BMC Public Health Open Access McNabb and Chungong BMC Public Health 2010, 10(Suppl 1):S3 http://www.biomedcentral.com/1471-2458/10/S1/S3 R E V I E W Scott JN McNabb* Abstract Comprehensive effective and efficient global public health surveillance At a crossroads, global public health surveillance exists in a fragmented state. Slow to detect, register, confirm, and analyze cases of public health significance, provide feedback, and communicate timely and useful information to stakeholders, global surveillance is neither maximally effective nor optimally efficient. Stakeholders lack a global surveillance consensus policy and strategy; officials face inadequate training and scarce resources. Three movements now set the stage for transformation of surveillance: 1) adoption by Member States of the World Health Organization (WHO) of the revised International Health Regulations (IHR[2005]); 2) maturation of information sciences and the penetration of information technologies to distal parts of the globe; and 3) consensus that the security and public health communities have overlapping interests and a mutual benefit in supporting public health functions. For these to enhance surveillance competencies, eight prerequisites should be in place: politics, policies, priorities, perspectives, procedures, practices, preparation, and payers. To achieve comprehensive, global surveillance, disparities in technical, logistic, governance, and financial capacities must be addressed. Challenges to closing these gaps include the lack of trust and transparency; perceived benefit at various levels; global governance to address data power and control; and specified financial support from global partners. We propose an end-state perspective for comprehensive, effective and efficient global, multiple-hazard public health surveillance and describe a way forward to achieve it. This end-state is universal, global access to interoperable public health information when it’s needed, where it’s needed. This vision mitigates the tension between two fundamental human rights: first, the right to privacy, confidentiality, and security of personal health information combined with the right of sovereign, national entities to the ownership and stewardship of public health information; and second, the right of individuals to access real-time public health information that might impact their lives. The vision can be accomplished through an interoperable, global public health grid. Adopting guiding principles, the global community should circumscribe the overlapping interest, shared vision, and mutual benefit between the security and public health communities and define the boundaries. A global forum needs to be established to guide the consensus governance required for public health information sharing in the 21st century. Current state At a crossroads and fragmented, global public health surveillance is deﬁned as the ongoing systematic collec- tion, analysis, and interpretation of health data, essential to the planning, implementation, and evaluation of public health practice, closely integrated to the dissemination of these data to those who need to know and linked to prevention and control [1,2]. Global, siloed surveillance systems are often slow to detect, register, conﬁrm, *Correspondence: scottjnmcnabb@emory.edu Emory University, Rollins School of Public Health, Atlanta, GA, USA analyze, and report cases of public health signiﬁcance, provide feedback, and communicate timely and useful information to stakeholders [3]. Further, they are neither maximally eﬀective nor eﬃcient in guiding (and being guided by) appropriate interventions. As an essential public health function, surveillance is relatively poorly supported in terms of a global consensus policy, strategy, and governance model and adequate training and resources [4]. While the promise and intuitive added value of integrat- ing public health surveillance highlighted in earlier reports [5] still remains valid (e.g., enhanced timeliness, increased © World Health Organization;licensee BioMed Central Ltd. This is an Open Access article in the spirit of the BioMed Central Open Access Charter http://www.biomedcentral.com/info/about/charter/, without anywaiver of WHO’s privileges and immunities under international law, convention or agreement. This article should not be reproduced for use in association with the promotion of commercial products, services or any legal entity. There should be no suggestion that WHO endorses any specific organisation or products. The use of the WHO logo is not permitted. This notice should be preserved along with the article’s original URL.