NATIONAL CENTER 

For HEALTH STATISTICS 

VITAL and HEALTH STATISTICS 

DOCUMENTS AND COMMITTEE REPORTS 

PROPERTY
OFTHE


PU3LlCATiONS BRANCH 

EDITORIAL LIBRARY

Report of the 

Fifteenth Anniversary 

Conference 

of the United States National 

Committee on Vital and Health 

Statistics 

Review and evaluation of past activities of the 

Committee with suggestions for future study in 

demographic, health, and medical-economic statistics. 

Washington, .D. C. June 1966 

U.S. DEPARTMENT OF 

HEALTH, EDUCATION, AND WELFARE Public Health Service 

John W. Gardner Wil Iiam H. Stewart 

Secretary Surgeon General 
Public Health Service Publication No. loi3(J.Series .& No. ~ 
NATIONAL CENTER FOR HEALTH STATISTICS 

FORREST E. LINDER, PH. D., Director 

THEODORE D. WOOLSEY, Deputy Director 

OSWALD K. SAGEN, PH. D., ~ss;s~afzt Director 

WALT R. SIMMONS, M.A.,Stathical --4dvi~or 

ALICE M. WATERHOUSE, M.D.,Medical Advhor 

JAMES E. KELLY, D.D.s.,Dental Advisor 

LOUIS R. STOLCIS,M.A.,Executive Q?icer 

OFFICE OF HEALTH STATISTICS ANALYSIS 

IWAO M. MORIYAMA, PH. D., Cfiief 

DIVISION OF VITAL STATISTICS 

ROBERT D. GROVE, PH. D., Chief 

DIVISION OF HEALTH INTERVIEWSTATISTICS 

PHILIP S. LAWRENCE, Sc. D., Chief 

DIVISION OF HEALTH RECORDS STATISTICS 

MONROE G. SIRKEN, PH. D., Chief 

DIVISION OF HEALTH EXAMINATION STATISTICS 

ARTHUR J. MCDOWELL, Chief 

DIVISION OF DATA PROCESSING 

SIDNEY BINDER, Chief 

Public Health Service Publication No. 1000-Series 4-No. 4 

Library of Congress Catalog Card Number 66-60074 
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CONTENTS


Introduction


Dr. Robert Dyar, Chairman


Background


Dr. Halbert L. Dunn


Review, Evaluation, and Recommendations


A.	 Demographic Statistics


Presentation by Dr. Taeuber


Presentation by Dr. Kirk


Marriage and Divorce Statistics


Natality Statistics


Mortality Statistics


Population Projection and Estimates


Data for Negroes and Other Nonwhite Persons


Illegitimacy Data ---------------------------------------------


Family Statistics


Use of Agencies Outside Government


Need for aBener Vital Statistics System


Discussion


B. Health Statistics


Presentation by Dr. MacMahon


Discussion


Presentation by Dr. Densen


Discussion


Other Smdy Proposals


C. Health Resource and Service Statistics


Presentation by Dr. Anderson


Discussion


Presentation	 by Mr. McNerney


Discussion


Committee Functions and Procedures


Committee Functions


The Committee Mechanism


External Relationships of the Committee


Conference Summary


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CONTENTS—Con. 

Page 

Appendix I


Past and Present Members of the Committee 18


Observers and Guests of the Committee 21


Appendix II. Recommendations of Smdy Topics 22


A. Demographic Statistics 22


B. Health Statistics 23


C. Health Resources and Services 24


D. Committee Functions, Smucture, and Prwedures 25


Appendix III. Functions of the Committee 26

THIS REPORT is a summary of the discussion that took place at the 15th 

Anniversary Conference of the U.S. National Committee on Vitat and 

Health Statistics. Present and past members of the Committee met to 

review and evaluate past activities with special attention given to major 

gaps in the pro~am. This overall review was undertaken for guidance 

of a futwe program to include subject matter areas neglected in the 

past, those needing renewed attention, and those related to new areas 

resulting from changes of interest in and emphasis on demographic and 

health statistics. Evaluation of and suggested changes in functions and 

procedures of the Committee were also outlined. 

Suggestions for study in demographic and health statistics included mechanisms to facilitate vesearch in these fields-such as a population ~egis ­

ter, a universal birth number, and a type of national archives. Attention 

should be paid to methods for obtaining answers to current questions in 

natality and for gveater understanding of differentials and changes in 

mortality. Improvement in coverage of marriage and divovce statistics 

and more vital and health statistics for small areas aye obvious needs. 

Other ideas for studies included relation of migyation and health, epidemiolo~ic uses of vital and health statistics, and their uses inprograrn 

planning and evaluation. 

Fundamental questions exist about health resources and services, as, 

for example, medical care payment, measures of quality, types of flow 

within the health seyvice system, and translation of consume~ needs into 

estimates of needed personnel and facilities. These and many other 

questions are being Yaised by both the mayket and consunzeys of medical 

services. 
FIFTEENTH ANNIVERSARY CONFERENCE


OF THE UNITED STATES NATIONAL COMMITTEE 

ON VITAL AND HEALTH STATISTICS 

Past and present members of the U.S. National Committee on Vital 

and Health Statistics, a technical group advisory to the Surgeon General 

of the U.S. Public Health Service, met in Washington, D.C., on December 

14 and 15, 1964, to commemorate the 15th anniversary of its creation 

by assessing its record and planning for its future. Former and present 

Committee members and those who attended the anniversary meeting 

are shown in Appendix I. The present document, summarizing the discussions that took place over these 2 days, is structured according to 

the agenda that was followed. 

Material in this report was selected and summarized from the 

verbatim record by John Storck, Ph. D., Division of Vital Statistics. 

Occasionally the order of discussion has been rearranged to bring 

closely related topics together. A few quotations from the verbatim 

record have been edited slightly for purely verbal reasons. Suggestions 

for future study topics are summarized in Appendix II. 

INTRODUCTION 

DR. ROBERT DYAR, Chaiyrnan 

Dr. Dyar opened the meeting with three 

actions of respect: he named the Committee’s 

predecessor chairmen (Dr. Lowell J. Reed, Dr. 

Philip M, Hauser, Mr. Pascal K. Whelpton, and 

Dr. Brian MacMahon); he noted with regret that 

death deprived the conference of three former 

Committee members (Dr. W. Thurber Fales, Mr. 

P. K. Whelpton, and Dr. Harold F. Dorn); and he 

greeted two guests (Mr. F. Fraser Harris, Director of the Health and Welfare Division of the 

Canadian bminion Bureau of Statistics, and Dr. 

Ruth R. Puffer, Chief, Health Statistics Branch of 

the Pan American Health Organization). 

Dr. Dyar called attention to the uniqueness 

of the Committee: it is multidisciplinary (an 

unusual concept 15 years ago); it provides a means 

for vital and public health statisticians to cooperate with sources and users of their data; it conducts no statistical programs of its own, has no 

authority except its judgment, and endeavors only 

to be constructively responsive to questions posed 

by others in the public health and medical fields; 

and it is part of an international movement, since 

some 50 countries have the same or similar 

framework. 

It is the purpose of this conference, Dr. Dyar 

observed, to discuss forward-looking ~ssibilities 

for the consideration of the present Committee. 

Peyhaps we should modify OUY activities and 

inteyests to meet the challe~e of new pYoblems. What issues should we face? Whut 

new subjects should we considey ? What 

methods and procedures should we use? 

1 
BACKGROUND 

DR. HALBERT L. DUNN 

Dr. Dunn reminded the group that the International Conference for the Fifth Decennial Revision of the International List of Causes of Death 

recommended in 1938 that the United States 

continue its studies of the statistical treatment 

of joint causes of death. The resulting United 

States Committee on Joint Causes of Death 

included among its members and consultants 

experts from the United Kingdom, Canada, and 

the Health Section of the League of Nations. 

This Committee “realized that the big job was to 

. . . produce an international list of causes of 

illness which was in some way linked directly 

with the causes of death. ” 

The Sixth Decennial Revision Conference held 

in 1948 substantially accepted the Committee’s 

proposal and gave the world the Manual of the 

Interndional Statistical Classification of Diseases, Injuries, and causes of Death. 

The U.S. Committee on Joint Causes of Death 

had succeeded, Dr. Dunn observed, through a 

broad interpretation of its mandate and because it 

had included in its deliberations a wide representation of experts interested in establishing a 

morbidity classification. The effort had been so 

successful that, Dr. Dunn remembered, it was 

felt that a similar mechanism was needed to 

tackle future problems. The proposal for the 

establishment of national committees on vital 

and health statistics or its equivalent, a subject 

of heated discussion, was finally adopted. As 

Dr. Dunn put the matter once: “If this were to be 

done, the conference would have to request nations 

to undertake such actions, since international 

protocol would be necessary for nations to work 

on international technical problems. ” 1 The 

strength of national committees on vital and 

health statistics, Dr. Dunn concluded, is “in 

granting complete freedom . . . to technical peolDunn, H. L.: Objectives underlying future patterns of 

work of national committees on vital and health statistics. 

Bulletin of the Wodd Health Organization. Vol. 11, No. I-2, 

Geneva, Switzerland. World Health Organization, 1954. p.159. 

pie.” That freedom, of course, is confined to 

making recommendations concerning technical 

matters. 

REVIEW, EVALUATION, AND 

RECOMMENDATIONS 

The substantive activities of the Committee 

were considered by the Conference under the 

following headings: 

A. Demographic statistics 

B. Health statistics 

C. Health resource and service statistics 

A moderator introduced each of these topics; 

and separate presentations were made by two 

discussants, after which the topic was thrown open 

for general consideration. Each topic, preceded 

by a short introduction based on the remarks of 

the moderator, will be treated here in terms of 

the two presentations and the ensuing discussion. 

In a few places the discussion has been added 

directly to the eliciting presentation. 

A. Demographic Statistics 

Moderator: Dr. Elbridge Sibley 

Discussants: Dr. Conrad Taeuber 

Dr. Dudley Kirk 

Prior to 1946, Dr. Sibley observed, the numerators and denominators of vital rates were located 

in the same organization—the Bureau of the 

Census. Since then the numerators have been 

located in the Public Health Service. 

