McNabb BMC Public Health 2010, 10(Suppl 1):S3 http://www.biomedcentral.com/1471-2458/10/S1/S3 completeness), many more resources and focused eﬀort is required to fulﬁll this dream that eludes even some of the more advanced and wealthy countries. New movements have now come to the fore to expedite tomorrow’s digital, paperless public health surveillance workplace and promote comprehensive surveillance. There is strategic merit in conceiving a vision of the end state for comprehensive, global, multiple-hazard public health surveillance; one that acknowledges the challenges and identiﬁes steps to overcome them. We propose here a perspective for comprehensive, eﬀective and eﬃcient global, multiple-hazard public health surveillance and describe a way forward to achieve it. Global movements Three important movements now set the stage to achieve comprehensive, eﬀective and eﬃcient global, multiple- hazard public health surveillance: 1. The adoption of the revised International Health Regulations [IHR(2005)] by all World Health Organi- zation (WHO) Member States, which includes national obligations to achieve a set of core surveillance and response capacities to prevent the international spread of disease [6]; 2. The maturation of information sciences (e.g., public health informatics [PHI]) capabilities and the remarkable penetration of information technologies (IT) to the most distant parts of the globe [7]; and 3. A consensus that both the security and public health communities have overlapping interests and mutual beneﬁts to collaborate in supporting the development of essential public health functions, especially public health surveillance [8]. These movements oﬀer the practical opportunity to empower, enhance, and enjoin global public health surveillance, as never before. Movement 1 – Adoption of IHR(2005) The IHR(2005) constitutes the WHO’s legal and opera- tional framework for activities around prevention and control of the international spread of disease, regardless of origin or intent (e.g., chemical and radio-nuclear sources, as well as biological). The adoption of IHR(2005) by WHO Member States challenges them in a new and urgent way to assess and strengthen core surveillance capacities [9]. This agreement also provides the policy context to uniformly assess these capacities [10]. Movement 2 – The rise of public health informatics (PHI) Information sciences and IT both used in a public health setting (i.e., public health informatics) are a means to an end; the end being the achievement of eﬀective and eﬃcient public health surveillance. Concerned with eﬀective and eﬃcient collection, collation, transmission, Page 2 of 7 analyses, visualization, storage, and retrieval of electronic data, the scientiﬁc discipline of PHI has emerged to leverage the inherent merits found in IT and computer science technology. But this merger yields more than the sum of its individual parts—it has the potential to enhance the transformation to a 21st century global public health surveillance digital (paperless) workplace. By identifying and deﬁning standards and making them easier to apply, PHI adds value to eﬀorts already performed by public health practitioners at all health levels. This added value derives from the inherent ability of PHI to facilitate digital communication in a more robust, eﬃcient, and standards-based manner. Over the past ten years, many public health processes have been improved by PHI solutions [11]. These improved processes include the increased quantity and timeliness of mandatory case reporting; decreased data- entry burden on public health programs; provision of tools needed for emergency preparedness (e.g., rapid awareness of new cases, linkages to automatic alerting systems for public health personnel); and management support necessary during outbreak situations [12]. PHI also oﬀers paper-to-digital conversion techniques and tools that empower and enable epidemiologists and surveillance practitioners to work better, faster, and cheaper [13] by providing health information, including any information about individuals demonstrated to be related to health (e.g., medical records, laboratory reports, behavioral risk factors, medical examiner and vital records, school records) that is more complete, speciﬁc, and timely [14-16]. Movement 3 – Alignment of security and public health The third movement aligns the overlapping, mutual interests of the security and public health communities around the domain of public health surveillance. It forces policy discussion, increases focus, as well as provides sources to drive progress. The WHO’s 2007 World Health Report, “A safer future: global public health in the 21st century”, addresses the interface of health and security [17]. The following points are noted in the foreword: “Given today’s universal vulnerability to [internationally signiﬁcant health and security] threats, better security calls for global solidarity… as the determinant and conse- quences of health emergencies have become broader, so has the range of players with a stake in the security agenda … successful implementation of the IHR(2005) serves the interests of politicians and business leaders as well as the health, trade and tourism sectors.” Additionally, World Health Assembly Resolutions 54.14 and 55.16, respectively, requested the WHO to “provide technical support to Member States for develop- ing intervention programmes that prevent epidemics and respond to communicable disease threats and