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County Health Rankings and the Cult of the Imperfect

Sir Robert Watson-Watt, who developed early warning radar in Britain during World War II to counter the rapid growth of the Luftwaffe, proposed a “cult of the imperfect,” which he stated as “Give them the third best to go on with; the second best comes too late, the best never comes” (Brown 1999). Just as imperfect radar detected incoming German aircraft to protect British citizens, imperfect public health surveillance systems are widely used to measure and monitor the health of populations to mobilize action toward community health.

Defined as the ongoing systematic collection, analysis, interpretation, and dissemination of health data for use in planning, implementing, and evaluating public health practice, public health surveillance serves as the centerpiece of all community health improvement efforts (Remington and Flood 2014). In practice, public health surveillance is a continuous process involving four diverse components: (1) data collection, (2) analysis, (3) interpretation, and (4) dissemination. Each of these steps in the process requires different skills and systems. Information technology and systems engineering are needed to design data collection systems. Epidemiologic and biostatistical methods are needed for data analysis, especially for small areas where data may be sparse or missing. But public health surveillance also requires skills in communications and program planning, to assure that the data are translated into useful information that supports community health improvement efforts (Remington and Nelson 2010).

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