Options for future military health surveillance systems.

This paper examines the requirement for health surveillance systems for military forces. Military health surveillance is the routine systematic collection, analysis, interpretation, and reporting of standardised, population based data for the purpose of characterising and countering threats to the military population's health, well-being and performance. The components of a health surveillance system should enable concurrent or retrospective analysis of health effects in military personnel using a cohort study design. Military hazards include trauma, infection, toxic effects, radiation, psychological stress and ergonomic stress. Variations in distribution of the hazard, distribution of the population, fragility of the cohort, and the variation in the duration and magnitude of exposure complicate definition of the exposed cohort. The measurement of biological effect is complicated by limits in knowledge about the relationship between exposure to the hazard and effect. A biological model that explains detection, causality, pathological process and health effect should support this knowledge. Lastly the definition of health effect needs to consider the difference between clinical activity rates and true measures of health outcome. The UK has a number of health surveillance systems including sentinel reporting, a population-based primary care reporting system and measures of medical discharge and death. The US Army is developing IT-based surveillance systems to link hazard, personnel and medical databases. The paper suggests a conceptual model for such a system in the UK military.