NATIONAL CENTER Series 4

For HEALTH STATISTICS Number 9

VITAL and HEALTH STATISTICS

DOCUMENTS AND COMMITTEE REPORTS

Migration, Vital, and

Health Statistics

A Report of the United States National

Committee on Vital and Health Statistics

An assessment of the needs for migration statistics; the procedures

whereby statistics might be secured; the interrelations of vital processes and health with the movements of people; and the steps required to secure data and advance research.

U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE

Public Health Service

Health Services and Mental Health Administration

Washington, D.c. November 1968
Public Health Service Publication No. 1000-Series 4-No. 9

For sale by the Superintendent of Documents, U.S. Government Printing Office, Washirrgton, D. C’. 20402- Price W writs
NATIONAL CENTER FOR HEALTH STATISTICS

THEODORE D. WOOLSEY, Director

PHILIP S. LAWRENCE, SC.D., Associate Director

OSWALD K. SAGEN, PH.D.>, Assistant Director for Health Statistics Development

WALT R. SIMMONS, M.A., Assistant Director /or Research and Scierzti/ic Development

ALICE M. WATERHOUSE, M. D., Medical Consultant

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

EDWARD E. MINTY, Executive O//ice?

MARGERY R.. CUNNINGHAM, lrz/ormation O//icer

OFFICE OF HEALTH STATISTICS ANALYSIS

IWAO M. MORIYAMA, Ph. D., Director

DEAN E. KRUEGER, Deputy Director

Public Health Service Publication Na. 1000-Series 4-No. 9

Library of Congress Catalog Card Number 68-62235
FOREWORD

The United States is a Nation built by a migrant population. The

population of the country continues to be mobile through internal as

well as international migration. The resulting migration patterns influence and are in turn influenced by marriage, birth, illness, and

death.

This report, prepared under the auspices of the U.S. National .

Committee on Vital and Health Statistics, calls attention to the opportunity, especially in the 1970 census period, for the study of migration

and the vital processes by official agencies-Federal, State, and local—

and by research workers in universities and foundations. Recommendations are made for the improvement of vital records and statistics

to provide the adequate statistical base needed for the formulation of

national policy, plans, and programs.

Robert L. Berg, M.D.

Chairman

U.S. National Committee on

Vital and Health Statistics

...

Ill
U.S. NATIONAL COMMITTEE ON VITAL AND HEALTH STATISTICS

Robert L. Berg, M.D., Chairman

Professor and Chairman, Department of

Preventive Medicine and Community Health

The Medical Center

The University of Rochester

Rochester, New York

Iwao M. Moriyama, Ph. D., Executive Secretary

Director, Office of Health Statistics Analysis “’ “.

National Center for Health Statistics

..

Public Health Service*

Washington, D.C.

Donald J. Davids

Chief, Records and Statistics Section

Colorado State Department of Public Health

13mver, Colorado

Clyde V. Kiser, Ph.D.

Senior Member, Technical Staff

Milbank Memorial Fund

New York, New York

Herbert E, Klarman, Ph.D.

Department of Public Health Administration

School of Hygiene and Public Health

The Johns Hopkins University

Baltimore, Maryland

Forrest E. Linder, Ph.D.

Department of Biostatistics

School of Public Health

University of North Carolina

Chapel Hill, North Carolina

Robert Parke, Jr.

Program “Planning Officer

, Bureau ‘ofthe Census

U.S. Department of Commerce

Washington, D.C.

John R. Philp, M.D.

Health Officer

County of Orange Health Department

Santa’ Ana, California

Donovan J. Thompson, Ph.D.

Department of Preventive Medicine

School of Medicine

University of Washington

Seattle, Washington

Theodore D. Woolsey, ex officio

Director, National Center for Health Statistics

Public Health Service*

Washington, D.C.

SUBCOMMITTEE ON:MIGRATION AND HEALTH STATISTICS

Irene B. Taeuber, Ph. D., Chairman

Senior Research Demographer

Office of Population Research

Princeton University

Princeton, New Jersey

Mindel C. Sheps, M.D., M.P. H., Secretary

Professor of Biostatistics

School of Public Health and Administrative

Medicine of Columbia University

New York, New York

William R. Gaffey, Ph.D.

Statistical Consultant

Division of Research

State Department of Public Health

13erkeley, California

Robert D. Grove, Ph.D.

Director, Division of Vital Statistics

National Center for Health Statistics

Public Health Service*

Washington, D.C.

William Haenszel

Chief, Biometry Branch

National Cancer Institute

National Institutes of Health

Public Health Service*

Bethesda, Maryland

Everett S. Lee, Ph.D.

Head of the Department

Department of Sociology and Anthropology

University of Massachusetts .

Amherst, Massachusetts

Henry S. Shryock, Jr., Ph.D.

Assistant Chief, Population Division

Bureau of the Census

Department of Commerce

Washington, D.C.

Karl E. Taeuber, Ph.D.

Professo2 of Sociology

Department of Sociology

The University of Wisconsin

Madison, Wisconsin

‘Department of Health, Education, rind Welfare.

iv
CONTENTS

Page

Foreword ------------------------------------------------------------

Introduction ---------------------------- --------------------------- ----

Summary ofRecommendatibns ------------------ ------------------- ------

1.

