Valuing health surveillance as an information system: interdisciplinary insights

Economic evaluation of health surveillance systems and health information is a methodological challenge, as for information systems in general. Main present threads are considering cost-effectiveness solutions, minimizing costs for a given technically required output, or cost-benefit analysis, balancing costs with economic benefits of duly informed public interventions, both adopting adapted viewpoint and time horizon. The latter option, following a linear command-and-control perspective, implies considering a strong mono- causal link between information, decision, action, and health benefits. Yet, valuing information, taking into account its nature and multiple sources, the modalities of its processing cycle, from production to diffusion and gradual building of a shared information capital, constitutes a promising challenge. This work proposes an interdisciplinary insight on the value of health surveillance to get a renewed theoretical framework integrating information and informatics theory and information economics. The main idea is to push the boundaries of surveillance evaluation, to draw the focus on changes and trends, on the dynamic and networked structure of information systems, on the contribution of diverse data, and on the added value of combining qualitative and quantitative information. Distancing itself from the command-and-control model, this reflection considers the behavioral fundaments of many health risks, as well as the decentralized, progressive and deliberative dimension of decision-making in risk management. Drawing on the particular case of surveillance of antimicrobial resistance, as a paradigmatic example of complex health risk situation, the framework also attempts to learn lessons from recent applications within and outside of health sector, as in the use of big data or web sources, the diffusion of technological products and large-scale financial risks. Finally, the challenge here is to propose a workable approach to economic evaluation of health surveillance through a better understanding of health information value, not over-simplifying the range of its benefits across society. - Research impact highlights: Reconsidering the value of health information is paramount in providing a sound and fruitful economic evaluation of surveillance systems. Antimicrobial resistance appears as a paradigmatic example of a complex health risk calling for a renewed theoretical framework of health information value. Drawing on a diversity of present threads of research on information and risk management, this interdisciplinary reflection proposes tracks to tackle this important challenge.