The changing landscape of public health surveillance

Today, public health surveillance takes into account not just officially reported data and statistics, but also data collected from informal channels such as twitter, blogs, social networking sites, chat rooms and crowdsourcing platforms. Likewise, dissemination of outbreak data is now made through multiple channels.

To get a flavour of the changing landscape of international disease surveillance, visit the website of the International Conference on Digital Disease Detection, held in February 2012, at the Joseph B. Martin Conference Centre, Harvard Medical School, and access the archived presentations and panel discussions.  Scroll down the page and click on the adjacent graphic to explore the presentation topic or panel discussion  of interest, and discover the amazing research underway or locate tools to further explore ideas.

While there are many improvements to the way public health can be practiced within this new surveillance landscape: decreasing time between an outbreak and formal recognition of an outbreak, which allows a faster response to containing the outbreak, for example, there are also many challenges to managing, using, and making sense of the vast flows of data.  The presentations touch on techniques, analysis, applications and challenges. 

Patient-Centred Care

Among resources I consulted for a recent project on “Patient-Centred Care” was a policy paper by the Ontario Medical Association (OMA).  According to the OMA: “A patient-centred care system is one where patients can move freely along a care pathway without regard to which physician, other health-care provider, institution or community resource they need at that moment in time. The system is one that considers the individual needs of patients and treats them with respect and dignity”.  In many systems, it says in the review, the patient faces challenges of access to services, continuity in care, long waiting times, involvement in decision-making about their care, having to “adapt to the system and to navigate through its many intersections”. The problems identified relate to funding priorities, lack of sufficient integration and co-ordination of care, and policy and practices at the system and institutional level, and inadequate communication and shared-decision making between health care providers and patients.  Many practical and useful solutions are presented in the paper, which, as a researcher, patient and care advocate for elderly family members, I heartily endorse.

On March 5th, 2013, a few weeks ago, I attended a talk given by London, Ontario physician Dr. Ramona Coelho entitled "Suffering and Medicine".  She spoke of the need to go beyond solving medical problems, to helping patients cope with an unsettling diagnosis or an incurable illness through acknowledging accompanying fears, validating feelings, and providing a sympathetic ear.  In focussing on suffering rather than on medical problems, her discussion focussed squarely on the patient. This, I thought, is what patient-centred care is all about.  Evidence based care, though highly effective for solving medical problems, is surely less than effective if applied without a sympathetic and empathetic approach to understanding the patient's feelings of inadequacy, fears of not being in control, financial worries, depression, loneliness, anger and many conflicting emotions that in themselves can negatively affect health outcomes.  One may worry that this approach requires doctors to spend a bit more time in consultation, but ultimately, if it helps patients understand and better manage their own care, it should result in a lower burden of care within the health system.