Criteria for screening

There are good public health reasons for screening certain populations, or sub-populations. However, you need to think carefully about the role of screening and whether the time, energy and money involved are justified. Screening can intrude into people's lives and invade their privacy.

The following criteria for screening have been adopted by the WHO and National Health and Medical Research Council (NHMRC) when planning screening programs.

WHO criteria for screening

The condition sought should be an important health problem for the individual and community.
There should be an accepted treatment or useful intervention for patients with the disease.
The natural history of the disease should be adequately understood.
There should be a latent or early symptomatic stage.
There should be a suitable and acceptable screening test or examination.
Facilities for diagnosis and treatment should be available.
There should be an agreed policy on whom to treat as patients.
Treatment started at an early stage should be of more benefit than treatment started later.
The cost should be economically balanced in relation to possible expenditure on medical care as a whole.
Case finding should be a continuing process and not a once and for all project.

Wilson and Jungner 1968 cited in Mak et al 1998:646

Community health surveys

In the past, community health surveys (or health audits) have taken place in many Aboriginal communities. They were often 'one-off' surveys or happened intermit-tently. A team of health professionals would travel to a community to record a wide variety of factors in as many people as possible.

From the point of view of population health, these community health surveys are 'prevalence surveys'. They "document the presence of risk factors and disease in a population" (Mak et al 1998:646). The results may or may not have been fed back to the community.

Screening… can reduce Aboriginal people to objects of knowledge, and this knowledge may help to maintain the domination of non-Aboriginal people over Aboriginal people in our society…. Screening should not occur as an activity on its own; it should only be implemented as part of a process of early intervention. However, too often inadequate thought is given to ensuring that the resources are available to follow-up and manage the problems identified in the screening.

Scrimgeour 1996:5

"Sometimes Aboriginal communities request community health surveys… health professionals have an ethical obligation to carefully discuss all the costs and benefits of a survey prior to its implementation to ensure that community residents do not have unrealistic expectations of what the survey will or can achieve. A community's request for a survey doesn't justify doing the survey…"

Mak et al 1998:645

Minimum acceptable criteria for community health surveys

The following list of criteria can be used when planning community surveys:

Community groups are consulted and involved in planning the community health survey and approve of its aims and methods.
The community has sufficient time to think and talk about the community health survey.
There is adequate provision for individuals to decline participation.
Community health surveys and screening activities (other than those in guidelines accepted by the local primary health care services) are approved by an ethics committee with adequate Aboriginal representation.
The community health survey meets the National Health and Medical Research Council criteria for research in Aboriginal Communities.
The community health survey meets the criteria for scientific validity, hypothesis testing and measurement which would be expected in any research project.
The costs, including opportunity costs, of both the survey and the follow-up of screen-detected abnormalities, should be estimated and presented to the participating communities and the ethics committee.
There is adequate provision for the feedback of results to individual participants and to the community.
There is adequate provision for the appropriate follow-up of screen detected abnormalities by either the researchers and /or the primary health care team.
There are plans, involving the community's members and health care service(s), for community interventions following the survey if appropriate.

Mak et al 1998:647


		Evaluate any screening program in which you participate

		Always provide feedback to the community