Contamination of the nearshore marine environment contributes to a high burden of illness among recreational bathers. Disease surveillance activities carried out by local, state, and territorial agencies in the United States are at present voluntary and passive. Several gaps in the existing regulatory framework for beach management and public health protection are highlighted in this paper. The need for disease surveillance of marine bathers is established. A demonstration is made of how surveillance activities can be used to guide risk management and gauge the effectiveness of current water contact standards. Recommendations are offered for agencies to improve surveillance and protect public health. A foundation is presented on which to develop a model marine health code.