Wednesday, June 13, 2012

Data are the coins of the public health realm

Last Monday, June 4th, I had the opportunity to welcome the attendees of the joint annual meeting of the National Association for Public Health Statistics and Information Systems (NAPHSIS) and the National Center for Health Statistics (NCHS). Hundreds of people from around the country were here to learn about the latest advances in the field of vital statistics, electronic health records, and various other aspects of collecting and using population-based data. From the title of their conference, “Shooting for the North Star: Our Journey from Good to Great” and from the focus of many of the scheduled sessions, it was obvious that they were also here to find out how to navigate their field through this time of major change in health and health care. 
In welcoming attendees to the North Star State, I mentioned the usual things like the fact that Minnesota has more shoreline than California, Florida and Hawaii combined; that we really are all above average; and that Minnesota is truly becoming a land of many cultures – and not just throat. I also mentioned the many public health firsts that have occurred in Minnesota like: the first clean indoor air act; the first Great American Smokeout (aka D-Day); the first study linking dietary fat, serum cholesterol and heart disease; and the first reliable diagnostic test for typhoid fever. 
I then acknowledged that in preparing for this short presentation, I realized that this year we are celebrating the 100th anniversary of the establishment of the Children’s Bureau in the U. S. Department of Labor. The mission of the Children’s Bureau was “to investigate and report...upon all matters pertaining to the welfare of children and child life among all classes of our people and shall especially investigate the questions of infant mortality, the birth rate, orphanage, juvenile courts, desertion, dangerous occupations, accidents and diseases of children, employment, and legislation affecting children…”
The establishment of the Children’s Bureau is of particular relevance for people attending this conference because the first major initiative of the Children’s Bureau was the development of a National Birth Registry and institution of compulsory birth registration. With compulsory-birth-registration, not only could a state generate accurate birthrate and infant-mortality statistics as well as providing children with accurate proof of age, it could also begin to identify the medical, social, and economic conditions leading to high rates of infant mortality. 

I also pointed out to the audience that June 4th (the day of my talk) was the day in 1919 when Congress passed the 19th Amendment to the Constitution giving women the right to vote – one of the greatest public health achievements of the 20th century. Women’s Suffrage was crucial to the passage of the Sheppard-Towner Act in 1921, an act promoted by the Children’s Bureau. Among other things, the Sheppard-Towner Act established a partnership with federal and state governments around maternal and child health, it created the first public grants-in-aid program in the U.S., it established MCH programs in all state health departments, and it expanded birth registration from 30 to 46 states. With funding from the Sheppard-Towner Act states were able to build a state-level infrastructure for birth registration, appoint local registrars, and train doctors and midwives to register births. 
Although I didn’t mention it in my speech, there are some interesting parallels between the Shepard-Towner Act and the Affordable Care Act. It was a state/federal partnership which required enabling legislation by the states for some (but not all) portions of the Act. It was also not universally supported because it was considered “socialism” and an overreach of the federal government.
Despite its detractors, the data that came available through the work of the Children’s Bureau and the Sheppard-Towner Act had a tremendous impact on the health of mothers and children. Vital statistics data were made available in ways never before imagined and they were the key to the initiation and implementation of multiple programs and policies. The results were dramatic; maternal mortality began to plummet shortly after the implementation of the Act and the rate of decline in infant mortality rates accelerated. 
In concluding my remarks to the conference attendees, I suggested that, in many ways, our situation today is similar to the early days of the Children’s Bureau. In the last decade we have gained access to an incredible amount of old and new quantitative and qualitative data. We’ve developed methods to analyze those data and turn them into useful information. We have found ways to link data so that we can see the interactions of many of the genetic, social, environmental, behavioral, and medical determinants of health. And we have new partners to work with who help us gain a broader perspective from these data. 
I ended by opining that the need for good data has grown in importance. Given the magnitude of the problems in our communities and the rapid and dramatic changes that are occurring in the realms of medical care, social service, and public health, the need for good data is unprecedented. Also unprecedented are the opportunities that exist to link our data capabilities with programmatic and policy initiatives that will benefit everyone in our society. 
Although I gave this challenge to a group of statisticians and registrars attending last week’s conference, it is a challenge that all of us in public health need to embrace. Data are the coins of our public health realm. We need good data to accomplish our public health mission. Not since the 1920s have we had such an expansion in our data capabilities. Fortunately, this expansion has come at a time when we most need good data to help transform our health systems. Let’s not waste this magnificent opportunity.