Worldwide surveillance of risk factors to promote global health.

Surveillance is considered the bedrock of public health. A global health perspective requires a worldwide system to monitor risk factors in diverse populations identifying emerging scourges at the international or regional level and devise workable preventive actions. Surveillance of causes of death provides a unique source of data allowing limited international comparisons across most populations. Surveillance of risk factors is needed to track intermediate outcomes of chronic disease and particular lifestyles associated with cardiovascular disease. Two extreme strategies are outlined to help delineate the boundaries for constructing a worldwide system of risk factor surveillance. The first strategy would use a centralized standardized approach. An advantage of this model is that data collected in different populations throughout the world would be directly comparable. A second radically different strategy would be to forgo any a priori attempts at standardization of protocols across locations. The ultimate goal of a worldwide risk factor surveillance system will be to identify the components of public health strategies around the globe that successful and to use this information to bolster policies and programs to promote health worldwide.