Public health institutions at local, regional, and national levels face evolving challenges with limited resources. Multiple forms of data are increasingly available, ranging from streaming statistical data to episodic reports of confirmed disease incidence. While technological tools for collecting and using these data proliferate, economic pressures often preclude growth of concomitant staff with required expertise. The intent here is to provide perspective on evolution of public health surveillance since the late 1990s, suggest how methodological approaches can be improved, and recommend areas of growth given mandates for evidence-based policy and practice. Remarks in this article stem from my last 18 years’ work on surveillance system development at the Johns Hopkins University Applied Physics Laboratory, as consultant to the US Centers for Disease Control and Prevention, and as board member and research committee chair of the International Society for Disease Surveillance. These efforts have been enriched by collaborations with US and international public health partners, both civilian and military.