PRESENTATION BY DR. TAEUBER 

Dr. Taeuber emphasized two aspects of the 

country’s demographic statistics: they are a 

byproduct of administrative statistics, and their 

improvement sometimes has depended on statistics that are produced by a unique Federal-State 

relationship involving the cooperation of many 

units with varying interests and resources. On 

occasion the Committee has recognized that some 

demographic needs can best be met by private 

agencies. 

Accuracy and completeness in the registration 

of vital events have been an early and continuing 

concern of the Committee, which has strongly 

2 
emphasized the need for central tabulation of 

national vital statistics fromcopies of theoriginal 

records, It also has stressed the need to provide 

technical services to State vital statistics offices. 

There was considerable discussion of the 

need to improve the accuracy of information on 

vital records. The Iowa study to evaluate the 

reporting of congenital malformations on birth 

certificates by matching with hospital records 

was mentioned. It was noted that hospital records 

also needed checking; even within one clinical 

record there can be discrepancies. 

The Committee has encouraged completion of 

marriage- and divorce-registration areas. There 

is urgent need for more adequate marriage and 

divorce statistics, including statistics on family 

formation and dissolution. 

We need to know more about the relationship 

between ?nawiage and the rate of household 

and family fo~mation. . . . In many instances a 

wawiage reduces the number of households. 

. . . Divovce. . . may lead to the establishment 

oj” two kowsekolds whe~e there was only one 

befo~e. 

We need to know more about the remarriages of 

divorced and of widowed persons, about the impact 

of divorce and widowhood on fertility, about the 

relationship of marital status to death rates. 

Dr. 

With respect to timeliness of publication, 

Taeuber held that 

We kave passed tke time wken the analytical 

uses to wkick statistics could be put were 

suck tkat it didn’t matter much whethey the 

mateviats weye wp to date. . . . Pevhafis we 

need to give move attention to the possible 

contributions of sampling and advance repoyts 

in o~der to keep abreast of Yapidly changirg 

developments. 

He pointed out that the recommendation to use a 

sample of birth records to make some data on 

fertility available long before the regular timetable would permit had not been implemented. In 

the discussion it was suggested that this proposal, 

as well as the currently collected 10-percent 

mortality sample, may now be obsolete in view 

of “. ., substantial progress made in speeding up 

the tabulation of the full annual materials. ” 

Dr. Taeuber noted a considerable broadening 

of interest in demographic statistics combined with 

the need for data pertaining to areas better suited 

to analytical uses than the traditional administrative areas. Areas such as the concept of standard 

metropolitan statistical area and the concept of 

rural and urban areas need to be more carefully 

defined for statistical uses. “The mechanics of 

coding addresses to such units as census tracts 

or city blocks are far simpler than they were 

even a few years ago. ” 

Dr. Taeuber also considered ‘‘. . . the social 

and economic background in which birth and 

death occur. ” After referring to questions that 

were raised about accuracy of occupational entries 

on basic records and their comparability with 

census records, he pointed out that the Committee’s alternative of educational attainment had 

not met with general acceptance among the 

registration areas. 

The Committee had given little attention to the 

underregistration of deaths, to the possible effect 

of age biases in reporting deaths, or to the results 

that might follow from adjustment of census 

figures and population estimates. In general, he 

concluded, 

Much move attention needs to be given to 

the cimurnstances that contribute to eyyoy 

OY the absence of en’ov in the pyepa~ation 

of oyi~”nal documents. 

The Committee, in common with others, has 

paid no attention to internal migration, which 

is of great importance to the public kealth 

analyst and is a majov element for the 

demographic anulyst. Migration. . . is frequently related to health conditions in both 

the areas of in- and out-migration. Mawiage 

very frequently involves migvation on the 

payt of one OYboth payties. BiWt and deatJz 

rates aye subject to considerable en-oy 

unless nzi~ation is taken into account. 

The Committee has shown little concern for 

the social and economic correlates of mortality, 

for such phenomena as changing and even increasing mortality at the older ages, for continuing 

mortality differences among population subgroups, 

or for the relatively low mortality of nonwhite 

persons among the aged. We know too little about 

family and household characteristics of people 

who die. 

3 
Dr. Taeuber reviewed the Committee’s extensive studies of needed improvements in fertility 

statistics and noted with satisfaction that a 

recommendation favoring more analysis ”.. . in the 

first instance by the staff that prepares the 

statistics” is now being implemented. 

Illegitimacy has been neglected—its distribution in the population, the rate at which it 

occurs, its geographical variability. 

In spite of considerable concern with population projections, there is still a need for more 

appropriate techniques, perhaps requiring extensive computations which are now within the 

reach of the computer. Especially difficult is the 

task of getting current estimates of the population 

of small areas such as counties, which are 

essential for obtaining rates for these areas. 

In the ensuing discussion a conferee mentioned 

a national coordinate system for locations that 

was being worked on Around 1940 by the Bureau 

of the Census and the Post Office Department. 

The Committee’s endorsement of a quinquennial census has as yet produced no effect. In the 

discussion a conferee questioned whether even a 

complete ~pulation figure for local areas would 

give the local health statistics the base that i.s 

needed if it were available only every 5 years. It 

is understood that demographic data to be gathered 

would be limited to a few items, and in any event 

conditions could change greatly in a few years. 

Local household surveys that are beginning to 

approach the National Health Survey appear to 

be needed to supply information required to 

handle local-area health programs. Admittedly 

results might be spotty and might not reach all 

service programs. The little places would probably 

be left out. 

PRESENTATION BY DR. KIRK 

Dr. Kirk discussed in turn the four types 

of vital statistics of concern to demographers — 

marriage and divorce, natality, mortality, and 

population projections and estimates; three special 

problems—data for Negroes and other nonwhite 

persons, illegitimacy, and family statistics; and 

two broader questions—how governmental organizations should be related to outside agencies, and 

need to improve the vital statistics data system 

itself. 

Marriage and Divorce Statistics 

Marriage and divorce statistics together with 

natality and mortality data should be full partners 

in the vital statistics system. Marriage should 

enter, no less than age of mother, as an important 

factor in natality analysis. Perhaps no other vital 

statistic is more significant to business users than 

the marriage rate. “The number of children is 

perhaps more properly considered as a function 

of the marriage than it is of the woman. ” We need 

better measures of the changing age at marriage, 

cross-tabulations of husbands and wives, trends in 

residential origin of mates, age-adjusted rates far 

populations eligible for marriage or at divorce, 

and marriage attrition tables, 

Natality Statistics 

Dr. Kirk noted, “great progress. . . under the 

leadership of this Committee. . . [which] resulted 

in revolutionizing the reporting, tabulations, and 

analysis of natality statistics. ” Howeverj the 

gains are partial: 

These new developments are a valuable 

contribution to inquiry into the sources of 

obsevved changes infertility, but they do not 

resolve the question of determining the 

contempova~y trend infertility. To that extent 

the new measuves are a failu~e. 

Short-range forecasts must bring marriage into 

the equations. First births are closely connected 

with time of marriage—90 percent occur within 

5 years of marriage, and a good deal more than half 

of that 90 percent occur within 24 months of marriage. This means that date of marriage should 

be added to the birth certificate. In the ensuing 

discussion a conferee with registration background 

suggested that certificates be used as a sampling 

base for gathering needed information in lieu 

of adding items to them. It was noted that the 

National Center for Health Statistics currently is ‘ 

conducting special studies using samples of 

certificates as initial information sources to query 

for additional data. Also suggested was “. . . a 

medical record of birth which would be separate 

from the legal record.” 

4 
Data on expected family size, future births, 

and further surveys on family planning are also 

needed. It maybe difficult for a government agency 

to make this last kind of inquiry. However, there 

are reasons associated with the transition from 

ora 1 to intrauterine contraceptives which make 

1’)65 an excellent year for a study of family 

planning programs. 

A conferee pointed out that in one study of 

expectation and performance with respect to 

pregnant white women, a large proportion were 

not using contraceptives; among those who were 

using them the older women took longer to become 

pregnant. “There are so many things involved that 

it is really a miracle to . . . come up with anything 

that really approaches something useful.” In the 

words of another conferee, “.. . we have no really 

very good studies. ” 

Mortality Statistics 

It is important to find out why there have 

been little or no gains in age-specific mortality 

since 1954. Involved in the comparisons that 

might answer this question are difficult statistical 

problems with which the Committee should be 

concerned. Even the fundamental data—the ages 

at death in the numerators and the age-specific 

distributions in the denominators—need to be 

questioned. Perhaps an intergovernmental study 

is needed. 

More work is needed on the reasons for higher 

mortality of males; on problems of perinatal and 

infant mortality (although the Committee has been 

active here), including such things as the statistics 

on induced abortion; and on genetic studies of 

hereditary diseases and defects. 

Population Projection and Estimates 

“The history of population projections m not 

a distinguished one, ” to which cohort fertility and 

other recent developments “have added very 

little.” The Committee needs to be concerned with 

this problem. 

Current estimates, especially for the geographic divisions of the country, lack the most 

crucial element—migration. “The crucial variable 

. . . is now not births, not deaths, but migration. ” 

Although the rate of natural increase for about 

95 percent of the States is usually between 1 and 

2 percent per year, the population change for the 

States has ranged from minus 7 percent to over 

75 percent in the decade 1950-60. “The Committee should regard migration . . . as a priority 

item even though there may be some question as 

to whether migration is a vital statistic.” 

Theve is the possibility now with electronic 

computation of @ite elaborate regression 

procedures usinga whole battery of measures, 

such as school enrollment, social security 

records, telephone listings, utilities, construction data, births, deaths, and historical 

experience. 

Dr. Kirk next discussed three specific data 

problems not confined to the particular areas 

considered before. 

Data for Negroes and Other 

Nonwhite Persons 

Bogue (University of Chicago) has estimated 

that the 1960 census shows an 8.1 percent undercount of Negro males, with a 3.7 percent undercount of females. By age, there is an estimated 

undercount of 15 percent for males aged 20-29 

and an overcount of 29 percent .at ages 75-79. 

In short, these figures are “a mess,” needing study. 

