Researchers require data to make inferences about relationships between key variables (e.g., between race/ethnicity and treatment and outcomes). A key product of the proposed surveillance framework will be an increased ability to match research priorities to the needs of the population for health improvement.

Finally, a policy maker, such as a state or federal health officer, will seek perspective and support for public health programs and services, as well as new regulations or legislation based on demonstrated population needs, often involving multiple geographies. For example, a great deal of national, state, and local policy is based on national surveillance data on obesity, diet, and physical activity (including the impact of those health behaviors on obesity rates). First Lady Michelle Obama has led a national campaign to reduce obesity, encourage children and adults to eat more fresh produce, and increase physical activity. Her national campaign included highly visible public education events to promote home and community gardens, as well as efforts to mobilize voluntary health agencies and food manufacturing corporations to reduce the fat content and calories of their products. Public health leaders at the state and local levels have led similar public education and policy efforts as well as efforts to change food and beverage policies of school districts.

The types of information and level of detail required will vary among users of surveillance data. For example, physicians must apply available clinical guidance in the context of the individual needs of each patient. Such personalization may be best served by the ability to relate any patient to surveillance information collected and analyzed at a highly disaggregated level. Health system managers will typically need less granular information, although the degree to which surveillance information can be directly related to the population for which care is being provided will strongly influence its use. The researcher needs information on changing and contemporary trends in disease magnitude, management, predisposing factors, and acute and more long-term outcomes, including the utilization of healthcare services in order to identify topics worthy of further investigation for prioritizing research efforts, and also to generate hypothesis or to answer questions that may be addressed with surveillance data. Policy makers must balance multiple and often complex needs and perspectives, further testing the ability of surveillance systems to provide both applicable and actionable data. Data for policy development and advocacy must be relevant to the health issue that policy will target, the factors that are believed relevant to addressing the health issue, and the geographic location and demographic characteristics of the population involved.

These user examples (not an exhaustive list), the physician, the health systems manager, the researcher, the public health expert, and the policy maker may be found at the micro, meso, and macro levels (Table 6-1). Similar and often overlapping vertical hierarchies of role and professional decision-making data needs exist within other health-related perspectives, such as physician practice organization and governance, or among employer purchasers of health care. All these decision makers share the need for timely, relevant, and robust information about common populations of individuals, but they differ substantially in the granularity of their data needs and in how they process and leverage available data and information into action through the decisions they influence and control.

The different types of users of surveillance data access and use the data in different ways, as well as for different purposes. Researchers—whether they are clinical researchers or epidemiologists, behavioral scientists or health services researchers—are typically comfortable downloading micro data sets and analyzing them with appropriate data management and statistical software. Physicians and other clinicians benefit from the results of research studies that are transformed into guidelines by professional organizations and public agencies and then communicated widely to practitioners through peer-reviewed journals and other professional literature and conferences.

Policy makers and advocates as well as the news media similarly benefit from studies conducted with the data, using published findings to develop policies to address the health problem and the factors identified and supported by the studies. But policy audiences also benefit from being able to conduct descriptive analyses of the data to answer their own questions about an issue and to provide such descriptive evidence for the specific population—whether defined by demographic characteristics or geographic boundaries such as their district or county—for which they have some responsibility. Online data tools, such as CDC’s WONDER,1 which can be used to query many CDC data sources, and the California Health Interview Survey’s very user-friendly and flexible AskCHIS2 query tool, are valuable ways to provide access to surveillance data for policy audiences as well as for others.

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1 See http://wonder.cdc.gov (accessed August 2, 2011).

2 See http://www.chis.ucla.edu (accessed August 2, 2011).



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