2.

3.

4.

5,

6.

7.

Definitions, Procedures, and Tabulations-------------’--------------

Rates, Risks, and Models ------------------- --------- --------- -----

Sources for Healti, Vital, and Migation Statistics ------------------

Marriage, Natali~, and Mi~ation SWtistics ------------------------

Special Populations ----------------------------------------------

Essential Bases for Research 'md Development ---------------------

Plans and Programs for the1970 Census Period --------------------

Findingsand Recommendations -----------------------------------------

1.

2.

3.

4.

5*

6.

7.

Definitions ofWgation ------------------------------------------

Rates, Risks, and Models --------------------------- --------------

Sources of Data -------------------------------------------------

Marriage, NataUty, mdM&ation Statistics ------------------------

Special Populations ----------------------------------------------

Essential Bases for Research md Development ---------------------

Plans and Programs for the1970 Census Period --------------------

...

111

1

2

2

2

3

3

3

4

4

4

4

5

7

9

10

13

13
IN THIS REPORT a Subcommittee of the U.S. National Committee on

Vital and Health Statistics presents its findings on the needs for migration statistics as velated to health and recommends the development

of data fov the study of migration and health. These recommendations

relate to definitions, procedures, and tabulations; measures of risks;

sources of vital and health statistics and migration statistics; marm“age, birth, and migration statistics; and to studies of spectil popukztions, including the disadvantaged and migratory labor and migvant

families. The Subcommittee also proposes an analytical and research

program for the 1970 censws period, when migration olu!awill become

available.

vi
MIGRATION, VITAL, AND

HEALTH STATISTICS

INTRODUCTION

The National Committee on Vital and Health

Statistics noted the diverse but little explored

relations between vital processes, the movements

of people, and health and appointed a Subcommittee on Migration and Health Statistics. The

tasks of the subcommittee involved the assessment of the needs for migration statistics; the

procedures on how statistics might be secured;

the interrelations of vital processes and health

with the movements of people; and the steps required to secure data and advance research.

The frequencies of migration, the places of

origin and destination of migrants, the types of

movements, the characteristics of migrants, and

the stabilities and nobilities within areas of

residence influence and are influenced by marriage, birth, and death. Health is related in varying ways to natural movements and to migrations.

Technically, migration is a component of and a

disturbing factor in the definitions of numerators

and denominators in vital and health statistics.

Analytically, migration can be viewed as an independent or a dependent variable in population

dynamics,

The needs for data and analysis of population

dynamics influence the National Center for Health

Statistics (NCHS), the U.S. Bureau of the Census,

other governmental agencies, and universities and

research institutions.

The field of migration, vital, and health statistics is broad. Perhaps the goal of the Subcommittee on Migration and Health Statistics

should have been a survey of activities and studies

relating vital and health statistics and migration

variables. This would have yielded an assessment of needs, feasibilities, and priorities, with

reference both to special or recurrent surveys

and to the inclusion of migration or mobility variables in the continuing registrations of a vital

statistics system. There was neither time nor

resources for this substantive and methodological

survey. Therefore, the subcommittee assessed

the state of the data and the needs for analysis

in three time perspectives.

In the short run, advances must be keyed to

the vital records as now secured in the States,

the decennial census as now planned, and the

possibilities of integrated analysis with partial

linkages of vital and census statistics. In the

intermediate period, there may be -supplements

to the basic data through the National Health

Survey and the Current Population Survey. In the

long run, there may be special studies of processes and populations, improved and expanded

data collection, and incisive analyses.

The crises in the cities, the movements toward equal opportunities for all, and the unequal

distributions of population, economic resources,

and social facilities create urgent needs for social

as well as economic statistics and analyses. The

most neglected resource as a statistical base in

the national search for policy, plan, and program

is the vital records system, with major statistical

needs in improving the collection, tabulation,

and analysis of its records. The most neglected

areas are those of most immediate relevance to

the national needs: marriage and natality.

The time is appropriate for advance in the

fields of migration, vital, and health statistics.

There is a developing background in analysis and
theory. Current surveys, queries ofsamplesfrom

vital records, and other sources supplement

census and. vital statistics. There are regional

and local differences in problems and in resources for analysis. There are technical facilities that permit the coordinated and multiple

uses of basic data.

Comprehensive activities in the years 1969

through 1971 would provide information and

analysis significant in science and relevant to

policies and plans. Concerted drives ‘inpreviously

neglected fields of vital and health statistics

would yield evaluations of current data and improvements in vital rates while contribut~g to

ongoing and projected programs and the cooperative efforts of the National Center for Health

Statistics, State and city statistical organizations,

and research itistitutions.

SUMMARY OF

RECOMMENDATIONS

1. Definitions, Procedures, and Tabulations

1.1

1.2

Definitions, procedures, and tabulations

of variables and for areas should k

comparable with those of the Bureau of

the Census so that vital and health statistics can k related to census base

populations and data from both sources

can be available for integrated analysis.

This requties a mechanism for continuing consultation and coordination between

the agencies lxxh in general plaming and

in specific operational details of relevant programs.

