Table Of ContentSummary Report
November 2002
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This is a summary version of a more
comprehensive report, of the same
title. The full report can be accessed
at http://www.ncvhs.hhs.gov/hsvison/
Shaping a
Health
Statistics
Vision
for the
21St
Century
PolicyMakers Summary
November2002
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S52% £ very day, countless decisions are made concerningpublic and
private health. Local, state, and federalbudgets are drawnup
2002
annuallythat committaxpayers’ dollars to, orwithdrawthem from,
healthprograms. Legislaturesroutinelyconsiderhealth-relatedlaws
with immense human, bureaucratic, andfinancial consequences.Yetoften,
decision-makers have access to onlypartofthe informationtheyneedto
make thebest decisions.
Guiding the assessment, development, andevaluationofhealthpolicy
is amajoruse ofhealth statistics, the numerical datathatcharacterizethe
healthofapopulation andthe factors influencing it. Health statistics are
used, as well, to create fundamentalknowledge andto guidepopulation
healthprograms andpersonalhealthdecisions. Buttheirpotential for
informing decision-makingwillberealizedonlywhenthe health statistics
enterprise has adequate coordinationandresources andis guidedbyabroad
view ofpopulationhealth.
Itis notdifficultto imagineways inwhichbetterinformation could
leadtobetterdecisions:
• Coordinateddata collection and analysis wouldresultin
more reliable statistics andmake itpossibleto draw
conclusions from estimates to guide decision-making. For
example, national and state surveys currentlyproducevarying
estimates ofthe numberofpeoplewithouthealthinsurance,
adding confusionto the efforts ofpolicy-makers to address this
issue.
• Information on allthe factors that influencepopulationhealth
wouldmake itpossibletojudgewhich factors aremost
significantforparticularpopulationhealthissues andtotarget
appropriate interventions. Forexample, betterinformation on
physician supplycouldenablepolicy-makersto understand
whetherandhow anincrease inthenumberofspecialists
inmedium and smallercities impacts uponthe functional status
ofpersons withchronic disabilities.
• Knowingtherelative contributions topopulationhealthof
differentinvestments wouldmake itpossible to set evidence-
basedpriorities forfixture investments. Forexample, better
information could enablepolicy-makers to determine the
relativereturn on investmentfrom increased funding ofskin
cancerpreventionprograms comparedto increasedfunding of
skin cancerscreening clinics.
Shaping a Health StatisticsVision forthe 21st Century
• Having access to timelydatawouldallowdecisionstobe
made onthe latest evidence. Forexample, more timely datawould
enablepolicymakers to considerthe impactofprograms beforethey
arereauthorized, orprovide earlywarning signals ofnewhealth
trends.
• Comparable statistics across geographic levelswouldprovide
state andlocal executives andlegislatorsthetoolstotarget
problems ofparticularsignificance intheirareas, as well as to
evaluate success intheirprogram interventions. Forexample, better
informationcouldincreasethe capacityofthepublic healthand
healthcare systemsto identifylowrates ofimmunizationininfants
andchildreninspecificneighborhoods, enablingmore effective,
efficient, andtimelytargetingofimmunizationprograms.
A Vision for Realizing the Potential of
Health Statistics
Building ahealth statistics enterprisethatcanfully supportinformed
decision-makingrequires anumberofinterconnectedconceptual, structural,
andfunctional changes inourcurrentsystem. Theyare describedbriefly
below anddiscussedmore fully inShapingaHealth Statistics Visionfor
the21st Century anewreportdevelopedthrough atwo-year, national
,
consultativeprocess. Theprocess involvedmore than 200policymakers,
publichealthandhealthcareprofessionals, health statisticspractitioners,
researchers, andothers inawiderange oflocations intheUnited States.
TheNational Committee onVital andHealth Statistics (NCVHS)*, the
NationalCenterforHealth Statistics (CDC/NCHS), andthe DataCouncil
oftheU.S. Department ofHealthandHuman Services (DHHS) coordinated
theprocess andproducedthe report. NCVHS recommendations for
translatingthe vision intopractice are attachedto the report.
A view of population health and its determinants
Thereportbegins bydefininghealthstatistics anddescribingthe
health statistics enterprise. It stressesthatto be usefulto healthandhealth
policydecision-makers, health statistics mustrepresent allthe factors
influencingpopulationhealth. T—hatis, inadditiontorepresenting all
dimensions ofhealthoutcomes includingmeasures offunctional status
—
andwellbeing as well as disease inthe population health statistics must
*NCVHS isthe statutorily mandated public advisory body on health information policytothe
Secretaryofthe U.S. DepartmentofHealth and Human Services. The NCVHSWorkgroup on
the21stCenturyVisionforHealthStatisticsconductedthisprojectfortheCommittee.
