Public health screening is a vital component of healthcare systems in Europe, aimed at detecting diseases or risk factors in asymptomatic individuals to enable early intervention and improved health outcomes. In the European context, the principles of public health screening are guided by the Wilson and Jungner criteria, established by the World Health Organization (WHO) in 1968, and adapted to the specific needs and objectives of each country within the European Union (EU) and European Economic Area (EEA).

Wilson and Jungner Criteria

The Wilson and Jungner criteria, first proposed in a 1968 World Health Organization report, provide a set of principles to guide the development and evaluation of screening programs in public health (Wilson & Jungner, 1968). These criteria consider a range of factors, including the importance of the disease in a population, the availability and acceptability of treatment, and the ability to detect the disease early through screening. According to these criteria, a disease should be an important health problem, its natural history should be well understood, and there should be a recognizable early stage of the disease. Additionally, there should be an effective and acceptable treatment, and the cost of case-finding should be balanced against the benefits of disease detection. Screening is not merely about test administration; it involves the integration of screening programs into the healthcare system, ensuring there is a process in place for further diagnostic testing, treatment, and follow-up. The Wilson and Jungner criteria remain a foundational tool in the planning and assessment of public health screening programs.

1. The condition sought should be an important health problem.
   • There should be a clear understanding of the epidemiology of the condition, including incidence and prevalence, and the health and economic burden on individuals and society. The condition should be a significant public health problem justifying the investment in a screening program.
2. There should be an accepted treatment for patients with recognized disease.
   • If no treatment or intervention is available that changes the course of the disease, or if the treatment is not generally accepted, then early detection might not lead to improved outcomes.
3. Facilities for diagnosis and treatment should be available.
   • Prior to starting a screening program, health systems should ensure there are sufficient resources for diagnostic confirmation and treatment of individuals who screen positive, as well as appropriate follow-up.
4. There should be a recognizable latent or early symptomatic stage.
   • This criterion refers to the natural history of the disease. There should be a period during which the disease can be detected before the onset of symptoms, and intervention at this stage should lead to better outcomes.
5. There should be a suitable test or examination.
   • The screening test should be reliable, safe, inexpensive, and valid with high sensitivity and specificity. It should be able to accurately detect the early or latent stage of the disease.
6. The test should be acceptable to the population.
   • The screening program should be organized in a way that encourages high participation rates. The test should be acceptable to potential participants in terms of comfort, cost, and accessibility.
7. The natural history of the condition, including development from latent to declared disease, should be adequately understood.
   • A comprehensive understanding of the disease process is essential, including how the disease progresses from the early or latent stage to symptomatic disease.
8. There should be an agreed policy on whom to treat as patients.
   • Clear guidelines should be established on who will be treated once a disease is detected through screening, considering factors such as stage of the disease, age, and comorbidities.
9. The cost of case-finding (including diagnosis and treatment of patients diagnosed) should be economically balanced in relation to possible expenditure on medical care as a whole.
   • A cost-benefit analysis should be performed to determine if the benefits of early detection and treatment through the screening program outweigh the costs.
10. Case-finding should be a continuing process and not a “once and for all” project.
    • Screening should be an ongoing, systematic process rather than a one-off project. There should be a commitment to maintaining the program, with regular intervals for repeated screening.

References:

• This text was originally generated on 11 July 2023 by ChatGPT4.0 and reviewed by Arnold Bosman.
• Wilson, J. M. G., & Jungner, G. (1968). Principles and Practice of Screening for Disease. World Health Organization. Public Health Papers, 34. [This is the seminal work where the criteria were first proposed.]
• Andermann, A., Blancquaert, I., Beauchamp, S., & Déry, V. (2008). Revisiting Wilson and Jungner in the genomic age: a review of screening criteria over the past 40 years. Bulletin of the World Health Organization, 86, 317-319. [This paper reviews the criteria and their application in the era of genomic medicine.]
• Raffle, A. E., Gray, J. A. M. (Eds.). (2007). Screening: Evidence and Practice. Oxford University Press. [This book offers a comprehensive overview of screening, including the use of Wilson and Jungner's criteria.]