Diane Wagener, PhD
Acting Director, Division of Health Promotion Statistics

National Center for Health Statistics, CDC

Ron Bialek, MPA
Executive Director, Public Health Foundation

Measuring Health Objectives and Indicators: 1997 State and Local Capacity Survey.

Findings:

• States emulate Healthy People.
• States choose objectives for which they have data.
• States use State data sources predominantly with some Federal and private sector data.
• States have mortality and infectious disease data; need behavioral and process data.
• States are challenged by getting timely data--on average baseline data were two or more years old.
• States have difficulty in supplying morbidity data to localities.
• If given a $1 million budget increase, States would choose to put that money into training to use better the data that are available.

Harry Rosenberg, PhD
Chief, Mortality Statistics Branch, Division of Vital Statistics

National Center for Health Statistics, CDC

Challenges in data collection for Healthy People 2010.

Revisions of the International Classification of Diseases (ICD).

• ICD-9 contains 3,000 diseases; 72 causes of death.
• ICD-10 contains more than 8,000 diseases; 113 causes of death. ICD-10CM contains more than 45,000 codes.
• Implementation of ICD-10 begins in 1999.
• The additions of new diseases and reclassification could result in discontinuity in tracking trends.
• Suicides will be called self-inflicted injury; motor vehicle accidents will look very different.
• Age-adjustments for mortality data.
• Currently NCHS uses age adjustment standards based on the population composition of 1940.
• To update these standards based on the current demographic composition and to create uniformity among HHS agencies, Secretary Shalala issued a directive requiring that effective in January 1999, deaths be recorded and adjusted to the projected year 2000 population estimates; this standard will be called age adjustment to the year 2000.
• The new age adjustment will have an effect on death rates; overall the rate estimates will be higher, black rates will be improved relative to white rates--an effect that the Office of Minority Health and NCHS are working on to communicate.
• Revisions will be considered every 10-20 years to the age adjustment standard.

OMB Standard on Race and Ethnicity.

• OMB Standard on Race and Ethnicity is reported in the Federal Register on October 30, 1997.
• The revision adds Asian as a separate category from Native Hawaiians and Pacific Islanders.
• The new classification takes effect in 2003.
• The year 2000 census will enable people to check more than one race. Because an estimated 5 percent of the population is expected to report multiple races, tabulations will need to be run to compute race specific rates. These methodologies are still under development.

Ron Wilson
Consultant, National Center for Health Statistics, CDC

Challenges in Small Area Data Collection for Healthy People 2010

Do we need small area data?

• National data or synthetic estimates can be used to identify problems at a local level. However, local, small area data are needed to track progress.
• There is a need for a discussion regarding what kinds of small area data are appropriate. Health outcomes may be difficult to measure because of small numbers, whereas process indicators would be more reliably assessed.
• There is a need for careful evaluation of what is being measured. Some indicators are more sensitive to social system changes than to actual health status, for instance limitations in activities depend on what activities are considered "usual". Is there consistency between indicators? What effect do different survey questions or modalities have on the responses?

• There is a need for guidelines on how the national objectives are being calculated so that the measures can be replicated at State and local levels. As a corollary, there is a need to refine and collect the consensus set of indicators.
• In light of these many statistical changes, how can States respond to Dr. Satcher's call to the States to produce their health improvement plans by Public Health Week in the year 2000?
• There is a need to enhance data sharing between agencies in the States. A common language would facilitate this sharing.
• There is a need for guidelines on when statistics can be appropriately calculated for small populations and a need for educational materials to explain data limitations to the population.

  Philadelphia Transcripts and Summaries