The Committee should also continue to exercise a watchdog function in keeping so important 

an item as color or race on the basic documents. 

Illegitimacy Data 

The rise in illegitimacy rates over recent 

decades creates serious problems in health and 

demography, and there are many statistical 

problems connected with these data. 

Family Statistics 

The situation is not yet ready for a comprehensive system of family statistics, but the 

Committee should begin to explore ways of 

getting usable family statistics. 

Dr. Kirk next turned to two broader questions. 

5 
Use of Agencies Outside Bwt -if the Committee is going to wont at 

Government 

There is a growing need to recognize the 

importance of cooperative work with outside 

organizations. A conferee later suggested that the 

Committee explore the responsibility and the role 

that these organizations might assume. 

Need for a Better Vital Statistics 

System 

We need another kind of system—one especially that can cope with migration. The country 

“is going to have to come to a population register 

system” even though there are massive problems 

in establishing and maintaining it. The Committee 

should review the operation of such systems 

elsewhere, it should consider how electronic 

methods might facilitate its operation, and it 

should explore the legal problems that are involved. 

With a register “the effects of migration and 

current population estimates. . . are intrinsic in 

the system . . . . The longitudinal record is on the 

books . . . and related kinds of longitudinal documents” could be created like “a basic medical 

record for individuals.” At present “there are 

fragments . . . of records or registers of the 

population of the United States”; besides vital 

statistics records, there are census, Social 

Security, and Internal Revenue data which are 

too diverse for a genuine population register. 

Discussion 

Because of the magnitude of the problem and 

the technical difficulties that would have to be 

solved, it was suggested that sampling studies 

might better be used than a population register. 

Another conferee emphasized “the terrific burden” 

that would be placed on the population and added 

that the plan of a population register would’ ‘create 

for scientific purposes a police activity. ” It 

was suggested that registration might have an 

award attached to it. Another conferee saw ao 

objection to the Committee making the three 

studies Dr. Kirk had envisaged [of register 

systems now in use, of new electronic possibilities, 

of legal problems connected with a register]: 

this, jimt I’d ~ather have them decide what 

the system is for, and I don~t think the 

Committee can come up with an agenda, 

a menu of pwposes that this thing would 

serve that would make it useful. . . . Let’s 

assume it worked. . . . What have you got h 

there to start with, and what do you want to 

do with it that’s any good? I can’t think OJ’ 

any statistical operation in which the ratio OJ= 

yield to cost is as unfavo~able as it probabl> 

is in this situation. 

Small-area population statistics were cited as a 

major area in which a population register might 

prove useful. 

In the course of the discussion the birthnumber concept was briefly described. Proposed 

around 1950, it was not adopted by all of the 

registration areas, and it has been dropped by 

quite a few areas since then because it was not 

used. A Public Health Conference on Records 

and Statistics study group is now wo”rking on 

this problem of record linkage. This group is 

considering the merits of an index of deaths to 

be used for death clearance. 

Mr. Harris described the Canadian uniform 

numbering system for all births, deaths, and 

marriages, which is associated with the national 

family allowances program. It covers all persons 

born after 1925, and in some provinces it extends 

back into older records. In Quebec, especially, 

the birth number will be made 

an all:pwpose number to be used as the 

actual filirg fyamework in certain social 

secuvity Pyogvams and as a central number 

cross +efeyenced to the actual filing numbem 

in others. 

The Canadian birth number has been used to match 

cohorts of marriages with births, identifying marriages consanguineous at the first cousin level 

with subsequent linking of infant deaths to study 

death and handicapping-condition differentials. 

Such studies need not stop here. Thus Newcombe 

(Canada) has studied the degree to which stillbirths and infant deaths tend to be replaced 

within stated periods for given characteristics 

of mothers. 

6 
A total linkage system also would enable 

the translation of case-basis hospital records 

into person-basis statistics. This could result 

in differential predictions regarding future hospital stays of groups having different prior hospital 

experiences. 

With respect to the need for a total population 

register in Canada, Mr. Harris reported that the 

proposal under consideration 

is not to registev the whole population from 

scratch and then move it forwayd in the fovm 

of a population registey but to take advantage 

qf the ~ecoyds that do exist mainly in the 

kealth field and to use some common numbering system such as the birth numbey to link 

these togcthev in such a way that one will? in 

jtzct, have.. . something that quite closely 

would ~ese Pnble a po~lation register. 

For example, changes in address would be picked 

up automatically by the system (as from the post 

office or other agencies), and the record could 

easily be updated without requiring individuals 

to report a change of address. 

B. Health Statistics 

Moderator : Dr. Forrest E. Linder 

Discussants: Dr. Brian MacMahon 

Dr. Paul M. Densen 

Dr. Linder introduced the discussants by 

suggesting that the topic to be discussed was 

concerned with what the entire country should be 

doing in health statistics and not just the National 

Center for Health Statistics and that the perspective should be international as well as national. 

Later Dr. Linder reminded the conferees that the 

international program of the National Center for 

Health Statistics is “. . . at a place where we can 

afford to stop and look around and see where we 

might go. ” Further, the Committee also is at a 

point of change. Over the past few years a great 

deal of work was put into revising the International 

List. With this activity approaching completion, 

the Committee “.. . has a chance to look around 

and see with what new and challenging ideas they 

might want to engage themselves. ” 

PRESENTATION BY DR. MacMAHON 

Dr. MacMahon dealt with the use of vital and 

health statistics for epidemiologic purposes. He 

noted, extending a phrase of Dr. Taeuber’s 

11. . . that epidemiologic statistics are a byproduct 

of the demographic statistics that area byproduct 

of the administrative statistic s.” To date, however, 

demographic improvements have been relevant 

chiefly to what might be called classical epidemiologic methods. As epidemiology has moved 

from hypothesis formation to hypothesis testing, 

there has arisen 

the need fov covvelation of data on imlividuals ~ather than on populations. Studies 

involving vital ~ecovds aye often reco~dlinked rather than Yecovd-dependent. They 

sta~t OY end with a vital record, but rarely 

is the vital reco~d the sole source of info~­

mation. 

The need for tabulated data is reasonably 

well-filled, often by regularly published information and sometimes by special tabulations. Now, 

however, existing records must be supplemented 

by data from other sources that might be obtained 

from nonstatistical information appearing on these 

records—for example, the names of possible 

informants. 

The issue of confidentiality of vital record 

information, the availability of personnel and 

resources at the record source, and whether 

the investigator has the item of information a 

particular State filing system requires for locating 

a certificate are matters of concern. 

To deal with these central problems, Dr. 

MacMahon made two proposals for Committee 

study, one of which was 

The desirability andfeasibility of establishing 

a national archives of vital and health veco~ds 

in which would be presevved, informs pYoviding reasonable accessibility, as a minimum 

the bin% and death certificate material now 

routinely sent to NCHS, but, additionally, 

basic vecoyds of other activities such as those 

of the National Health SuYvey and individual 

epidemiolo~”c investigations. 

7 
Discussion 

Various names were suggested for the proposed nationalarchives of vital and health records, 

including “access file” and “National Center for 

Health Records.” 

There was doubt as to the accuracy and 

validity of such an accumulation- almut “the 

value and the propriety of routinely collected 

information for epidemiologic purposes.” 

The minimum core of the national archives, 

one conferee noted,would be something like a 

national index of bti and death records. At its 

maxhnum it might become a repository for a 

vast number of different kinds of records, and 

questions of quality certainly would arise. 

Dr. MacMahon replied that you at least might 

expect to learn, for example, the date and place 

of death of apemon, thusopening up the possibility 

of locating ahospital record or some other source. 

In any event the vital records would not lose 

quality through being stored in a central place, 

and they would certainly be more accessible. 

A conferee with registration experience 

doubted that a national index would be legally 

possible. As another remarked, to make individual 

records generally available ‘‘. . . would scare a 

State regislrsr to death-” 

As a second proposal Dr. MacMahon recommended that the (hmnittee engage in 

An examination of the issue of confidentiality 

of b“rth and death certificates and of the 

practicability . . . [of tmnsferritg’] to the Federd government power to authorize use of 

birth and death certificate material for health 

stwdies. 

A conferee stated that some registration 

areas are in such financial straits that they 

bide bebind the confidentiality restriction to keep 

from filling research requests. This could be 

remedied, however, through financial grants to 

States to enable them to fill these requests. 

Another conferee held that what is needed is 

A set of guidelinesas to how. . . to carry 

out. . . stdutory requirement of con/identiafity of vital records plus the inte~est of 

the medical society and the fact that certain 

records might lead to liability of the physician 

that WOKU end in court. 

Also needed, another conferee observed, is to 

have funds coming from research fees go into a 

revolving fund set up for the purpose in the vital 

records operation within the health department, 

These funds could then be used to engage additional 

personnel needed to supply research needs. This 

would require new legislation in some areas. 

It was suggested that the Committee might 

conduct a study of just what the confidentiality 

issue is, not only with respect to vital records 

but medical records in general. Another conferee 

warned, however, that giving the problem visibility 

might be destructive. It also was suggested that 

the Committee might consider generally how 

records could be made more usable for research. 

As another broad area for Committee ccmsideration, Dr. MacMahon instanced need for new 

data sources. Epidemiologic methods are being 

transformed for two reasons: 

A change of subject matter to majo?’ concern 

with the chronic diseases, a need to look at 

low-level epidemics, diseases in which thew 

% a long latent peviod between cause and 

effect, and for which development is insidious 

and diagnosis in the early states often 

difficult . . . [an4 the Potential in data processing equipment. 

All existing data sources—vital records, 

morbidity reporting (including the National Health 

Survey) —need review from the viewpoint of 

epidemiologic utilization. Other data sources, 

such as model hospital reporting areas and model 

physician reporting areas, should be considered. 

In England groups of about 100 physicians each 

who know their base population agreed to keep 

uniform records of every patient they see, of the 

diagnosis, and of the treatment. In the United 

States there would be the problem of defining 

the population at risk. 

A conferee agreed on the need for such groups, 

instancing physical rehabilitation and coronary 

heart disease as areas of application. While 

there is much work going on with respect to these 

problems, there are no community programs nor 

will there be any until we find ways, first, to 

control the incidence and, second, to work with 
practitioners in the community who see this 

possibility. 