The National Center for Health Statistics and the State organizations should

adopt the following procedures to insure

the availability of the data now needed:

1.2.1

1.2.2

Identification and tabulation of data

specifically for Negroes, instead

of grouping them under the heading of “nonwhite” as previously

done.

Coding and tabulating data on State

and country of birth on vital rec1.2.3

1.2.4

1.2.5

1.2.6”

1.2.7

orals, and distinguishing Puerto

Ricans and identifying the countries of birth of the foreign-born.

Coding educational data when

available and taking all possible

steps to insure the inclusion of

educational queries on standard

forms in “all States.

Coding of legitimacy status when

data are included in birth records.

Devising procedures for the continuing integration of reports of

infant deaths and births.

Urging the States and cities to use

the 1970 geographic codes of the

Bureau of the Census for alloca-

-.—. .—

tions of areas within standard metropolitan statistical areas or cities, as feasible.

Exploring the use of supplementary

statistical forms in selected

standard metropolitan statistical

areas, cities, or other special

areas in 1970 or 1969 through

1971, with queries on health, migration, mobility, and stability

along with the regular information

on marriage, natality, or mortality.

2. Rates, Risks, and Models

2.1

2.2

2.3

Nobilities associated with vital and

health processes should be defined in

relation to the specific process and the

research or analytical need.

The National Center for Health Statistics should work with the Bureau of the

Census on problems of allocations of

residence for the Armed Forces, students, institutional inmates, and other

problem groups and on allocations of

migrant status to those not reporting it.

The National Center for Health Statistics

in cooperation with the Bureau of the

Census should provide for a technical
2.4

study of definitions of migrants, migration and other movements, problems of denominators for migration and

vital rates, and appropriate bases for

rates. Such a study should also assess

migration as a longitudinal process, the

temporal relations of movements with

vital events, and the development of

needed techniques for nieasurement and

analysis.

There is need for a comprehensive and

critical review of migration models and

of general demographic models that include migration, with specifications of

concepts, events, and probability distributions to be considered in future models.

3. Sources for Health, Vital, and

Migration Statistics

3.1

3.2

The definition, testing, and validation of

procedures to secure information on

health through census and survey procedures are essential. Health questions

should be included in population surveys, mobility questions in health surveys,

Pilot studies on the uses and limitations

of hospital records are indicated. There

should also be explorations of the techniques, feasibilities, and difficulties in

combining such records for local areas

and regions.

4. Marriage, Natality, and

Migration Statistics

4.1

4.2

The national needs for marriage and

natality statistics and analysis require

expansions in geographic detail and analytic depth.

The steps that can be taken in the near

future require the utilization of information now on registration forms. This

involves emphasizing the importance of

completing all items on the forms, check4.3

4.4

4.5

ing the coverage of the data, and testing

the precision and validity of entries.

The upgrading of marriage and natality

data, tabulations, and analyses to levels

coordinate with those of mortality requires an expansion of the national data

system, not a reallocation of efforts

within it.

The measurement of the health dimensions in marriage, fertility, family stabilit y, and individual and family nobilities should be subjected to intensive

research and field experimentation.

The extent and nature of the current a+

longitudinal relations of migration and

mobility with marriage and reproduction

should be explored in field studies and

in special queries of samples of those

reporting events.

5. Special Populations

5.1 Economic deprivation, social retardation, marital instabilities, high rates of

childbearing, and high morbidity and

mortality are concentrated in certain

segments of the population in limited

areas. The greatest numerical concentrations of the problem groups and the

problem environments are in the centers

of the great cities. There are also serious difficulties in Appalachia and in

parts of the Deep South and the Southwest.

The largest of the disadvantaged groups

is the Negro, but there are also major

problems among other ethnic and cultural

minorities such as the Puerto Ricans in

in the Northeast and the Spanish Americans in the Southwest. Modern facilities

for the storage of data on tapes and their

processing permit the development of

these regular and special tabulations

that are needed. Planning for these developments should be initiated even prior

to the provision of additional staff and

finances.
5.2 The responsibilities for vital, health,

and migration statistics extend to special

groups where new procedures are essential to the procurement of the data

needed in plans and programs.

5.2.1 In the study of migratory labor

andmigrant families, the continuing focus is on agricultural labor,

but similar problem groups may

be involved in current difficulties

with vital records and “census enumerations in urban settings.

5.2.2 Indians, particularly those on reservations, and the Aleuts, Eskimos, and Indians of Alaska remain

the most economically retarded in

the American population. The associations” of migration with the

declining mortality and the very

high fertility should be measured

in vital and health statistics.

6. Essential Bases for Research and

Development

7.

The bases essential for research, development, and experimentation require not only

the direct involvement of the National Center

for Health Statistics but also its stimulation

of work in universities and research institutions through grants and contracts.

Plans and Programs for the 1970

Census period

7.1 Concentration of activities.

- 7.1.1

7.1.2

7.1.3

7.1.4

7.1.5

Coordination of vital records and

census tabulations.

Detailed tabulations in selected

areas and for special groups.

Special tabulations of vital records

as needed.

