Perspectives on Global Risk Factor Surveillance

Abstract

In the last decade of the 20th century we witnessed a watershed in public health. Three seminal events occurred that changed the landscape for public health surveillance. The first was the rise of chronic disease and health promotion into the mainstream of public health. A great epidemiologic transition occurred throughout the 20th century. At the beginning of the century in the United States the average life expectancy was less than 50 years; by the end of the century it was nearly 80 years. In 1900 most people died from pneumonia, tuberculosis, and other infectious disease; by the end of the century the overwhelming majority died from heart disease, cancer, and stroke—pneumonia and influenza being relegated to causes of death in the elderly and the frail. With this transition we realised that the actual causes of death could be attributed to lifestyle behaviours, notably tobacco use, poor eating practises, substance abuse, and lack of exercise. Furthermore, we realised that these behaviours are often highly associated ways of living linked to social determinants.