Finally, Dr. MacMahon recommended that 

a program of epidemiologic studies based on the 

National Health Survey, similar in structure to 

studies based on vital records that we now have, 

should be considered. For example, a recent 

study of peptic ulcers, though useful for administrative and economic purposes, was only the 

start of an epidemiologic investigation, because 

there was neither a confirmation of diagnosis 

nor a separation from other types of ulcers 

(e.g., gastric or duodenal). 

PRESENTATION BY DR. DENSEN 

Dr. Dens en dealt with the use of vital and 

health statistics in program planning and evaluation. He spoke first of the need for localarea health statistics, which might be developed, 

for example, by local household surveys modeled 

on and tied to the National Health Survey. For 

areas with large populations, such surveys could 

be coordinated with the National Health Survey, 

either to supplement it or sometimes to indicate 

that its values can be relied on for the area. 

When one comes to local neighborhood areas, 

however, we may need to develop the statistics 

further. The Committee should examine this 

whole subject of local-area statistics. 

Discussion 

Dr. Densen did not believe that the National 

Health Survey should expand its program as 

such into local areas. It should keep its national character. Local-area studies should be organized, however, to find out in what ways they 

differ from the national picture. While conforming 

in this manner with the national survey, they 

could also contain additional questions that depict 

the local scene in fuller detail. 

It might be a good idea, also, for the National 

Health Survey to consider some kind of subsidizatj.on to local area surveys or at least some 

experimentation on tying the two kinds of surveys 

together. 

Dr. Linder reminded the group that the 

Committee had developed the plan for a national 

health survey which led to the passage of the 

National Health Survey Act of 1956. It might now 

study how local health surveys might be organized 

The styategy of them, the plan of them, how 

they ave implemented. . . the various mechanical and organiz&”onal ways that they 

could be done, and. . . set UP a constif@oIs 

framework . . . as the Committee did fw the 

National Health Survey 10 years wo. 

It was suggested that the medical examination 

part of the National Health Survey might gaiE 

something by enlisting the cooperation of local 

physicians, as for example in determiningg the 

frequency of hernias, where there is little diagnostic variability. “Imcal health departments 

which are concerned with . . . bringingpublicheskh 

directly to the population, must find ways of 

working with practicing physicians of the community. ” Otherwise they are confined to the 

indigent population. 

Mr. Woolsey cautioned against the use of 

national results to clarify local situations. “If 

there is a lot of money at stake they would 

probably need to collect their own data to get 

better information.” Gn replicating the national 

survey, even on an independent basis, 

the Nationul Health Survey, and pati-cularly 

the Health Intewiew Survey, seems to be 

discwssed as a perfected instmment, and it 

is by no means such . . . . We are in the midst 

of a pvogram. . . of reappraisal of the whale 

.swvvey to try to bm”rg to bear the methodolo~”cal research that has been carried out 

over the past 5 or 6 years and make such 

improvements as we can, and perhaps cut 

back on the objectives at points where we 

think that it is pretty evident that we are 

not accomplishing the job and sins’tyet 

know how to accomplish the job. 

Perhaps attention should be shifted to chronic 

disability, for example, rather than to chronic 

morbidity. Also, it seems possible that disability 

is what health departments should be concerned 

with. “This represents our Wures in the field 

of public health just as mortality does.” 

9 
It was also pointed out that local surveys, 

differing from the national survey, would allow 

a great deal of experimentation. In particular, 

local surveys can ask questions that are directly 

related to service programs of the health department. To gain local support, household surveys 

must ask questions that are meaningful at the 

local level. 

One method of cooperation would involve joint 

consideration of certain methodological problems 

by the National Health Survey and selected local 

surveys. Similarly, medical-care utilization could 

be studied by the Committee to see what approaches 

promise to be most useful. 

Local-area surveys can study special 

groups— e.g., Puerto Rican migrants to the United 

States or Negroes migrating to Northern cities. 

In the course of this discussion another 

problem was emphasized—the question of 

response error on surveys of the kind under 

discussion. In Dr. Linder’s words: 

TheYe is an enormous field he~e foy. . . 

methodological YeseaYch wo~k. We visualize 

this as peYJ2aps a crisis in social science. 

Moye people aye taking suyveys of moye 

t12ings. . . asking people questions without any 

commensurate amount of work in trying to 

[test] the accuracy with which these questions 

can be answeyed OY are answeyed . . . . I think 

these questions can be answered and the 

methods [of validation] can be developed, but 

it is cevtainly going to take a lot of effort 

to do it. 

One conferee mentioned longitudinal observation as a means of evaluating survey results. 

Some time was spent inquiring what the word 

might mean. Is it enough that there is continued 

observation of a single panel? One conferee 

distinguished this type of observation, which he 

called a prospective study, from a true longitudinal study, “in which the intermediate steps form 

an important part of the analysis. ” It was suggested 

that the Committee might investigate this term. 

Turning to another matter, Dr. Densen noted 

that the chief means now available for control 

of the increasingly important chronic diseases 

is comprehensive, high-quality, continuous medical care. Health departments are at least acting 

as catalysts in providing this type of care, but 

what they urgently need are precise statistical 

measurements for measuring its effectiveness. 

Thus we need ways of describing the clinical 

and functional status of the patient when he enters 

the program; and we need measures of the 

effectiveness of alternative procedures. 

For example, some hospitals tend to keep 

acute, nonfatal coronary occlusion patients about 

15 days, while others average about 30 days, 

Which is the better procedure from the standpoint 

of the patient’s subsequent experience? To answer 

this question we must start with similar patients; 

we must agree on the prognosis end points to be 

examined; we must know what we mean by 

“severity”; what measures of the impact of stay 

we shall use; how changes in functional capacity 

shall be arrived at. 

But beyond this we are moving away from 

providing services through categorical disease 

entities to general medical care: 

A geneyal medical-care pYogra??2 is one in 

which the age?2cy YendeYing t)2e service to 

the eli~”ble gyoup assumes Responsibility 

foy the total health of those to 2vhon2 it 

gives care. 

According to what measures can one say that 

this approach provides better medical care than 

can be provided otherwise? Further, with one 

group of elderly people it was found that many of 

the things that are being done “are not in the 

clinical area at all but are more concerned with 

improving their capacity to cope with the exigencies of daily living.” For example, they may 

need foot care. Therefore, there is need for some 

measure of functional capacity which might 

possibly be combined with clinical status: 

What we need heye is the equivale?2t of au 

early international list 2uith a recognition 

that though the list may be imperfect, it 

will be better than what we now 12ave in the 

sense that people agree to Yecord things in 

similar fashion. 

In the long run we need to determine what are 

“meaningful end points” based on epidemiologic 

10

observation in relation to the different chronic 

diseases; only then “are we going to get measures 

of the quality of medical care in relation to its 

impact on the health status of the population. ” 

I%rlier, Dr. Dens en had remarked that mortality 

is a relatively poor standard for measuring the 

health status of the aged. 

With another problem, the addictive disorders, the usual methods for obtaining prevalence 

and incidence are impractical. Mortality statistics 

do not reveal the addicts; household surveys 

seldom count them; lalmratory tests are not 

available on a population basis; and no single 

agency in the community comes in contact with 

them. 

During discussion it was suggested that the 

Committee might develop “a plan of service 

statistics for some of the new health programs 

that are going into areas where we haven’t 

tried measurement and evaluation heretofore. ” 

The mental health and mental retardation areas 

were mentioned as examples. 

OTHER STUDY PROPOSALS 

At the close of the session of which he was 

moderator, Dr. Linder asked for other study 

suggestions. Included were the following: 

Ways in which the Committee might develop 

and maintain closer liaison with teaching 

institutions 

Family studies 

Conceptual problems arising from multiple 

cause-of-death tabulation 

A food survey to consider the relationship 

of food to health 

A more fundamental consideration of causeof-death statistics, not necessarily based on 

the present format of the death certificate 

A reconsideration of the conceptual design 

of the National Health Survey in the light of 

changing needs for morbidity data 

Emotional stress in pregnant women and the 

effect on pregnancy outcome 

Topics the Committee had decided not to 

investigate over the 15 years of its existence 

C. Health Resource and 

Service Statistics 

Moderator : Dr. Franklin D. Yoder 

Discussants: Dr. Odin W. Anderson 

Dr. Walter J. McNerney 

In introducing the discussion of statistics on 

health resources and services Dr. Yoder noted 

that this is a very broad subject in which 

standards are now changing rapidly. 

PRESENTATION BY DR. ANDERSON 

Dr. Anderson reminded the conferees that 

the order of discussion that had been pursued 

was valid both chronologically and logically in 

that it had proceeded from consideration of mor ­

talit y and natality through consideration of morbidity to consideration of health resources, facilities, and personnel. Routine reporting in these 

last areas is now as reasonable as routine 

reporting in the other areas; and we must now 

try to join or relate the three major areas to 

each other. 

The Committee’s recently issued document, 

“Statistics on Medical Economics” (PHS Publication No. 1125), is an excellent summary and 

estimate of current routine reporting, combined 

with realistic recommendations for further reporting in the third major area of health statistics 

now to be discussed. 

Our health services system, which has illness 

as its central concern, can be regarded in a number of ways: 

AS an economic system, involving the flow 

of funds, investments, expenditures, into, 

through, and out of it 

As an anatomical system involving a dis - ‘ 

tribution by types of work of facilities 

and personnel 

As an organizational system, involving an 

interrelationship of patients, funds, personnel, use, in a vast establishment costing over 

$35 billion a year 

As a humans ystem, involving human relations 

and interactions 

11

We know very little about the flow of funds 

in relation to private practitioners—our dentists, 

pharmacists, physicians—although perhaps 90 

percent of the volume of physician services flows 

through our private practice structure. We know 

nothing about the investments private practitioners 

have made in setting up and amortizing their 

practices. Hence, we cannot indicate how the 

private, the institutional, and the governmental 

sectors are intertwined economically. 