Collation of infant death records

with birth records.

Special topical, area, and group

studies.

7.2 Guidelines to types of approach and

studies.

7.2.1

7.2.2

7.2.3

7.2.4

7.2.5

7.3

Relevance and significance not

only to research but to public

policy and program.

Additions to rather than replacements of activities or analyses

regularly carried out by the government.

Contributions to knowledge,

whether evaluations of data, exploration of relations, or advances

of concepts and methods.

Incisive studies in depth, often

directed to State, city, regional,

or special groups rather than the

national population.

Cooperation with State and local

heaith departments, as with universities and research institutions.

Contributions.

7.3.1 A forward thrust in data, record

utilization, and research.

7.3.2 A movement for comparability in

and cumulative contributions from

the many special tabulations, surveys, and analyses that will be

made on the basis of or in relation to the 1970 census.

7.3.3 Major contributions to knowledge

of the interrelations of vital processes, health, and migration.

FINDINGS AND

RECOMMENDATIONS

1. Definitions of Migration

.

Migration is a change of residence from one

area to another. A migrant is a person resident

in an area who moved in from another area. If a

change of residence involved crossing national

boundaries, the person is an international migrant. If a change of residence involved cross-

.4
ing a boundary within

an internal migrant.

The definitions of

the country, the person is

migrant status prevalent

in official statistics and in most studies are those

developed by the U.S. Bureau of the Census.

Movements from one residence to another are

classified according to whether a county boundary

was crossed. Changes of residence within counties are referred to as short-distance mobility,

those from one county to another as migration.

Migrants are further classified as movers within States or between States.

The census of 1970 will include questions

on State or country of birth of the perso~ country of birth of the parents; place of residence,

activity, occupation, and industry 5 years prior

to the census; year moved into present house;

place of work; and, if foreign-born, year of immigration.

The vital registration forms include State

or country of birth, with place of birth of parents

included in the marriage forms.

Definitions of migration and of migrants in

relation to the crossing of political boundaries

are generally practical and operational, There

may be questions about the differing sizes of areas

and about the length of time a person who has

entered an area must remain a migrant. There

may also be questions about the definition of

residence and what constitutes a change of residence.

If vital and health variables are to be used

directly in conjunction with census data on migrant status, the technical demographic definitions

of migrant status must be utilized. The products

of analysis pertain to the characteristics of area

populations and the associations of variables in

such populations. This is relevant in studies of

areal distribution and ecological association.

There are other dimensions, however, even more

significant in the analysis of the interrelations of

health, mobility, and the various vital events.

These are. the associations and sequences of

events in the lives of individuals.

The frequencies, types, and timings of movements cliffer according to age, economic status,

and place in the family cycle. Migration is related in many ways to fertility; place of birth and

movements during childhood or adolescence influence marriage and reproduction. Family size

itself influences movement within the area of

residence or between the central city and fringe

areas.

The movements that influence health and disease, survival and death may be current or they

may have occurred at earlier periods in the life

cycle. Analysis of lifetime residential histories

has clarified some of the relations between migration, smoking, and cancer. It has also shown

the cumulative effects of residence and population

movement on disease, health, and mortality.

The relations of seasonal or recurrent movements to vital and health variables may be major.

The journey to work may alter the ecological

milieu and influence home and community relations.

The difficulties in analysis are greater for

morbidity and other health hazards than for vital

statistics. Since morbidity is not included in the

vital records system, there are limitations to the

data. Information of this type may be collected

in special studies. There may be inquiries within

or outside the National Center for Health Statistics and the State health departments. Migration

questions may be included in the Health Survey

and health questions in the Population Survey. If

indicators of health status, needs, and services

can be validated, data can be procured in census,

survey, and general questions.

2. Ratesr Risks, and Models

If migration is a variable used jointly with

marriage, natalit y, and health analysis, the specific questions of area populations and types of

rates assume central interest in planning for data

acquisition and tabulations. ‘Rates in which migrants are related to the population of their

areas of origin have probability connotations. If

migrants are related to populations in the areas

of destination, the statements are limited to those

of relative frequencies. If the primary orientation

of the analysis is the vital or health question

rather than migration, decisions as to bases become aspects of the research.

The problems of the bases of rates for types

of places within geographic areas present special

difficulties. Census delineations of urbanized

areas provide meaningful data for description

and analysis within census contexts, but the allo5
cation of vital events for the fringes of urbanized

areas presents major if not insuperable difficulties. Definitions of the rural population are

dependent on definitions of the urban populations.

If the fringes of urbanized areas cannot be delineated in vital records, the fringe populations

must be part of the rural nonfarm rather than

the urban population. This compounds the problems of a type of area that includes military

installations, college dormitories, homes for the

aged, and labor camps. The rural farm population itself presents complexities in vital and

health statistics contexts, particularly those associated with the aging population, the erosion of

the younger productive ages, the prevalence of

marginal groups, and the inclusion of seasonal

workers wherever they are at the date of enumera -

tion.

The 1970 census will include questions on

place of residence and type of activity at a date

5 years before the census. This will permit the

construction of alternate populations for areas

through differing allocations of the Armed Forces

and college populations. Tabulations of detailed

characteristics for alternate populations of the

geographic areas may be a major problem.

