Symposium on Public Health Law Surveillance: The Nexus of Information Technology and Public...

Angela McGowan

The Centers for Disease Control and Prevention's (CDC) goal is to develop a surveillance system of public health laws that would both support research and analysis among policymakers and legislators, and support the scientific basis for public health law. This session was convened,

in part, to discuss the value of creating an electronic system to track public health legal information. Public health surveillance is the "ongoing, systematic collection, analysis, interpretation, and dissemination of data regarding a health-related event for use in public health action to reduce morbidity and mortality and to improve health. Data disseminated by a public health surveillance system can be used for immediate public health action, program planning and evaluation, and formulating research hypotheses." There is currently no system available that meets the goals of this definition of "surveillance" for public health laws.

To develop such a system, many issues must be considered. For example, this system should clearly define the purpose of such a system, identify the stakeholders, identify the gaps, describe the uses of the data and analysis, and determine what actions will be taken as a result of the information gathered. In addition, data sources must be identified, case definitions must be agreed upon, and procedures to analyze and disseminate the data must be considered. Finally, resources must be found, unintended consequences and threats considered, impediments identified, and a timeline established.

Michael Schooley

In 1994, the Office on Smoking and Health started tracking tobacco laws including those addressing advertising, excise taxes, licensure, preemption, smoke-free indoor air, and youth access, all of which influence health behaviors and could affect tobacco use rates. CDC put the results of these law-tracking activities into an on-line system called the State Tobacco Activities Tracking and Evaluation System (STATE).

The purpose of STATE was to provide summary information on a breadth of tobacco-related issues for program managers, decision makers, and health researchers. STATE provides information about planning, monitoring, and evaluating a tobacco use prevention program. The system summarizes information about tobacco-related behaviors, the economic burden of tobacco use, the health consequences of tobacco use, tobacco-related legislative information, and funding sources for tobacco programs. The focus of STATE is on state-level information and laws. Local level information is available on the Internet and from tobacco control advocates, but it is collected passively rather than proactively.

STATE includes both the enacted date and the effective date of tobacco-related laws in order to associate the law with outcomes and consequences, as well as attitudes and behavior changes. The surveillance activities made possible by STATE can indicate progress toward health improvement, such as preventing initiation among young people, and eliminating exposure to environmental tobacco smoke. Looking at public health law data is a critical part of assessing the impact of interventions because often such impacts are associated with changing laws and policies.

Helen Narvasa

The Health Policy Tracking Service (HPTS) is a non-partisan web resource that systematically collects, tracks, and analyzes state health care legislation on behavioral health, health insurance, managed care, Medicaid, pharmaceuticals, health care providers and facilities, long-term care, tobacco, nutrition and physical exercise, public health preparedness, and state health budgets.

Many lessons were learned in creating the HPTS system. Having qualified research staff to identify, analyze, and interpret the data is crucial to HPTS' success. It also is important to consider the audience when developing aspects of or making changes in the system (i.e., keep it simple, but also suit a variety of information needs and user levels). E-mail alerts help remind users of the resources available to them. It also is vital to solicit regular internal and external feedback, disseminate information beyond the website, and monitor other available resources to ensure relevancy of the system.

Reference librarians get a wide range of questions from public health practitioners, researchers, lawyers, clinicians, policy makers, legislators, and public health and law school faculty and students. A library serves as a collaborative learning space, communication center, quality filtering device, value-added service center, and locus for information tools development and knowledge creation. A library is not a place to provide legal advice or interpretation or to provide medical diagnosis, treatment, or other health advice.

CDC's new Information Center will be the locus of CDC's outreach programs and collaborations with both the public health community and the broader public, and a bridge between the public side of CDC and the more secure laboratory functions. A needs assessment will determine whether there should be a public health law and health policy information service.

Libraries are moving toward more virtual services, with electronic resources, desktop access to library resources, electronic delivery between libraries, customized products and services, and systems that hyperlink and reflect cognitive mapping. There will be new tools for organizing web-based resources, new publishing paradigms with more open access, prototypes for institutional repositories for information, systems to insert knowledge at the point of need, meta-search engines, more options for full-text searching, and federated searching capability.

REFERENCE

REFERENCES

1. Centers for Disease Control and Prevention. Updated guidelines for evaluating public health surveillance systems. MMWR 2001;50(RR13);l-35.

AUTHOR_AFFILIATION

Angela McGowan, Michael Schooley, Helen Narvasa, Jocelyn Rankin, and Daniel M. Sosin (Moderator)