Public Health Data for Action:

10 Questions to Focus On For the Next Decade to Address the Most Pressing Health Issues Globally and in India

Dr. Michael Friedman

World Bank Consultant

Retired CAPT, US Public Health Service

Former CDC Country and Program Director; Senior Medical Epidemiologist

Aim of the Next 8 Minutes

• to challenge ourselves regarding the next generation of public health surveillance
• to focus in on the key health questions facing our health systems and society
• to bridge the gap between these questions and investments in public health surveillance systems

to answer key public health questions

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burden of disease

risk factors

impact of public health actions

reasons for a lack of progress

innovative opportunities for the future

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and spur real action

Disease Surveillance is a tool….

10 Questions to Focus on for the Next Decade

to Address the Most Pressing Health Issues Globally and in India

1. Why is it so hard to maintain a healthy lifestyle these days?  

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What investments and societal changes are required to get people to:

a) eat more vegetables and fiber

b) exercise moderately at least 3 times per week

c) sleep at least 7 hours per night

d) stop smoking

e) consume less alcohol, and

f) maintain strong social networks.

10 Questions to Focus on for the Next Decade

to Address the Most Pressing Health Issues Globally and in India

2. How can we best prepare for and address the coming epidemic of mental health disorders?

10 Questions to Focus on for the Next Decade

to Address the Most Pressing Health Issues Globally and in India

3. What is the main driver of premature death (death under age 65) and what are we doing about it?

10 Questions to Focus on for the Next Decade

to Address the Most Pressing Health Issues Globally and in India

4. What is the next great pandemic and how will the world react to it and attempt to deal with it?

10 Questions to Focus on for the Next Decade

to Address the Most Pressing Health Issues Globally and in India

5. Why don’t we have more vaccines for more diseases?  

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What is holding us back?

10 Questions to Focus on for the Next Decade

to Address the Most Pressing Health Issues Globally and in India

6. What can be done to reduce our love affair with antibiotics?

10 Questions to Focus on for the Next Decade

to Address the Most Pressing Health Issues Globally and in India

7. How can AI transform health and health care?
8. In what ways do our medical training systems for doctors, nurses, and other health personnel need to evolve? What will they need to know tomorrow that they are not being taught today?
9. To what degree will climate change impact our global and local health outcomes?
10. Is the commodification of health and health care the only way forward?  

Bonus Question: Should health systems be judged on extending life expectancy or on measures of quality of life?

10 Questions to Focus on for the Next Decade

to Address the Most Pressing Health Issues Globally and in India

What questions do you believe should be on this list based on your experiences and challenges you face and see?

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Surveillance Platforms Most Required

to Address the 10 Most Pressing Health Issues Globally and in India

1. Comprehensive Mortality Surveillance - death registration, ICD11 coding or verbal autopsies, deep dive death audits for unexpected deaths or a sample of certain age groups or causes
2. Hospitalization Data (with final primary diagnosis on discharge)
3. Demographic Health Survey Platforms
4. Longitudinal Cohorts (urban and rural; children/young adults/older adults; other risk groups)
5. Health Services Data that can measure Quality of Care (vaccinations, preventative screenings, blood pressure monitoring, tobacco cessation, antibiotics prescribed, diabetes control, mental health screening and treatment, etc.)

Surveillance Platforms Most Required

to Address the 10 Most Pressing Health Issues Globally and in India

6. Event-based Surveillance Platforms for Detection of New or Uncommon Severe Pathogens
7. Environmental Surveillance
1. air and water quality, lead exposure, food safety
2. infrastructure for safe walking/cycling, city livability scores
8. Health Worker Information Systems
• number of physicians, nurses, pharmacists, mental health counselors, nutritionalists, physical therapists, public health managers, epidemiologists, etc. and future projections
• training/specialization, location and type of practice, continuing education, etc.
• Periodic Assessments of Quality of Training Programs
9. Heath Technology Innovations - New vaccines, new diagnostic tests, new health software in development and brought to market

Disease Surveillance is a tool…

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to answer key public health questions

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and spur real action

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policy reforms

innovations

improved access and quality of care

behavior change

infrastructure development

shifts in social norms

Why Does Disease Surveillance matter?

What Gets Measured, Gets Done

Take Home Message

“If you don’t know where you are going, you may end up somewhere unexpected and not even know it”

Final Thoughts

Thank You

• What kind of health care systems do we have vs. what we need

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• How do we balance between curative medicine or preventative public health. Are we doing a good job of this in recent decades?

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• What previous investments have paid off in terms of health and development both locally in TN and globally
• What kind of health/public health information do we require to better understand where we stand in terms of health and what changes are happening

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• How do we collect this information: surveillance platforms, clinical health data systems, longitudinal cohorts, RTCs, qualitative deep dives into specific issues, etc.