Alternate total populations would provide

only limited solutions for the problems of health

and vital rates, The base populations that are

required from the decennial census include not

only numbers by sex but by such characteristics as

age, marital status, race, nativity, place of

birth, and highest grade of high school completed,

with cross-tabulations for specified areas. It is

essential that the definitions of these characteristics in numerators be identical with those in

denominators. It is also essential that tabulations

of numerators and denominators be available for

identical areas. Differences in definitions and in

forms of reporting as between the vital records

and the census systems are particularly serious

in the areas of marriage and natality, Census

queries on marital status are de facto, the vital

records de ju$’e, Census questions about the number of children ever born are asked only of

women who state that they are or have been

marrie~ vital records concern all births. The

questions on the reporting of marital status of

mothers who have illegitimate births and the

childbearing of the legally single pose serious

problems in the computation of vital rates, as

in marriage and fertility analysis.

The problems of migration as a demographic

process or of migrant status in a census enumeration are significant to the National Center

for Health Statistics, but they are not its responsibility. Nevertheless, rates for groups classified

by migrant status are essential in vital and

health statistics. Thus the Center is concerned

with definitions of residence, types of nobilities,

and the planning of tabulations that yield consistency in numerators and denominators. If the

entry on State of birth in vital records is coded

and utilized “indescriptive and analytical tabulations and studies, cooperative planning with the

Bureau of the Census is imperative.

The problems of comparabilities in data,

rationality in the type of population base, and the

impact of migration on size and structure of

population are all involved ~ the determinations

of numerators and denominators for vital and

health rates. Given the most appropriate and

feasible decisions with reference to these problems, there remains the specific question of the

time reference of the denominator. The usual

procedure of estimating a midyear population

assumes implicitly an even distribution of change

throughout the year or period of time, Migration

that is episodic or otherwise changing often

makes this assumption invalid,

The difficulties in defining the proper bases

for vital and migration rates are major. There is

often a time lag between migration and the risk

of a vital event or between a vital or health

event and migration. The probabilities of moving

seem to be related to previous movements and

length of residence in particular places. Multiple

decrement life tables and other analytic methods

may be appropriate.

There are no simple answers to the proper

denominators for vital and health rates, Rather,

there are different measures and different denominators appropriate for special purposes. A

technical study is needed on definitions of migrants, migration, and other movements and on

problems of denominators to be used for migration and vital rates. Such a study should

assess migration as a longitudinal process,

6
temporal relations with vital events and health,

and developing needed techniques for measurement and analysis.

The constraints imposed by the complexities

of the phenomena and the data are barriers to the

development of concepts, hypotheses, and experimental designs for relating migration, vital processes, and health, The development of integrated

stochastic approaches to marriage, births, deaths,

and migration should be investigated. A review

of the assumption, methods, uses, and limitations

of models should emphasize the difficulties in,

and the possibilities for, the inclusion of migration in general demographic models.

3. Sources of Data

Tlte vikzl recovds fo~m. --The major resource for analysis of migration in relation to

vital processes is the vital records system.

Curiously, many of the data on the vital record

forms are largely, if not wholly, unexploited. All

the vital record forms include place of birth and

current residence. All forms, except mortality

now include highest grade of school completed.

Marriage forms include marital history; birth

certificates include details of the present and

previous deliveries along with reproductive history and present status of each live birth (whether

living or dead), It is the possibilities inherent in

these and related data that underlie our later

suggestions for concentrated studies in population

dynamics at the time of the 1970 census.

Followback query. –The technique of the followback query for small samples of vital events

permits probing analyses beyond the scope of the

national record system as a whole, In 1958 the

National Vital Statistics Division collected residence histories for a sample of lung cancer

deaths; the Bureau of the Census collected residence histories for a sample of the population at

risk of this event. Residence histories have been

included in some later followback studies of vital

records conducted by the National Center for

Health Statistics.

Queries of samples of marriage and birth

reports during a census period using the migration and mobility questions of the census would

permit significant analysis. It would also provide

experimental testings of responses to migration

and mobility questions in followback queries and

in census enumerations.

The National Health Survey and the Current

Population Survey are major potential sources

for the probing needed to extend knowledge of

movements and their relations to specific sectors

of population dynamics. Health questions can be

added to the Current Population Survey or used

as supplements to it, along with specific mobility

questions as needed. Questions on migration or

mobility can be included in the National Health

Survey,

E@ansionand experimentation, State and cities.–The standard vital record forms of the

States yield minimum comparable data for the

United States, At periodic intervals when forms

are revised, individual States and cities or other

civil divisions could ask additional questions.

The responsibility for analysis would then lie

with the State or local departments of health

along with universities or other institutions

collaborating with them.

The advances in regions, States, and cities,

if they occur, will be in response to local needs

and will not reduce the potential for advances in

data collection and analysis. The statistical and

procedural problems of measuring migration,

the adjustment of migrants, and the impacts of

migration on vital processes, health, and health

needs are major in California, The death certificates of California include length of residence

in the State. If this were to be included on marriage and birth certificates, forceful arguments

could be advanced to include questions on length

of residence in sample surveys of the population

of California. Analysis of data for this populous

State would contribute to the knowledge of method,

technique, and interrelations of vital processes

whose values are not limited to California, The

advances in a State where specific relations are

prevalent and specific needs recognized could

serve as pretests for national assessments,

modifications, and advances.