Organizationally, we have inherited a health 

services system geared largely to acute conditions, with the hospital and the physician as the 

central core. But we are now creating many 

services for long-term illnesses which are on the 

periphery of that main core. We are extremely 

deficient in our knowledge of the flow from the 

central core to the periphery, and we do not 

know adequately what is entailed in this type of 

situation. 

In nursing homes, for example, the health 

services system shades off into nonprofessional 

services. The system also ramifies into families, 

with home helps, and into the society itself. We 

need to know’ ‘howthe professional health services 

structure interrelates with the nonprofessional 

helps of one kind or another. ” This means that 

“we must move more and more into a consideration of the human factors in the functioning of 

a unique system like our health services. ” 

Humanly speaking, waiting periods in outpatient departments often are unconscionable, 

and the outpatient department is too often a bleak 

place. Our statistics should record such facts. 

We should examine the concept of convenience. 

“We can figure out the tolerance points, the 

workload of physicians, the tolerance points of 

patients, and so forth. ” 

We see ranges of use patterns that differ 

in different contexts—in a group-practice context, in a fee-for-service Blue Shield context, 

and so on—but we don’t know why. 

With respect to measuring quality, we are 

still in the methodological stage. We can indicate 

whether or not surgery is performed by doctors 

with board certification. We could report more on 

what takes place in what kinds of institutions. 

Discussion 

A conferee suggested that it was high time for 

a group with wide recognition to develop “some 

kind of document that sets forth the different 

points of view from which you can look at 

quality.” This would not mean that the group 

would decide whether someone performing an 

operation was or was not qualified because he 

possessed or did not possess some accepted trait. 

Another discussant indicated that health services were too rigidly categorized as are health 

personnel. Nursing homes contain a substantial 

percentage of persons not really belonging there, 

who have no other place to go. They could be 

taken into day-care centers while the family 

is working during daylight hours. “The nursing 

home could keep standards but then the housing 

elements wouldn’t have to be under those standards. ” Also the housing unit could be associated 

with community activities in a community center. 

The Committee might well formulate patterns 

relevant to problems of this kind. 

During the course of the discussion Dr. 

Anderson reiterated his conviction that the 

Federal Government “should go more and more 

into routine reporting of use and expenditure 

data [in the health area], particularly from 

households. ” It was noted that other countries 

are looking to the United States to develop 

standards in these areas of health manpower 

and health facilities. 

PRESENTATION BY MR. McNERNEY 

Mr. McNerney observed that health administration is feeling the need for more facts and 

better information because it is moving from 

preoccupation with technical questions and good 

human relations to more basic matters of policy 

formulation and the concept of responsibility to 

a constituency. The shift is being hastened by the 

very rapid rise in health costs, which is highly 

visible to the consumer. The consumer also is 

noting great variations in admission rates, in use 

rates of facilities in hospitals, in use by race, and 

so on. Concern is accentuated by collective 

12 
bargaining and by politics. In labor agreements, 

where health benefits in 1952 constituted about 

20 percent of the fringe benefit dollar and 

ret irement about 50 percent, health now accounts 

for about 37 percent of the fringe dollar and 

retirement about 39 percent. 

Consequently, the consumer of health statistics is asking increasingly more sophisticated 

questions, such as 

How effective are prepayment or insurance 

in meeting episodical costs? Does the beneficiary at best merely stand still, or is he 

receiving increased covers.ge? A major industry wants a closely supervised panel setup to 

answer these and related questions. 

What are the impacts of service, supposedly 

with full payment, as against indemnity on 

medical costs ? Does the one encourage 

misuse, the other prohibit it? Is there a 

proper mixture? Do deductibles reduce needed 

care or unneeded care? 

What differences, say in admission rates, 

can be demonstrated as depending on the 

organization of medical practice, as for 

example, under or not under group-practice 

programs ? 

The consumer asks the very frank question, 

what is good and what is bad care? Accreditation does not satisfy him, nor does general 

reference to the quality of care. He wants 

to know the criteria according to which care 

is effective. 

The market wants better information about 

work standards—for example, allowable 

variations for performing an uncomplicated 

urinalysis. 

The market wants to know how multiple 

coverage should be handled. 

There is greater interest in better measures 

of disease and in their translation into the 

need for manpower and facilities. The 

market knows this is a difficult area, but 

it is not content with the present, wide 

variations in practice and planning. What 

is the matter with getting some health inventories taken, although the translation of 

either a symptom or complaint or a finding 

into the need for facilities or programs is 

a matter of judgment? 

With nursing homes and the like, how can 

we develop substitute facilities rather than 

additive facilities? 

With disadvantaged groups —the aged, the 

temporarily unemployed, the chronically lowincomed—the buyer recognizes that a lot of 

the data are averages, the problem might lie 

in distribution, and that we really don’t know 

as much about it as we think. 

Mr. McNerney next turned to a consideration 

of priorities and roles as between government and 

the private sector. In his view: 

The government is in afar better position to 

answer the incidence and prevalence of need 

and translation of this into terms of service, 

this broad descriptive type of information, OY 

again an analysis of the system. The government is in a much better situation to comment 

on the disadvantaged as they exist as a 

nationwide problem. 

Cowespondin.gly, you probably get furthey on 

the more sensitive areas of effective use 

and work standavds by having the format 

laid down perhaps nationally for the sake of 

some consistency, with implementation 

through the private sector. 

Mr. McNerney recommended that the Committee 

take an overview and draw some guidelines to 

avoid undesirable duplication and get certain 

agencies out of a posture of indecision, especially 

foundations and national associations. 

The time is ripe for better methods of data 

collection; for making use of more explanatory 

variables, including use of multivariate analysis; 

for separating the effects of rising costs from the 

effects of rising utilization, in terms of education, 

family size, and age. We need better definitions 

of specialist, nursing home, and nursing and 

better measures of comparative costs of types of 

care. In conclusion: 

13 
Finally I would uv.ge you in discussi~ the 

future of this Committee to keep a pipeline 

out to the nonprofessional, that is the consumeyj to keep the administrative point ofview 

befo?’e you, because it is now one to be 

~eckoned with. It is now an informed one, 

and it will give you some useful guidelines 

on how to be helpfid. This showld be an 

ingredient in this Committee as well as the 

scho.la~ly point of view which worvies about 

things OY should woYYy about things well 

beyond some of these considerations. 

Discussion 

Mr. McNerney was asked three general 

questions: 

1.	 Should the Committee study the hard facts 

that are wanted by buyers and consider 

how these facts might be produced? 

In Mr. McNerney’s thinking, demography, 

health statistics, and health resources and facilities should not be separated. “In order to know 

how many beds are needed I have to know 

population trends. In order to translate that into 

the number of beds I have to know morbidity. ” 

He was confident that the Committee could get 

honest answers from buyers of health services. 

2.	 Should the Committee try to adjudicate 

responsibility between the government, 

nongovernment, and various agencies in 

the field of health services? 

Mr. McNerney suggested that the Committee 

might be interested in sponsoring a conference 

of foundations and national associations to enlarge 

overall awareness. This should lead to’ ‘a slightly 

enlarged consensus about relative roles. ” It was 

noted that such a conference was recommended 

in the letter of transmittal of the medical econom ­

ics report to the Surgeon General. 

3. Would buyers of health services be willing 

to	 make resources available for considering Ithe kinds of questions that had 

been discussed? 

Mr. McNerney replied that they would, and in 

fact were doing this now by contributing to 

foundations and by having people for this purpose 

on their own staffs. 

One conferee endorsed the view that the 

Committee should enlarge its responsibilities by 

going more deeply into particular problems of 

methodology. The Committee should work on improving analytical methodology as well as data 

collection methodology. 

Another discussant noted that the Committee 

has 

people dealing in two universes: one whose 

primary concena is with the universe of 

people and another one whose universe consists of some kind of administrative actions. 

. . . Where problems of medical care administration involve the classification and sorting 

out of people and what happens to people, s 

I can see that the Committee has a strongand 

compelling intevest. . . . When it gets down to 

the universe of, say, contyols and tests. . . I 

don’t see the diyect connection with people. 

. . . We might shy away from divect involvwzen.t 

in seyvice activity measurement which departs from observations of people. 

It was agreed that the report on medical economics 

was a first venture of the Committee into a new 

field and that the merit of doing further work in 

that direction certainly should be assessed. 

Another discussant thought that this particular 

Committee of course should consider only those 

questions of vital and health statistics “that 

really have a basis for. . . [using] statistical 

techniques. ” It was noted that the Committee 

through its subcommittee mechanism could call 

upon experts in any area’ ‘within the broad purvi ew 

of health and vital statistic s.” 

14 
COMMITTEE FUNCTIONS AND 

PROCEDURES 

Discussants:	 Mr. Eugene L. Hamilton 

Dr. O. K. Sagen 

Mr. Hamilton said that he would call on Dr. 

0, K. Sagen to assist in leading the discussion 

on Committee functions and procedures, especially 

with respect to external relationships of the 

Committee. The open discussion had the benefit 

of replies to a questionnaire that had been 

distributed to conferees in advance of the meeting. 

COMMITTEE FUNCTIONS 

Mr. Hamilton first called attention to the 

six-item formulation of Committee functions 

(see Appendix III) which was developed in 1949 

and has appeared since then in the Committee’s 

annual reports. Dr. Moriyama was asked to 

comment on the Committee’s activities in fulfilling the stated functions. He noted considerable 

activity under each of them except (d), insofar 

as it states that the Committee shall ‘‘. . .s erve 

as a clearinghouse for activities dealing with 

public health statistics problems. ” 

It was noted that the original listing of 

functions had a strong international flavor, but 

aside from the international list problem the 

Committee actually has not been deeply involved 

in international questions. There is, for example, 

the problem of measuring population increase in 

countries without a registration system. In its 

early days, it was pointed out, the Committee 

did give considerable thought to developing the 

national committee system throughout the world. 

Two other problems where international experience might enlighten us, it was suggested, are 

infant mortality with its international differentials 

mid the development of comparable measures of 

performance in the medical-care system with a 

view to assessing our own system, Other special 

studies such as stomach cancer among Japanese 

in Japan, Hawaii, and the United States have 

international overtones. Study of international 

differentials in infant mortality, it was pointed 

out, is going forward in the National Center for 

Health Statistics, 

It was noted that the term “public health,” 

which appears throughout the statement of functions, should be interpreted broadly enough to 

include the study of demographic problems. That 

as a matter of fact is how the Committee has 

interpreted the term. 

