REFLECTIONS ON SURVEILLANCE

John C. Bailar III, University of Chicago


John Bailar reflected on several surveillance-related issues. “Surveillance” is service to the individual—the one person who is standing or sitting in front of you at the time of a contact.” Surveillance includes medical examinations, laboratory tests, personal medical histories, discussions about existing problems, and developing knowledge related to the effects of oil spills, said Bailar. The assembly of all the information gathered from contacts draws a picture of what is happening across the community. Conversely, “research is the handmaiden of surveillance and directly supports surveillance activities” by supplementing and refining current understandings of potential adverse health effects and vulnerabilities, continued Bailar. For example, research can help detect new effects, improve knowledge about the frequency and seriousness of various health effects, and identify susceptible subpopulations such as pregnant women and elderly people.

Bailar opined that research should be a highly centralized effort so that the various data collected by separate groups can be brought together to “tell a convincing story.” For the Gulf oil disaster, he envisioned a single organization headed by a single person who has the responsibility and the authority to conduct the research operation. While he was hesitant to suggest who that organization might be, he mentioned CDC or perhaps a new organization created by the affected states’ health departments or a consortium of regional universities. Surveillance, by contrast, should be highly decentralized. Bailar opined that, while it may be difficult to combine these two different, highly centralized and highly decentralized systems, it will be necessary.

Bailar addressed the types of surveillance that should be undertaken. He stated that there are several different types of surveillance, from passive surveillance (waiting to hear from affected persons or their providers) to active surveillance (periodic efforts to contact persons on a list). He strongly recommended that active surveillance be conducted whenever possible. Bailar also said that there will be a need for clear, specific operational rules about who to include in the surveillance program (e.g., clean-up workers, other responders and occupationally exposed persons, National Guard troops, local fishermen and -women, community residents, families of occupationally exposed individuals). There will be a need to include as controls exposed individuals, as well as those with limited or perhaps no exposure.



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