surveillance of disease to surveillance of risk factors
surveillance systems focus on monitoring mortality and to a lesser
extent morbidity. These systems are adequate for assessing the effectiveness
of public health intervention when the elimination of the cause
has immediate impact on incidence or mortality rates. They are,
however, insufficient when decades separate exposure to preventable
factors from the clinical manifestations of a chronic disease. In
this context, monitoring distributions of risk factors in populations
provides short term indicators to identify preventive strategies,
assess their effectiveness and predict emerging epidemics.
the 1960's, much methodological progress has been made following
the implementation of national surveys and surveillance systems
that repeatedly collect over time information about diets and other
determinants of diseases.
of national surveys and surveillance systems
programs have allowed us to observe mass changes in environmental
exposure (e.g., smoking, diet, exercise ) or biological measures
(e.g., cholesterolemia, blood pressure).
of risk factors is the object of the Geneva
Bus Santé project.
Each year, about 1000 subjects are identified from the list of all
residents published each year using a standardized procedure. Random
sampling in age-sex-specific strata is proportional to the corresponding
frequencies in the population. The participants answered a Food
Frequency Questionnaire, a Physical
Activity Frequency Questionnaire and additional questions about
health in general. They also have their blood presssure, lipid profile
and BMI measured.
of risk factors has also become part of the US national health promotion
and disease prevention objectives Healthy
People 2000 . Timely collection of data on physical activity,
nutrition, tobacco, alcohol, and biological function is required
to evaluate whether the objectives of the program are met.
attention has been given to the coordination and harmonization of
locally-run programs which are often population-based, decision
and action oriented, relevant, timely, readily accessible and effectively
(Europe Alimention, an European information campaign on diet and
nutrition) is an example of how coordination of seven independent
European locally-run surveys can bring together data but also authorities
and experienced folks from various populations and countries to
wrestle with prevention issues.
the use of different protocols limits comparability, the perspective
of a European surveillance system of risk factors derived from pooling
locally-based survey data should not be rejected out of hand. Additional
work is needed to practically determine the extent to which these
data can be integrated into an international system of surveillance
of risk factors.