It was pointed out that exercise of a clearinghouse function implies information collection and 

dissemination and, therefore, a considerable 

staff 

We assume we are all bright and ale?’t 

around here and awaye of what is going on. 

But a step beyond that YequiYes staff, money, 

time . . . . It would change the whole chayacte~ 

of this Committee. 

The functions of the Committee have evolved 

as two kinds of things: 

One, it is the Committee’s Responsibility to 

seek out brave new woylds to conquey, to 

point to pyoblems that exist and indicate 

possible lines of solution without the Committee itself solving the pyoblem. . . the 

classical example is the repovt on movbidity 

statistics that eventually vesulted in the 

establishment of the National Health SuYvey. 

The other is to be the watchdog and the 

conscience of the vital and health statistics 

activities of the count~y. . . and for both of 

these things the Committee needs to be 

info~med not in the clearinghouse sense but 

Yathey well and geneyally informed on what is 

going on in this whole a~ea of vital and 

health statistics intevpyeted in the broadest 

sense. 

As advisor to the Surgeon General in matters 

of vital and health statistics, the view was 

expressed that the Committee had legitimate 

functions going beyond areas that have specifically 

been assigned to the Public Health Service. As 

instances, demographic recommendations have 

been made to the Surgeon General, who could 

only pass them on to the Bureau of the Census; 

and recommendations in the field” of military 

health were transmitted from the Armed Forces 

to the World Health Organization through the 

Surgeon General. 

15 
THE COMMITTEE MECHANISM 

The Committee has a 4-year term of service 

which includes the term of service of those who 

become Chairman; therefore, a Chairman can 

seldom be expected to serve for more than 2 

years. One proposal was for a 6-year term of 

Committee membership, with one-third rotated 

off every 2 years. 

On the question of substantive discussion of 

proposed positions and actions, as against time 

given over to formal reports from subcommittees, 

the view was expressed that more time should be 

spent in identifying and developing in detail 

explicit charges to subcommittees and in assessing 

and evaluating their final reports with somewhat 

less time devoted to progress reports. It also 

was suggested that the Committee might be briefed 

more fully through correspondence and that 

reports might be supplemented by a face sheet 

summarizing the current status of the activity. 

The advisability of members of the Committee 

serving on Subcommittees, in addition to the 

Secretary, also was raised. 

With respect to personnel time involved in 

conducting the Committee, it has involved one 

full-time person for the clerical part, plus 

perhaps one-quarter of the Secretary’s time. 

It was suggested that the Committee might 

well seek a followup of some of its findings 

in a wider group of journals and that annual 

reports might “delineate problems, deliberate] y 

stimulate interest in given areas. . . and comment 

on international analogies and problems. ” Doing 

this might involve additional staff help. 

EXTERNAL RELATIONSHIPS 

OF THE COMMITTEE 

Dr. Sagen introduced ths following discussion. 

There has been some overlap especially in formc r 

years between the activities of this Committc e 

and those of the Public Health Conference cn 

Records and Statistics, which seeks to serve 

the professional interests of members of the 

country’s vital statistics system. This overlap 

has occasionally concerned the State registrars 

and health statisticians to whom the Committ~ e 

represents a consumer viewpoint with respect 

to the statistics of which they are producer~. 

The remedy was, and continues to be, adequate 

communication between interested parties. For 

example, the Public Health Conference has study 

groups of which the Committee should be cognizart 

and vice versa. Dr. Sagen described briefly the 

activities of its current study groups. 

16 
The 

much of 

by Mr. 

CONFERENCE SUMMARY 

course of the meetings together with 

the detail was summarized at this time 

Theodore D. Woolsey. Aside from his 

summary of details he found a number of major 

themes of the 2-day conference: 

The shift of attention of the National Committee from problems of completeness of our 

vital statistics to problems of response error 

and evaluation studies 

Consideration of the possibilities of a population register along with the related question 

of providing population statistics for small 

areas on a current basis 

The need for increased availability of vital 

records and the feasibility of that need being 

met by establishing what was called a national 

archives of vital records 

Problems associated with the confidentiality 

of vital records 

The need for statistics in evaluating medicalcare programs 

The question of local health surveys and the 

extent to which they should be related to the 

National Health Survey 

The dynamics of the health-service system 

Statistical needs of the health-service consumer 

The Chairman observed that many subjects 

covering a wide variety of fields have been 

studied and much has been accomplished in the 

impressive performance of the Committee in 

the past. In addition the discussions at this 

Conference provide much food for thought and 

will be of continuing value. In future deliberations 

the Committee will refer frequently to the suggestions that have been offered here in its attempt 

to see what can be done for further development 

of vital and health statistics in the United States. 

The conference ended its formal activities 

with a vote of thanks to the Secretary and his 

staff. 

000 

17 
--------------------------------

--------------------------------

-------------------------------

--------------------------------

-----------------------------

----------------------------

APPENDIX I


PAST AND PRESENT MEMBERS OF THE COMMITTEE 

Membey Affiliation Dates Sevled 

Anderson, Dr. Odin W. ................................ Research Director 

Center for Health Administration Studies 

University of Chicago 

Chicago, Illinois 

Baehr, Dr. George (absent) ........................ Mt. Sinai Hospital 

New York, New York ----------------------------

Beelman, Dr. F. C. (absent) ......................€Secretary and Executive Officer 

Kansas State Board of Health 

Topeka, Kansas


Chancellor, Mr. LorenE . ..........................€Director, Division of Vital Statistics 

State Department of Health 

Des Moines, Iowa 

Crosby, Dr. Edwin L. (absent) ................... Director 

American Hospital Association 

840 North Lake Shore Drive 

Chicago, Illinois 

Daily, Dr. Edwin F. (absent) ...................... Deputy Medical”Director 

Health Insurance Plan ofGreater New York 

New York, New York ----------------------------

Densen, Dr:Paul M. .................................... Deputy Commissioner of Health 

City of New York Health Department 

125 Worth Street 

New York, New York ----------------------------

*Dorn, Dr. Harold F . .,,.,,.,,,,,,,,,.,,,,,,,,,,,,,.,,,€Chief, Biometrics Branch 

National Heart Institute 

National Institutes of Health 

Bethesda, Maryland 

**Dunn, Dr. Halbert L. ...............................€Chief, National Office of Vital Statistics 

Public Health Service 

Washington, D.C--------------------------------

Dyar, Dr. Robert ....................................... Chief, Division of Research 

California State Department of Health

2151 Berkeley Way

Berkeley, California

1959-63 

1949-55 

1949-51 

1962-

1952-58 

1949-60 

1949-59 

1949-M 

1949-50 

1961-

18 
. ..

. .......

----------------------------

-----------------------------

-------------------------

--------------------------------

------------------------------

----------------------

---------------------------

----------------------

--------------------------

--------------------------------

*Fales, Dr. W. Thurber ............................. 

Huenszel, Mr. William M. ......................... 

Hamilton, Mr. Eugene L. ........................... 

H:imilton, Dr. C. Horace ............................ 

Hauser, Dr. Philip M. (absent) ................. 

Hcustis, Dr. Albert E. (absent) ................. 

Hubbard, Dr. John P * ,,!,,,,..,. . ........................, 

Hutqheson, Dr. Robert H. (absent) ............ 

Kirk, Dr, Dudley .,........................................ 

Lee, Dr. Everett S. ..................................... 

Linder, Dr. Forrest E. .............................. 

MacMahon, Dr.. Brian ................................ 

McNerney, Mr. Walter J . ........................... 

Director, Statistical Services 

Baltimore City Health Department 

Baltimore, Maryland 

Chief, Biometry Branch 

National Cancer Institute 

National Institutes of Health 

Bethesda, Maryland 

Director, Medical Statistics Agency


Office of Surgeon General


Department of the Army


Washington, D.C--------------------------------


Professor of Rural Sociology


School of Agriculture


North Carolina State College


Raleigh, North Carolina


Professor of Sociology


University of Chicago


Chicago, Illinois


State Health Commissioner


Michigan Department of Health


Lansing, Michigan


Professor of Preventive Medicine


School of Medicine


University of Pennsylvania


Philadelphia, Pennsylvania


Commissioner of Public Health


Tennessee Department of Public Health


Nashville, Tennessee


Demographic Director


Population Council


New York, New York ----------------------------


Associate Professor of Sociology 

University of Pennsylvania 

Philadelphia, Pennsylvania 

Director, National Center for Health Statistics


Public Health Service


Washington, D.C--------------------------------


Professor, Department of Epidemiology


Harvard School of Public Health


Boston, Massachusetts


President


Blue Cross Association


Chicago, Illinois


1949-53


1964-


1949-59


1960-


1949-60


1958-60


1956-61


1951-58


1961-


1964-


1958-


1959-63


1963-


19

.

------ ------ ------ ------

----------------------------

-----------------------

-------- ------ ------ -----

------ -------- ------ -----

-----------------------------------

----------------------------

-----------------------------

Moriyama, Dr. I. M. ................................... 

**Reed, Dr. Lowell J. (absent) .................. 

Sagen, Dr. O. K. ......................................,.,.. 

Schlesinger, Dr. Edward R. ....................... 

Shackelford, Mrs. Margaret ........0............. 

Sibley, Mr. Elbridge .................................. 

Taeuber, Dr. Conrad ................................. 

*Whelpton, Mr. P. K. ............!.................. 

Yerushalmy, Dr. Jacob ............................... 

Yoder, Dr. Franklin D. .............................. 

