Prospects and Challenges in Implementing Firearm-Related Injury Surveillance in the United States Not a Flash in the Pan

If there were any doubts that injuries, in general, and firearm-related injuries, in particular, represent a health problem to be addressed in a public health framework in the United States, the articles in the current supplement to the American Journal of Preventive Medicine should put them to rest. These articles describe the efforts of public health professionals to conduct and evaluate public health surveillance for firearm-related injuries. By adopting the rubric of surveillance, the cornerstone of public health practice, and thereby moving away from simply conducting studies of firearm injuries,1–11 the authors place prevention of firearm-related injuries squarely in the mainstream of traditional public health efforts. The traditional public health approach has its foundation in public health surveillance. Surveillance implies far more than gathering data for study purposes. The first definition of public health surveillance offered by Langmuir still serves to highlight the fundamental aspects of surveillance.12 Surveillance is characterized by the systematic collection, analysis, and interpretation of data regarding conditions of public health interest. It is an ongoing, not a one-time, activity. And, importantly, the results and interpretation of surveillance data are disseminated to those who need to know: public health practitioners, decision and policy makers, and the general public. It is this dissemination feedback loop and the ongoing nature of surveillance that are its sine qua non and that distinguish it from other data-gathering activities. A decade ago, Graitcer described the rationale and attributes of systems for injury surveillance, including potential sources of data.13 Several of the studies cited above calculated incidence rates of firearm-related injuries, and explored the usefulness and accessibility of the data sources needed to study the problem.9–11 However, these reports encompassed data collected under the more “ideal” circumstances of a one-time study, and they did not address the issues of the feasibility of ongoing data collection by a health department. The pilot surveillance projects described in this supplement to the Journal encompass the various elements of surveillance and show that it is possible to successfully conduct surveillance for firearm-related injuries.14–22 These papers use the approach of systematically applying CDC’s Guidelines for Evaluating Surveillance Systems23 to describe the following components of each surveillance system and project: defining the conditions under surveillance, data sources, information flow, the effort required to collect data, and surveillance system attributes (e.g., simplicity, flexibility, and acceptability). Since their publication, these guidelines have been applied to describing and improving surveillance systems across the spectrum of public health. However, although the results from these projects clearly indicate that surveillance for firearm-related injury is achievable and can meet many of the benchmarks of surveillance systems for infectious, chronic, and environmentally related public health problems, they also underscore the challenges of initiating and conducting surveillance in the current environment of limited public health resources and proliferation of electronic data systems designed for other purposes.24 In this sense, firearmrelated injury surveillance is facing similar challenges to surveillance in other areas of public health.