secretariat of the Pacific community (SPC) should provide the leadership by establishing a Centre for Coordinating Service-oriented Training in Surveillance and invite the University of PNG and the Fiji School of Medicine to incorporate training modules in surveillance into their degree programmes. Field support should be provided through the senior public health practitioners based in public health units and in health agencies throughout the region.     

Prioritization of occupational sentinel health events for workplace health and hazard surveillance: the Pan American Health Organization experience

Within the ongoing strategy of the Workers' Health program at the Pan American Health Organization on strengthening surveillance in the field of workers' health in the Americas (the Region), a project was conducted in July 1999 in Washington, D.C. The objectives of the project were to discuss the problems found in the surveillance of workers' health, to develop a methodology and use it to prioritize and select the top three occupational sentinel health events for incorporation into the surveillance systems in the Region, and to develop the initial protocols for establishing the surveillance systems for the three chosen occupational sentinel health events. The Pan American Health Organization invited 24 occupational health experts from the Region to participate in the project. Over an intensive 3-day period, the experts heard reports of workplace surveillance activities in the various countries in the Region; developed prioritization methods; identified and prioritized a list of occupational sentinel health events; and developed three surveillance protocols, one each for occupational fatal injuries, pesticide poisoning, and low back pain. The results on the prioritization of occupational sentinel health events and the development of surveillance protocols are reported in this article.     

Improving and integrating data systems for public health surveillance.

The National Center for Health Statistics (NCHS) is the nation's principal health statistics agency, with a primary mission to collect, disseminate, and analyze health data. NCHS has a clear commitment to a wide range of improvements in surveillance and public health information systems. Building on its long history of conducting multipurpose surveys where the needs and interests of a variety of programmatic interests have to be accommodated, NCHS is working on a number of fronts to improve and better integrate data systems so that they will be more useful for public health surveillance. Examples include the redesign of the National Health Interview Survey, the integration of the Department of Health and Human Services' health surveys, the retooling of the vital statistics system, and the movement to subnational data collection.     

Integrating public health information and surveillance systems.

The Centers for Disease Control and Prevention (CDC) recognizes sound public health information is the essential ingredient of all of its work and the key to effective public health decision making. A CDC/ATSDR committee reached a consensus that CDC needed to streamline and consolidate its public health surveillance and information systems into an integrated system. With integrated systems, a wide range of diverse individual information systems will continue to exist but these systems must be coordinated, interconnected, comparable, and easy to use. The "glue" that holds these systems together consists of (1) uniform data standards, (2) communications networks, and (3) policy-level agreements regarding data access, sharing, and reduction of data collection burdens. By putting the appropriate policy-making apparatus and resources in place, CDC believes the end result will be a streamlined process that meets the information needs of CDC and its partners with less confusion and frustration.