The analytical exploitation of the almost experimental diversities that characterize the

United States must proceed through the concentrated efforts and the intensive studies of local,

State, and regional institutions. The national data,

tabulations, and analyses can only be a least

common denominator insofar as geographic, eco7
nomic, social, and cultural diversities are concerned.

The needs, functions, and contributions of

statistical and research organizations in localities, States, and regions are complementary

rather than competitive with the national organizat ions. The pattern of governmental and university or research institute ‘cooperation is appropriate at all administrative and geographic

levels.

Special surveys and studies. - In principle,

the hlational Center for Health Statistics or State

and local health departments could undertake

studies with migration as a primary focus. In

practice, migration is likely to be included in

studies of marriage, natality, morbidity, or mortality. Similarly, analyses of migration or mobility are usually framed in demographic, economic,

and social rather than in health and vital statistics contexts. These diversities in approach could

become major channels for the advance of research in migration, vital processes, and health,

and the associations among these and other variables.

Perhaps the simplest way to discuss the role

and contribution of special surveys and studies

is by illustration. Longitudinal studies and continuing registers of heart disease or cancer, of

twins, and of persons with radioactive exposure

could include changes of residence and other indications of mobility. In recurrent surveys such

as the 10-city study of trends and changes in

morbidity and mortality from cancer, there

could be probes of the type and extent of associations with migration, local mobility, and

such special movements as commuting. Conversely, given technical and methodological advances, health variables or indicators of health

could be included not alone in studies of migration but in other studies in which some or all

of the migration and vital statistics variables

are included.

There are possibilities for innovation in

direction and technique. In special studies and

surveys, whether governmental or private, the

vital events registered for a sample or panel

of informants could be secured through cooperation with local registration offices. Followback or

query procedures would then add new dimensions

to data and analysis. Or, to pursue potentialities

further, special questions on migration or other

movements could be attached as supplemental

schedules to vital record forms.

Hospizlzl and health service records and

quevies. —Hospital and health service records

have practical but limited potential as data resources. Hospital records are administrative

rather than statistical. There is no routine procedure for the collation of records on the same

person from different hospitals or health agencies.

The Regional Medical Program and the introduction of regional medical centers may lead to

interhospital linkages of records among institutions in the same region. With the requirements

of Medicare and increasing computerization, the

use of Social Security numbers may become

routine. If so, intraregional and eventually interregional linkages of hospital records may provide

unparalleled sources of data on the movements of

patients. Since most births occur in hospit:ls,

analyses of mobility, morbidity, and reproductive

history would be possible. Interregional linkage

to a national system is so speculative a prospect

as to merit only the comment that pilot tests of

the feasibilities of such linkages and methodological analyses of form, feasibility, and relevance

should be supported when possible.

Clinic, hospital, and health service records

are sources for many types of special studies,

prior to or quite apart from overall record systems. Relations between migrant status and the

demands, receipt, and results of medical care or

health services may be studied in individual

institutions or areas. Hospital records may provide bases for intensive followup studies. The

mental health and cancer registers represent

another type of research activity associated with

medical and hospital records.

The population labo~atwy. —The use of designated area populations as human study centers

or laboratories in vital and medical research

has been productive. A continuing series of studies was inaugurated in Hagerstown, Maryland,

in 1921; health, vital events, and migrations of the

Eastern Health District in Baltimore were subjects of studies by or associated with the School

of Hygiene and Public Health of The Johns Hopkins

University. More recently, population lalxma-
tories as omnibus resources have been established in Tecumseh County, Michigan, and Alameda County, California.

Epidemiological studies in the human population laboratory context often require residence

histories or information on types (other than migration) and frequencies of movement. Therefore,

studies of the relations of migrant status or

mobility to the disease or vital process under

investigation yield byproduct information on

movements in community settings.

The utilization of materials collected in

human population laboratories for studies of the

movements of people should continue to receive

emphasis. Residence histories can be collected

retrospectively; information on changes in residence can be secured prospectively when the

populations are under surveillance. Probabilities

of subsequent moves can be investigated in relation to a range of demographic characteristics,

including previous residential histories.

Perhaps the most significant feature of the

population laboratory is the continued accessibility of the study group. Marriage, reproduction,

health, and mortality can be studied intensively

for in-migrants, out-migrants, the locally mobile,

and the stable within a circumscribed and generally known area.

The associations of sources. —The difficulties in the concepts and definitions of rates, the

lack of comparability in data from different systems, and the approaches to theoretical and empirical studies of interrelations can be simplified by efficient use of data from various sources.

If vital and health records and census and survey

schedules were collated, direct analysis could

replace much of what is now achieved by indirect

or aggregate techniques.

