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Year : 2018  |  Volume : 9  |  Issue : 1  |  Page : 47-48

Addressing the issue of ethics in public health surveillance: World Health Organization

Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Chennai, Tamil Nadu, India

Date of Web Publication24-Jan-2018

Correspondence Address:
Dr. Saurabh RamBihariLal Shrivastava
3rd Floor, Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Ammapettai Village, Thiruporur, Guduvancherry Main Road, Sembakkam Post, Kancheepuram - 603 108, Tamil Nadu
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/mjmsr.mjmsr_31_17

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How to cite this article:
Shrivastava SR, Shrivastava PS, Ramasamy J. Addressing the issue of ethics in public health surveillance: World Health Organization. Muller J Med Sci Res 2018;9:47-8

How to cite this URL:
Shrivastava SR, Shrivastava PS, Ramasamy J. Addressing the issue of ethics in public health surveillance: World Health Organization. Muller J Med Sci Res [serial online] 2018 [cited 2023 Jun 2];9:47-8. Available from: https://www.mjmsr.net/text.asp?2018/9/1/47/223907

Dear Editor,

Establishment of a disease surveillance system has been acknowledged as one of the key public health interventions, which can facilitate the health and development of the general population.[1] The process of surveillance enhances the accountability of any healthcare strategy and thus aids in its evaluation.[1] In fact, it has been identified as the predominant approach, which is expected to play a defining role in the accomplishment of universal health coverage and the Sustainable Development Goals.[1],[2] Further, by ensuring timely access to surveillance information will prove as an effective tool for advocacy for the community.[2]

Public health surveillance has been defined as the ongoing process of the organized compilation, analysis, and elucidation of health-related attributes to assist the stakeholders in the process of planning, implementing, and evaluating health strategies.[1],[2] This can be performed by deploying a variety of methods such as house-to-house surveys, disease registries, online surveys, and social networking platforms.[1] Moreover, failure on the part of the stakeholders to perform public health surveillance can significantly affect the quality of the response, as the policymakers are devoid of evidence and thus the outcome turns out to be fragmented.[2],[3]

Public health surveillance not only plays a crucial role in the response to an outbreak or epidemic but also is of utmost importance in minimizing the prevailing inequality or to have a comprehensive understanding about the rise in the caseload of lifestyle disorders.[1],[2],[3] Further, it even has a defining role toward ascertaining the trends of morbidity/mortality and can even improve the environment-related indicators.[2] In addition, such kind of surveillance in workplace settings can identify the potential hazardous occupations, and thus, appropriate measures can be suggested to improve the health status of the workers.[2],[3]

Regardless of the numerous benefits attributed to public health surveillance, the information obtained might result in interventions such as mandatory quarantine, isolation, or even the capture of possessions during the course of an epidemic.[3] In addition, if the process involves name-based reporting, it raises serious concerns about privacy, discrimination, stigmatization, and damage people or property.[3] Thus, the issue of ethics becomes extremely important in the effectiveness of public health-related surveillance activities, as in the absence of the assurance that the obtained information will be kept confidential, people will be reluctant to share their responses.[2],[3] This indirectly emphasizes the need to perform surveillance after anticipating the ethical concerns which may arise and how best to negate them.[3]

In other words, there is an indispensable need to involve local community, and this can happen only when the prevailing concerns or values or priorities are dealt in a transparent manner.[3] In fact, the local people cannot be involved, unless their leaders are not involved or they are not aware about the potential merits or risks associated with surveillance.[3] However, during emergency settings, the obtained data have to be shared either for the control of the outbreak or for justifiable research activities.[2],[3]

In the current era, despite the presence of guidelines pertaining to ethics in research or with regard to specific diseases, till date, no ethical guidelines have been framed to aid in public health surveillance.[2] Acknowledging the gap, the World Health Organization in collaboration with various stakeholders and scientific experts has come out with guidelines to resolve controversies that may emerge during surveillance.[3] In addition, specific ethical issues have been addressed in heterogeneous settings based on differences in cultural values or political scenario or opinions of community leaders.[2] The limitations of these guidelines are that it cannot provide perfect answers to all ethical issues, nevertheless by means of the proposed 17 guidelines and it will surely assist health professionals in taking the right decision about the collection, analysis, sharing, and use of the elicited data.[2],[3]

Furthermore, to avoid ethical issues, the identifiable information should be either concealed or geomasking approach can be adopted, which does not allow the precise identification of a cluster of cases.[2],[3] Another approach will be to combine surveillance with protection of economic, social, and civil rights of the individuals. Moreover, an oversight body can be created to not only identify the ethical issues but even consider new evidence or best practices and deal with the problem in an accountable and transparent manner.[2] Furthermore, the oversight body can actively monitor for harms and ensure that data are shared appropriately.[3]

To conclude, ethical issues in public health surveillance are a very important concern, and all the nations should implement the newly formulated guidelines and monitor the same in a periodic manner.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Shrivastava SR, Shrivastava PS, Ramasamy J. Role of surveillance in the strengthening of the public health care delivery system. J Clin Sci 2014;11:57-8.  Back to cited text no. 1
  [Full text]  
World Health Organization. Q & A: Ethics in Public Health Surveillance; 2017. Available from: http://www.who.int/features/qa/surveillance-ethics/en/. [Last accessed on 2017 Jun 30].  Back to cited text no. 2
World Health Organization. WHO Guidelines on Ethical Issues in Public Health Surveillance. Geneva: WHO Press; 2017. p. 1-24.  Back to cited text no. 3


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