*Deceased 

**Retired 

20


Chief, Office of Health Statistics Analysis


National Center for Health Statistics


Public Health Service


Washington, D.C ,------ -


President


Johns Hopkins University


Baltimore, Maryland


Assistant Director


National Center for Health Statistics


Public Health Service


Washington, D.C--------------------------------


Assistant Commissioner for Special Health Services


State Department of Health


Albany, New York ------------------------------


Director, Division of Statistics


Oklahoma State Department of Health


Oklahoma City, Oklahoma


Executive Associate 

Social Science Research Council 

Washington, D.C -------

Assistant Director


Bureau of the Census


Department of Commerce


Washington, D.C .------


Director, Scripps Foundation for Research in Population Problems 

Miami University 

Oxford, Ohio 

Professor of Biostatistics


School of Public Health


University of California


Berkeley, California


Director of Public Health


Illinois State Department of Health


Springfield, Ill~ois 

1949-

1949-56 

1954-58 

196c)-

1958-62 

1949..50 

1961-

1959..61 

1963-

1962 -
.

--------------------------------

-------------------------

. ... ..

OBSERVERS AND GUESTS OF THE COMMITTEE 

Councell, Dr. Clara E . ...............................	 Deputy Chief, Office of Health Statistics Analysis 

National Center for Health Statistics 

Public Health Service 

Washington, D.C -------------------------------- Observer 

Gurulnick, Miss Lillian ..............................	 Statistician 

Office of Health Statistics Analysis 

National Center for Health Statistics 

Public Health Service 

Washington, D.C Observer 

Harris, Mr. F. Fraser ...............................	 Director, Health and Welfare Division 

Dominion Bureau of Statistics 

Ottawa, Ontario, Canada Guest 

Lunde, Dr, Anders S. .................................. Assistant Chief 

Division of Vital Statistics 

National Center for Health Statistics 

Public Health Service 

Washington, D.C-------------------------------- Observer 

Puffer, Dr. Ruth R. .....................................	 Chief, Health Statistics Branch 

Pan American Health Organization 

c/o WHO Regional Office 

Washington, D.C-------------------------------- Guest 

Storck, Dr. John .......................................... Staff Assistant 

Division of Vital Statistics 

National Center for Health Statistics 

Public Health Service 

Washington, D.C -------------------------------- Observer 

Woolsey, Mr. Theodore D. .......................... Deputy Director 

National Center for Health Statistics 

Public Health Service 

Washington, D.C -------------------------------- Observer 

21 
APPENDIX II 

RECOMMENDATIONS OF STUDY TOPICS 

The United States National Committee on Vital and specific interests already evinced by substantial CcmlnHealth Statistics (Committee) is located organizationally mittee studies—e.g., development of the marriage- and 

in the National Center for Health Statistics (NCHS) and divorce-registration areas or desirability of a quinoperates in an advisory capacity to the Surgeon General quennial census—have been omitted. Possible study 

of the U.S. Public Health Service. The members of the topics with new directions for previous interests are 

Committee serve as individuals representing a technical included. 

discipline or field of subject matter interest and do not However studies mentioned are phrased here 

represent agencies or organizations. The Committee (chiefly for brevity) or in the verbatim record on which 

bases its studies and conclusions chiefly on investiga- this summary is based, it should be understood d at 

tions conducted by subcommittees that report to it on the Committee does not conduct substantive studits. 

questions that have been referred to them by the Com- Thus “cross-tabulations of characteristics of husbands 

mittee. and wives” indicates that the Committee should spec tfy 

The Committee was established in 1949 in accord- what tabulations are needed, the data required to obta in 

ance with a recommendation of the First World Health these tabulations, how these data might be gather~d, 

Assembly that all governments form such committees. their limitations and uses, and other similar matters. 

On December 14-15, 1964, past and present members Suggestions are identified as 1, 2, and so forl h. 

of the Committee met in Washington, D.C., to assess 

its record and plan for its future. The present report 

summarizes under the following headings possible study A. DEMOGRAPHIC STATISTICS 

topics mentioned without any attempt to reach consensus 

on desirability. 1. Fundamental Characteristics of the United St~t:% 

A. Demographic statistics Vital Statistics System 

1.	 Fundamental characteristics of the United 

States vital statistics system 

1.1: Evaluation of the present United States vi}al 

2. Marriage, divorce, the family, and the house- statistics system in the light of systems ussd 

in other countries and in terms of the att~ i- hold butes of a population register system, thc 3. Natality potentialities of new techniques of data pro:- 4. Mortality essing, and the legal questions involve d. 5. Other questions 1.2: Problems connected with increasing use of 

B.	 Health statistics vital records by agencies and individual re- 1. Epidemiological uses searchers. 2. Uses in program planning and evaluation 1.3: Review of birth and death certificate dutti C. Health resources and services 

1. Fundamental questions from the viewpoint of epidemiological nc,ecs. 

2. Questions raised by users of medical serv- 1.4: Possibility of separate medical and legal 

records of birth. ices 

D. Committee funcuions, structure, and procedures 1.5: Practicability of transferring the power to 

authorize use of birth and death certifictite E. NCHS functions, relations, and policies material for health studies to the Federal 

Subjects grouped under the last heading extend Government, and what would be required to 

beyond the activities of the Committee. Some suggestions effect that transfer. 

might have been listed in several places, and the order- 1.6: Specification of needed verification studies of 

&g here is somewhat arbitrary. Suggestions to continue data on vital records and on hospital recorLs. 

22 
2, Marriage, Divorce, the Family, and the Household 

2.7: Survey of the entire area with a view to making 

recommendations of needed family statistics. 

2,8: Marriage and divorce and the rates of family 

and household formation. 

2.9:	 Age-adjusted marriage and divorce rates by 

population eligible for marriage or divorce; 

attrition tables analogous to life tables; and 

so forth. 

2.10: Better measures of the changing age at marriage. 

2,11: Trends in residential propinquity and origin 

of mates. 

2.12: Family and household characteristics of people 

who die. 

2.13: Cross-tabulations of characteristics of husbands and wives. 

2.14; Relationship of marital status to death rates. 

3. Natality 

4.26:	 Induced abortion, in view of claim that they 

reach 1 million a year in the United States. 

5. Other Demographic Problems 

5.27: Possibility of using sampling techniques more 

widely than at present in the vital statistics 

area. 

5.28: Internal migration as a crucial factor in 

demographic change in the United States. 

5.29: Geographic areas better suited to analytic uses 

than the traditional administrative areas 

(whether these areas be larger or smaller than 

those now generally used). 

5.30: Obtaining satisfactory small-area estimates. 

5.31: Ways of identifying place of residence, as possibly by a national coordinate system. 

5.32: Adequacy of the classification into rural and 

urban. 

5.33: Census overcounts and undercounts affecting 

vital rates and life table data. 

5.34: Problems in getting valid age data on all kinds 

of records; possible approach by way of an 

intergovernmental committee or a joint study 

with the Social Security Administration. 

5.35: Circumstances contributing to errors on vital 

records, and ways of reducing their effects. 

5.36: Improvement of statistics on the Negro and 

other nonwhite persons. 

5.37: Statistical handling of hereditary diseases and 

defects. 

5.38: Methods of population projection, especially 

more complicated procedures using computer. 

B. HEALTH STATISTICS 

1. Epidemiological Uses 

1.39:	 Study of the need for and the possibility of 

creating “a national archives of vital and health 

records, ” so that epidemiology may make use 

of individual records (and gain access to material linked to individual records) in its now 

enlarging function of hypothesis testing. 

1.40:	 Review of National Health Survey procedures 

and analyses from the viewpoint of epidemiological utilization, including the possibility of 

epidemiological studies based on NHSrecords. 

1.41:	 Identification of desirable new areas of morbidity reporting-e. g., leukemia, congenital 

malformations. 

1.42: Characteristics and feasibility of model physician reporting areas. 

1.43: Characteristics and feasibility of model hospital reporting areas. 

3.15: 

3.16: 

3.17: 

3.18: 

3.19: 

Improved measures of natality that are more


sensitive to current changes, taking account


of all available and producible data—period


or current, cohort, and completed fertility


(with marriage data included, and especially


natality by duration of marriage).


Study of what information could be obtained by


querying a sample of births without addition


of numerous items on the certificate, with


cognizance being taken of present NCHS samp­


ling programs in this area.


Family planning in relation to economic, social,


psychological, and religious factors.


Planning of further inquiries on expected final


family size.


Illegitimacy.


4. Mortality 

4.20: 

4.21: 

4.22: 

4.23: 

4.24: 

4,25: 

The kinds of information needed from mortality


statistics.


The multiple cause-of-death problem.


Statistical problems connected with study of


why there has been so little gain in age-spe­


cific mortality in the United States over the


past decade.


Mortality differentials and changes at various


age levels, in various subgroups, especially


among nonwhite persons, the aged, males, and


other special, groups.


Social and economic correlates of mortality.


Accuracy of the data; e.g., underregistration


of deaths, age biases in reporting deaths.


23 
2. Uses in Program Planning and Evaluation 

2.44:	 Possible local-area uses of National Health 

Survey data. 

2.45:	 Feasibility and characteristics of local household surveys, perhaps even to the level of 

neighborhoods, modeled on and coordinated 

with the National Health Survey. 

2.46:	 Consideration de novo of the conceptual design 

of a national morbidity survey in the light of 

experience and changing needs. 

2.47:	 Uses that the National Health Survey might 

make of local physicians; e.g., to obtain data 

on the occurrence of diseases with little diagnostic variability, such as hernias. 

2.48:	 The response error problem in health surveys —a particular case of a crucial problem 

in social science surveys. 

2.49:	 Ways of measuring the impact of medical-care 

programs on the incidence, prevalence, and 

prognosis of chronic disease in the population; 

e.g., for particular conditions, how can the 

impact of length of hospital stay on prognosis 

be measured? 

2.50:	 Ways of measuring the efficacy of various 

programs; e.g., general medical-care programs which assume responsibility for the 

total health of clients, home-care programs, 

rehabilitation programs, nursing-home programs. 

2.51:	 Ways of measuring the continuity of medical 

care. 

2.52:	 Plans for service statistics for some of the 

newer health programs; e.g., certain neurological disorders, mental retardation. 

2.53: Ways of establishing closer liaison with schools 

of public health and other health institutions 

in dealing with problems of measurement, research, and planning. 

2.54:	 New ways (in addition to morbidity and mortality) of measuring the health status of the 

aged. 

2.55:	 Ways of getting satisfactory counts of the addictive disorders; e.g., narcotics addiction, 

alcoholism. 