Given modern data processing and storage

facilities, many plans once envisioned as ideal

are operationally feasible. The development of

national registers of deaths has been explored in

the past. The development of interpenetrating

registers of marriages, divorces, births, and

deaths would permit analyses of population dynamics at specific times. Once such a system

was operative, longitudinal studies that encompassed the vital events from birth to death

would be possible. Place of birth would be in

each record; the places of residence at successive events would yield new measures of mobility..

For instance, place of birth, place of marriage,

and place of birth of each child would be available for each woman who had ever been married.

Any information on place of birth and on birthplace of each child would be available for each

woman, whether single or married, Information

from a variety of registration certificates would

be available for the subject of any vital event

report, whether birth, marriage, divorce, maternity, fetal death, or mortality.

The technique of matching infant death and

birth records was developed in the 19th century.

Use of this technique has increased in recent

decades, with a corresponding increase in the

utility of integrated data. Perhaps a total integrated system of vital records. is visionary, but

some further progress in integration should be

feasible in the coming years.

4. Marriage, Natality, and

Migration Statistics

The registration of vital events is the responsibility of the States, but responsibility for

coordination and national tabulation is discharged

by the National Center for Health Statistics. The

allocation of responsibilities to health services is

obviously appropriate for morbidity and mortality

statistics. It is equally appropriate for natality

statistics because of the associations of doctors

and hospitals with delivery. In most States, the

State health departments are the custodians of the

marriage and divorce records.

The national needs for marriage and natality

statistics require expansions in geographic detail and analytic depth. The initial step is the

improvement and utilization of the information

now included on the registration forms. This

involves emphasizing the significance of the information and the importance of completeness

in filling out the certificates. There should be

checks of the coverage and tests of precision and

validity of entries.

The advances of marriage and natality data,

tabulations, and analyses to levels coordinate

with those of mortality statistics should be a

forward movement of the vital statistics system,

not a reduction of the levels and details of the

mortality statistics.

9
There are special difficulties in the development of marriage and divorce statistics because of their peripheral interest to many medical

and health personnel. The Public Health Service

has the responsibilities for the collection, processing, and tabulation of statistics that are needed

primarily in other sectors of the Department of

Health, Education, and Welfare, in other departments of government, and in the academic and

research community. The measurement of the

health dimensions in marriage, fertility, family

stability, and individual and family nobilities

should be subjected to intensive research and

field experimentation. Similarly, the measurement of the mobility dimensions in marriage,

fertility, mortality, and health should proceed

through intensive research and field experimentation.

The nature and extent of the current and

longitudinal relations of migration and mobility

with marriage and reproduction should be explored in field studies and special queries of

samples of those reporting events.

5. Special Populations

The metropolitan fro@.diztion.-The critical

problems in or associated with population dynamics and health are those of the metropolitan

areas. The critical population is the Negro. The

long stability, lethargy, and social and economic

retardation in the South resulted in an extraordinary exodus in the last half century. That

exodus, still in process, was not the conventional

migrant interchange. It began, rather, as movement of an ill-prepared people to the central

cities of large metropolitan areas. It occurred

in a period when mechanization and automation

were reducing the needs for unskilled labor to

low levels. A subculture, with unstable family

relations, female dominance, and limited male

responsibility, had persisted since the period

of slavery. Transferred to the cities, high fertility and illegitimacy became major problems,

intensified by the failure of urban society to

overcome racial discriminations.

In recent decades there were major movements of Negroes to central cities and of white

persons to outer areas. Migrations between

metropolitan areas are now replacing movements

from rural to urban areas as a central process.

The metropolitan populations are composed

largely of migrants and the children of migrants.

The major questions for research concern

marriage, marital status, and family instability;

childbearing within and outside marriage; their

variations by education and duration of residence;

and the trends of the generations born in metropolitan areas. The basic variables in marital

and reproductive history are includes in the vital

registration forms. These forms also include

place of birth and highest grade of school completed.

Thus the priority problems in research can

be probed if data now on the registration records

are given with completeness and accuracy, It is

unlikely that items long unused are filled in carefully in all or even in most metropolitan areas.

Moreover, the marriage-registration area is not

nationwide and many of the States do not note

legitimacy on the birth certificate. Questions on

education have been added to the standard forms

as of 1968. Thus some analyses can he nationwide, while others may involve studies of particular metropolitan areas or clusters of such areas.

The concentration of effort to secure complete

records combined with the demonstration of the

scientific values and policy relevance of the data

should yield improvements in the records.

Analysis of the population dynamics of a

metropolitan population is deficient if it involves

only a dichotomy of central city and outer ring.

There are major differentiations within the metropolitan area itself and, particularly, with the

central city. Insofar as possible, vital records

should k coded for the geographic areas of the

1970 census, and tabulations should be made in as

much geographic detail as possible. The essential

requirement is consistency of vital statistics

and census tabulations for standard metropolitan

statistical areas (SMSA’S).

Basic requirements and recommendations

are as follows:

1. Identification and tabulation of data specifically for Negroes, instead of grouping

them under the heading of “nonwhite” as

previously done.

2. Coding and tabulating data on State and

country of birth on vital records, and

10
3.

4.

5.

distinguishing Puerto Ricans and identifying the countries of birth of the foreignborn.

