Community Indicators for Your Community

Real, lasting community change is built around knowing where you are, where you want to be, and whether your efforts are making a difference. Indicators are a necessary ingredient for sustainable change. And the process of selecting community indicators -- who chooses, how they choose, what they choose -- is as important as the data you select.

This is an archive of thoughts I had about indicators and the community indicators movement. Some of the thinking is outdated, and many of the links may have broken over time.

Tuesday, December 30, 2008

Vital Statistics Data Collection At Risk

Due to budget cuts, the National Center for Health Statistics is looking at dramatically scaling back the data sets it purchases from states, which may significantly limit data availability and potentially data collection. Take a look at this letter from Emily J. Holubowich, from the Coalition for Health Services Research, and see if you would like to make your opinion known. I'm a little late sharing the letter with you, but I think you might be able to still make your voices heard in a number of ways.

And in any case, you need to be aware of the decisions being made, because they may affect your local community indicators projects.

Here's the letter:

Dear Friends,

As some of you may know, NCHS is proposing to purchase in 2009 a limited ‘core’ set of data items from all states and territories and ‘enhanced data items’ (including most public health data items) from a limited number of jurisdictions, depending on the availability of funds. Linked birth and death files, fetal death files, and enhanced data from the remaining jurisdictions would only be purchased if other agencies provide funding for this purpose.

The Excel spreadsheets attached outline which data are currently considered ‘core’ and ‘enhanced’ for births and deaths. The attached one-pager [note: I have these documents and if you'd like to see them, drop me a line and I'll e-mail them to you] prepared by NAPHSIS describes the proposal and its implications in greater detail. For example, nearly all data items that are routinely used to monitor maternal and infant health, such as use of prenatal care, smoking during pregnancy, medical risk factors, and educational attainment of parents, would be considered “enhanced data items” and would not be collected from all states. In addition, our ability to monitor and track select Healthy People 2010 objectives—including those related to Maternal and Child Health, Tobacco Use, and Occupational Safety and Health—will be compromised (see attached summary of implications).

NCHS proposes to redirect the money currently used to purchase these enhanced data to help states and territories implement the 2003 birth and death certificates, and to get all states collecting data electronically. Today only about half of the states and territories use the 2003 birth or death certificates to collect “enhanced” vital statistics. Fewer states collect both, and even fewer do so electronically. So the national vital statistics data are “only as good as the worst state.” NCHS has chosen to pursue this approach since it is unlikely the agency will receive the est. $30 million in one-time funding needed to modernize the system. The cost of collecting the enhanced data in 2009 could be anywhere $5-$7 million, give or take (depending on ongoing contract negotiations with states).

Members of the Friends met with NCHS staff in November to express our concerns about the proposed approach. We of course agree that the current system is far from optimal, and modernizing the National Vital Statistics System will improve data quality, efficiency, interoperability, and security. However, we do not believe it is prudent to cut data collection at this time--particularly when a new administration is preparing to take office and the future of FY 2009 appropriations remain uncertain. Based on our recommendations, NCHS agreed to postpone implementation of the core v. enhanced proposal from the original January 1 date until April 1, 2009 when more is known about FY 2009 funding and the FY 2010 budget. As Ed Sondik noted:

“Based upon the concerns raised by Friends, we’ve decided to postpone until April 1 the implementation of our new plan for funding our collection of vital records. Our new plan is based upon our belief that our primary commitment is to obtain twelve months of data on core items on birth and death certificates and to invest in the infrastructure required to improve quality and timeliness of vital statistics data. We will, of course, broadly notify our colleagues in the Department and our data users of our intention to implement this approach in April. In the meantime, we will monitor developments that may affect how funds will be allocated, and we’ll be open to modifying our current approach based upon any changes to our budget. We understand how important it is to obtain information from the "enhanced" items on the certificates, and we will invite our colleagues to identify those enhanced items that they consider of most critical importance. If at all possible, we will try to find a way to collect some of these items as funding allows.”

Carolyn Mullen of March of Dimes, Mary Jo Hoeksema of Population Association of America and myself late last month met with Wendell Primus of Spkr. Pelosi’s office and Ben Abrams and Ivana Alexander of Rep. Hoyer’s office to explore the possibility of including one-time funding in the January stimulus package to allow states and territories to modernize their vital statistics programs and mitigate the core v. enhanced proposal. The staffers were concerned by the proposed cuts in both vital statistics and the surveys, but admitted inclusion of these funds in the stimulus would be "a long shot." Instead, they urged the Friends to concentrate our efforts on FY 2010 appropriations and to submit a letter to the transition committee.

Per the suggestion of House leadership, we are:

  • Drafting a letter to the transition team (and hopefully scheduling a meeting) to express our concerns about the impact of funding shortfalls on NCHS's core infrastructure and urging the transition team to also evaluate the placement of NCHS. We would cc on this letter the appropriations committees, the House and Senate leadership, and OMB. I will not collect signatures on this letter and will instead include as an attachment a list of the Friends membership. I will circulate this letter to the Friends before the end of the week.
  • Drafting a letter re: the core v. enhanced proposal to OMB/CDC through the open call for comments on the vital statistics collection ( We will cc on this letter the Asst Surgeon General, the Asst Secretary, and the NCHS’s Board of Scientific Counselors. I encourage other members of the Friends to take advantage of this opportunity to get on record re the importance of vital statistics to your community. Comments are due by December 29.
  • Meeting with staff at OMB’s OIRA to develop some internal champions, as they all use these data.

As a longer term goal, we could do a “Dear Colleague” from Members of Congress to the new CDC director outlining the challenges the agency is facing and urging them to reinvest and rebuild in data collection.

I apologize for the length of this email and for just notifying you of these developments now but I felt it important to hold back until I had the official “facts” from NCHS before going public. I am happy to answer your questions.

Emily J. Holubowich, M.P.P.
Director, Government Relations
Coalition for Health Services Research
1150 17th Street NW, Suite 600
Washington, DC 20036
(p) 202.292.6743
(c) 202.557.9084
(f) 202.292.6843


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