2
Shaping a Health StatisticsVision forthe 21st Century
represent communitycharacteristics, the natural environment, andcultural
andpolitical contexts.
This view ofpopulationhealth and its determinants, shown inthe
model inFigure 1 below, defines the scope ofinformationthehealth
statistics enterprise shouldobtainandmake available. Themodel canbe
usedto identifygaps incurrentdata and inthe enterprise’s capacityto
providethe data.
Health
Population’s
the
on
Influences
1.
Figure
Shaping a Health StatisticsVision forthe 21st Century
A strengthened hub for the health statistics enterprise
Anothermodel developedforthe report(Figure 2) shows the stages and
components ofan idealhealth statistics cycle and specifies the activities of
thehealth statistics enterprise andtheirinteractions.
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Shaping a Health StatisticsVision forthe 21st Century
A
major difference betweenthis idealizedview and current conditions
is thatthe components ofthis health statistics cycle are tiedtogetherby an
integrating “hub.”As envisioned, the hub coordinates the activities ofthe
health statistics enterprise, stimulates collaborative efforts, sets standards,
reviews andrevises the vision, generates newmethods and approaches, and
protects privacy, confidentiality and security.
The needto strengthenthe hub to carry outthese functions was
amajoremphasis ofthe visioningprocess. Participants conveyed a
strong message thatnew approaches to enterprise-wide coordination and
integration are neededbecause existing ones are largely ineffective, causing
fragmentation and inefficiency.
Conceptual framework, core values, and guiding
principles
The reportproposes thatthe mission ofthe health statistics enterprise
is to efficientlyprovide timely, accurate, andrelevant informationthat can
be usedto improve the population’s health. It outlines the attributes ofthe
needed conceptual framework, and specifies core values andprinciples to
guide the enterprise in realizing the vision forhealth statistics.
The overarching conceptualframeworkenvisioned forthe health
statistics enterprise has these characteristics: it focuses onhealth, the
population, andthe community; it emphasizes distribution and level of
health; it delineates major influences on health; and it guides aresearch
agenda for improving the health ofthe population. The use ofan
overarching conceptual frameworkwill remindpolicy-makers andpublic
healthpractitioners ofthe myriad offactors that mustbe considered and
addressed in designing and implementingprograms to improvepopulation
health, andhelp to reduce narrow, disease-specific, and categorically-
focusedprograms.
Fourcore values are envisioned forthe health statistics enterprise:
• Maintainingthe confidentiality andsecurity ofindividually
identifiable health information
• Maximizingthescientific integrity ofall aspects ofhealth statistics
while acknowledging the specific ways inwhichthe political,
cultural, andbusiness contexts may affect data collection, analysis,
and interpretation
• Optimizing the enterprise’s accountabilityto its users to ensure
the availability ofthe informationthat is needed for improving the
nation’s health
Shaping a Health StatisticsVision forthe 21st Century
• Ensuring the enterprise’s accountabilityto its data suppliers to
minimize theirburden andto provide themwith timelyfeedback
The report concludes by identifying tenguidingprinciples for
actualizing the core values:
1. Enterprise-wideplanningandcoordination to ensure relevance
to local, state, andnationalpolicy andprogram decision-making
andto an overall conceptual frameworkofthe influences onthe
health ofpopulations
2. Broadcollaboration among datausers, producers, and suppliers at
local, state, andnational levels to ensure efficiency ofthe health
statistics enterprise andusefulness ofthe datathat itproduces
3. Rigorous policies andprocedures forprotectingtheprivacy of
individuals andthe confidentiality and security ofdata
4. Flexibilityto identify and address emergenthealth issues andneeds
5. Use ofdatastandards to facilitate sharing and comparability of
10. data
6. Sufficientdetailat different levels ofaggregationto support local,
state, andnational policy andprogrammatic decision-making
7. Integrated, streamlineddata collection formultiple purposes
8. Timelyproduction ofvalid and reliable health statistics
9. Appropriate access to andease ofuse ofhealth statistics
Continuous evaluation ofthe completeness, accuracy, and
timeliness ofhealth statistics and ofthe ability ofthe health
statistics enterprise to support theirproduction
The NCVHS Recommendations
Afterworking closelywith its partners to create a vision forhealth
statistics reflecting the views and concerns ofconsultationparticipants,
the National Committee onVital and Health Statistics developed 36
recommendations forrealizing the vision. Thirty relate to andflesh out the
guiding principles, and six move toward the adoption ofan overarching
conceptual framework. The recommendations are summarized in the
Appendix.
NCVHS
believes that the top priority forrealizing the vision is to
buildthe integrating and coordinating hub forthe health statistics enterprise.
This priority is expressed in guidingprinciple 1, regarding enterprise-wide
planning and coordination. FourNCVHS recommendations relate to this
priority:
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Shaping a Health StatisticsVision forthe 21st Century