2.56: Ways of measuring emotional stress. 

2.57: Food consumption statistics. 

C. HEALTH RESOURCES AND SERVICES 

1. Fundamental Questions 

1.58:	 Information needed about the economic aspects 

of our health services system; the investments 

and the fund flows within the entire system, including private practitioners, pharmacists, 

hospitals, and so forth and including private, 

institutional, and governmental investment and 

expenditure patterns. 

1.59:	 Ramifications of the health services system 

into the society, families, homes, and other 

suPPorts for health activities. 

1.60:	 Types of flow within the health services system; 

e.g., flows between its traditional central focus 

in the hospital and physician and the relatively 

new arrangements for long- term illness. 

1.61:	 Identification of detailed aspects of the system 

in operation: the physician-patient relationship 

(e.g., waiting periods); the convenience context 

of medical decisions (e.g., whether or not to 

hospitalize). 

1.62: Measures of quality of health services. 

1.63:	 Possibility of routine reporting of healthrelated use and expenditure data, particularly 

from households, which shall be as routine as 

the mortality and morbidity data now being 

reported. 

1.64: Specification of better measures of prevalence 

and incidence of disease as related to manpower and facilities. 

2. Questions Raised by Users of Medical Services 

2.65:	 Many of the topics listed below might be combined into a single comprehensive analysis of 

the kinds of information needed by users of 

medical services. 

2.66:	 Evaluation of hospital use under varying systems; e.g., insurance vs. no insurance, complete 

insurance vs. deductibles, and so forth. Which 

systems encourage overuse, underuse? 

2.67: Admission rates and other variations (e.g., 

productivity) between group and nongroup practice programs. 

2.68:	 What is good and what is bad medical core—if 

not in terms of quality, then in terms of 

whether it is effective according to stated 

criteria (rephrased later, to fit the Committee’s 

technical approach, as “the different points of 

view from which you can look at quality of say 

medical care”). 

2.69: Work standards; e.g., man hours needed for a 

regular urinalysis, with allowable variations. 

2.70: How to get the facts about multiple coverage. 

2.71: Getting health inventories, even though translation into needs involves judgment. 

2.72: Identification of linkages from one point to 

another in the health system. 

2.73:	 Establishment of varying patterns of care; e.g., 

when nursing homes are established, should 

we pile them on top of prior types of care or 

are there other types of organization? 

24 
2.74: 

2,75: 

2.76: 

r). 

D,77: 

D.78: 

D.79: 

D. HO: 

With the disadvantaged (e.g., the aged, the temporarily unemployed, the chronically lowincomed), what portion of the need is real and 

what portion is a statistical artifact (e.g., a 

matter of distribution over the curve)? 

Establishment of guidelines as to the priorities 

and roles between the private and the governmental sectors; e.g., government might be able 

to indicate the incidence and prevalence of 

need and translate this into norms of service 

requirements, might frame a view on the disadvantaged, and might develop use and work 

standards. 

Identification of statistical techniques (e.g., 

multivariate analysis) which would yield better 

data; provision of clearer definitions (e.g., 

specialist, nursing home); specification of 

needed information (as in the aged program). 

COIvlh41TTEE FUNCTIONS, STRUCTURE, 

AND PROCEDURES 

Should the Committee concern itself with more 

problems having aninternational flavor, suchas 

a. Population measurement problems in countries without a satisfactory registration system. 

b. Infant mortality problems, where the United 

States might benefit from a better understanding of why certain countries have a 

lower rate (actually, now being studied in 

NCHS). 

c, Development of comparable measures of 

performance in the medical-care systems of 

different countries. 

d, Comparable mortality statistics. 

e. Comparable morbidity measures. 

f.	 Studies of peoples of foreign origin in the 

United States. 

g. Cancer-rate differences. 

Should Committee chairmen have a longer 

tenure of service? 

Should the Committee give more attention to 

subcommittee drafts of final reports, with 

possibly less attention to interim reports? 

Should there be closer liaison between the 

Committee and its subcommittees, as by service of members of the Committee on each subcommittee? 

D.81: Should there be more or fuller documentation: 

summaries, facd sheets, fuller minutes, and so 

forth? 

D.82: Development of more explicit charges to the 

subcommittees? 

D.83: Advisability of more followup Committee recommendations in journals and elsewhere. 

D.84: More staff assistance to the Secretary? 

E. NCHS FUNCTIONS, RELATIONS, AND POLICIES 

E.85:	 Consideration of areas of profitable cooperative 

relationships between NCHS and other agencies, 

governmental and private. 

E.86: Further exploration of Federal-State relationships in the area of vital and health statistics. 

E.87: On the distribution of responsibility between 

governments at various levels and other 

agencies,
should NCHS “be interested . . . in 

sponsoring a conference that brings together 

representatives of foundations, of national associations (Professional Activity Service, for 

example),
and others who have an interest . . . 

so that at least they can be cognizant of what 

the overall picture is and what others are 

doing”? 

(On the international level, see D.77 above, which 

in some of its aspects might concern NCHS.) 

E.88:	 Study of what the confidentiality question is, 

not just with birth or death records but with 

medical records generally. 

E.89:	 Sampling and advance reports as ways of obtaining more rapid publication of vital data; 

should a birth sample, e.g., be initiated? 

E.90:	 Should the 10-percent mortality sample be 

continued? 

E.91:	 Record-linkage possibilities (now being studied 

by the Public Health Conference on Records 

and Statistics). 

E.92:	 Ways of taking account of the wide range of 

variation in health data within the United States. 

E.93:	 Clarification of the meaning of “longitudinal 

study” and of the kinds of problems that would 

have to be solved by such studies. 

E.94: Possibility of NCHS subsidizing local-area 

health surveys. 

E.95: Greater consultation with users of vital and 

health data, including nongovernmental users. 

E.96: Should NCHS from time to time summarize 

developments in statistical methodology? 

25 
APPENDIX Ill 

FUNCTIONS OF THE COMMITTEE 

The U.S. National Committee on Vital and Health 

Statistics, a committee of the Surgeon General of the 

Public Health Service, was created at the request of 

the Department of State in accordance with the recommendations of the First World Health Assembly. The 

major objectives of the National Committee are to 

promote and secure technical developments in the field 

of vital and health statistics and to obtain clearance of 

national and international viewpoints on vital and health 

statistics problems. 

The following statement of functions and policies 

will serve as a guide in performing the functions of the 

U.S. National Committee on Vital and Health Statistics. 

FUNCTIONS 

(a)	 Delineate statistical problems of public health 

importance which are of national or international interest; 

(b)	 Stimulate studies of such problems by other 

organizations and agencies whenever possible, 

or make investigations of such problems through 

subcommittees appointed for the purpose; 

(c)	 Review findings submitted by other organizations and agencies, or by its subcommittees, 

and make recommendations for national and/or 

international adoption; 

(d) Cooperate with other committees or organizations concerned with public health statistics 

in the United States so as to serve as a clearinghouse for activities dealing with public health 

statistics problems; 

(e) Serve as a link between the organizations in 

the United States engaged in public health statistics and the statistical secretariat of the 

World Health Organization, and other international agencies concerned with public health 

statistics; and 

(f)	 Cooperate with national committees of other 

countries in the study of problems of mutual 

interest. 

26 
OUTLINE OF REPORT SERIES FOR VITAL AND HEALTH STATISTICS 

Public Health Service Publication No. 1000 

Series 1. programs ad collection p~o~e&Yes,_ Reports which describe the general programs of the National 

Center for Health Statistics and its offices and divisions, data collection methods used, definitions, and 

other material necessary for understanding the data. 

Reports number 1-4 

SeYies 2.	 Data evaluation and methods veseavch. - Studies of new statistical methodology including: experimental 

tests of new survey methods, studies of vital statistics collection methods, new analytical techniques, 

objective evaluations of reliability of collected data, contributions to statistical theory. 

Reports number I- IT 

Series .3.	 Analytical studies. — Reports presenting analytical or interpretive studies based on vital and health statistics, cm-r ying tbe analysis further than tbe expository types of reports in the other series. 

Reports number 1-4 

Series 4. Documents and committee repovts. - Final reports of major committees concerned with vital and health 

statistics, and documents such as recommended model vital registration laws and revised birth and 

death certificates. 

Reports number I -,5 

Series 10.	 Data Fvom the Health [ntevview Suwey. - Statistics cm illness, accidental injuries, disability, use of 

hospital, medical, dental, and other services, and other health-related topics, based on data collected in 

a continuing national household interview survey. 

Reports number 1-’32 

Sevies 11.	 Data F~om the Health Examination Su~vey.—Statistics based on tbe direct examination, testing, and 

measurement of national samples of the population, including the medically defined prevalence of specific diseases, and distributions of the population with respect to VaI-i(IUS physi~al, physiological. 

ami psychological measurements. 

Reports number 1- LC 

Series 12.	 Data From the Health Recoyds Survey. — Statistics from records of hospital discharges and statistics 

relating to the bealtb characteristics of persons in institutions, and on hospital, medical, nursing, and 

personal care received, based on national samples of establishments providing these services and 

samples of the residents or patients. 

Reports number 1-4 

Sevies 20.	 Data on mortality. -Various statistics on mortality other than as included in annual or monthly reportsspecial analyses by cause of death, age, and other demographic variables, also geographic and time 

series analyses. 

I{cports )l~llnlx,r 1 and Q 

SeYies 21.	 Data on natality, mawiage, and divorce. —Various statistics on natality, marriage, and divorce other 

than as included in annual or monthly reports— special analyses by demographic variables, ZISO geographic and time series analyses, studies of fertility. 

Reports number 1-9 

SeVies 22.	 Data Fyom the Natioml Natalitv and k’o~tality Suvveys. —Statistics on characteristics of births and 

deaths not available from tbe vital records, based on ‘sample surveys stemming from these records, 

including such topics as mortality by socioeconomic class, medical experience in the last year of life, 

characteristics of pregnancy, etc. 

Reports number 1 and 2 

For a list of titles of reports published in these series, write to:	 National Center for Health Statistics 

U.S. Public Health Service 

Washington, D.C. 20201