The Next Public Health Revolution: Public Health Information Fusion and Social Networks

摘要

Social, political, and economic disruptions caused by natural and human-caused public health emergencies have catalyzed public health efforts to expand the scope of biosurveillance and increase the timeliness, quality, and comprehensiveness of disease detection, alerting, response, and prediction. Unfortunately, efforts to acquire, render, and visualize the diversity of health intelligence information are hindered by its wide distribution across disparate fields, multiple levels of government, and the complex interagency environment. Achieving this new level of situation awareness within public health will require a fundamental cultural shift in methods of acquiring, analyzing, and disseminating information. The notion of information “fusion” may provide opportunities to expand data access, analysis, and information exchange to better inform public health action. Internet-based technologies (e.g., social-networking Web sites, wikis, and blogs) have led to an explosion in social networks that harness the “wisdom of crowds,” giving Internet users convenient instant access to information and communities. 1 These new tools and novel information sources are also becoming ubiquitous in our increasingly wired (and wireless) society, such that members of the general public can readily disseminate their own interpretations of public health events outside a public health context or scientific framework. As these developments make clear, an information revolution is overdue in public health, particularly in epidemiology and surveillance (i.e., biosurveillance), where there is an increasing need to develop, “fuse,” and share critical health information for decision-making across numerous fields, communities, professions, organizations, institutions, and health systems. Public health epidemiology and surveillance that are conducted through an electronic medium (chiefly the Internet)—termed “infodemiology” and “infoveillance,” respectively—present good opportunities for practice and research. 1 Public health also confronts an increasing proliferation of novel electronic surveillance approaches and multiple legacy data systems amid growing concerns about appropriateness of data release, data validity, and costs versus benefits. 2 , 3 Although more information now exists electronically than ever before, there is no guarantee that electronic information can be successfully exchanged; in addition, the exchange of electronic information can still be constrained by organizational boundaries erected in response to technical, legal, and privacy concerns. 4 In recent years, it has become evident that public health events can threaten our national security. Bioterrorism poses an obvious threat to health and life, but any public health event might weaken public confidence in a government's ability to respond to emergencies, undermine a nation's social order, catalyze regional instability, or cause adverse economic impact, including trade restrictions. 5 The worldwide response to the 2009 pandemic influenza (H1N1) outbreak was a prime example of the need for rapid exchange of public health information. 6 Similar recent examples include the SARS (severe acute respiratory distress syndrome) epidemic that spread from China in early 2003 in a matter of days and was associated with local transmission in 4 additional countries, with an economic impact of at least $50 billion 7 ; the largest US foodborne disease outbreak of Salmonella Saintpaul in history, with an estimated $100 million loss to the tomato industry in 2008; and an outbreak of foot-and-mouth disease in Great Britain in 2001, with a tourism industry loss of ￡2.7 to ￡3.2 billion and a loss to agriculture and the food industry of ￡3.1 billion (equivalent to 0.2% of Great Britain's gross domestic product). 8 A typical pandemic of influenza in the United States is estimated to result in 89 000 to 207 000 deaths and economic costs of $71.3 to $166.5 billion, excluding disruptions to commerce and society. 9 To identify novel risks and address extant threats, the United States must implement a nationwide biosurveillance capability that connects domestic and international surveillance systems to provide early warning and ongoing characterization of disease outbreaks in near–real time. 10 Comprehensive biosurveillance ideally would use multiple modalities of information collection, analysis, and dissemination, as well as secure yet flexible information architecture. In addition, strengthening existing surveillance networks and infrastructure, enhancing clinician awareness and participation in biosurveillance, and strengthening laboratory diagnostic capabilities and capacity would result in potential threats being recognized as soon as possible. Integration of routine surveillance information with other potential indicator sources (e.g., health care, veterinary care,