Coding of highest grade of school completed.

Integration of infant death reports with

birth records.

Use of the 1970 geographic codes or

other procedures for allocation to areas

within SMSA’s, insofar as possible.

There should be explorations of the use of

supplementary statistical forms in selected

SMSA’S for 1970 or for 1969 through 1971, with

questions on health and on migration, mobility,

and stability.

Special areas and groups.-Types of nobilities and the associations among them differ by

age and place of residence. Moreover, the relations of vital or health variables to migration

sometimes differ significantly for males and females. Furthermore, measurable divergences

in subcultural and social psychological factors

dictate that all analyses be’made specifically for

white and Negro persons.

The counterpart of metropolitan growth is

rural depopulation. The population dynamics of

the rural areas with aging and eroded age structures present special problems Jri definition and

measurement as well as topical approaches. For

instance, the selectivities in past out-migrations

leave aging groups whose vitality and longevity

must have been affected along with their educational and economic characteristics. Questions of

the residual populations in rural areas assume

a new significance as government policy turns’

toward investment in the rural areas and smaller

places with a view toward arresting, if not reversing, the urbanward movement.

Analysis of the population dynamics and health

of Appalachia and other problem areas is needed.

The critical questions are not so much the crosssectional analysis of retardation as the dynamic

analysis of exodus and metropolitan influence.

The focus should be the developments in the

younger ages rather than those among the aging

and aged, Major analysis of Appalachia and other

areas would be possible with the coding, tabulation,

and utilization of information from vital records

and the 1970 census. The basis would have to be

agglomerations of counties rather than combinations of States. Special surveys and studies could

be formulated efficiently on the basis of this

analysis.

The areas for special study should not be

limited to recognized problem areas. Comparative

analyses are essentiat both the areas of origin

and the areas of destination of the migrants

should be examined. For example, studies of the

Negro population still in Mississippi would be

significant in research and program. For comparative purposes, there might be similar studies

of the residual white populations in the rural areas

of the Dakotas or the northern region of the States

on the Great. Lakes.

The foveign stock. —Oneof the most neglected

of the resources for measuring the associations

of marriage and divorce, natality, morbidity and

mortality, and mobility itself with the migrations

of past periods is the foreign stock, including

both those born in foreign countries and those

of foreign or mixed parentage. General or specific analyses for populations of various national

origins could contribute to the measurement of

the cultural aspects and the ‘chronological attenuations of migrant differentiations and adaptations.

ongoing studies of foreign-born populations

suggest other possibilities. The cohorts of residents in the United States who were born in Norway and the United Kingdom from whom residence

histories have been collected are representative

samples of migrants from these countries. Materials for migrants in the United States can be

compared with findings for living sibs of migrants and for probability samples of the general

populations in Norway and the United Kingdom.

Populations of Spanish or Mem”canorip”n.—

The problem minorities moving to the central

cities of metropolitan areas include the Negroes

(classified in vital and census statistics as nonwhite). They also include the Puerto Ricans in

the East and the populations in the West with

Mexican or Spanish surnames, the majority of

whom are classified in vital and census statistics

as white.

Vital records include State or country of

birth and thus permit identification of those

born in Puerto Rico and in Mexico. Marriage

11
forms include an item on place of birth of parents

of bride and groom, but the birth and death forms

do not include this item. Thus if vital records

are used without linkage to each other or to the

census, analysis would include persons born in the

United States of Puerto Rican or Mexican parentage and would be limited largely to those born in

Puerto Rico or Mexico. The nobilities and adjustments of the second generation would be lost.

The dynamics of the Puerto Rican population

are particularly significant, for the entire population of Puerto Ricans is included in the American statistical system. Analysis can cover the

population in Puerto Rico, persons born in Puerto

Rico and now living in the United States, and

persons born in the United States of Puerto Rican

parentage. If vital records for centers of concentration such as San Juan and New York could

be linked to census schedules, the resultant

analysis would be highly significant to the United

States and to the Commonwealth of Puerto Rico,

It would also contribute to the knowledge of a

demographic transition in process. Comparable

analyses for Puerto Ricans, Negroes, and southern

white immigrants in New York could probe the

distinctive aspects of race, culture, origin, and

socioeconomic status in metropolitan adjustment.

The problem of identifying populations of

Spanish or of Mexican origin is difficult. Mexican

immigrants can be identified by country of birth,

but this is not possible with persons of Mexican

parentage or descendants in later generations.

Then there are the descendants of the Spanish

inhabitants who were once subjects of Spain or

Mexico. Movements of these populations of Spanish

origin from Texas to California is major; so is

the dispersion’ from the Southwest to the metropolitan regions of the Great Lakesf.

To identify persons of Spanish origin, the

Bureau of the Census coded from a list of

Spanish surnames in 1950 and 1960 for the five

Southwestern States. Such coding may be undertaken again in 1970; the needs of the National

Center for Health Statistics would be a factor in

the decision, Experimentation and analysis of the

list of names and the tasks of coding in California

provide a basis for assessment and decision as to

procedures for the 1970 census period.

Indiuns and othw

other subcommittee of

12

indigawua groups, --Anthe U.S. National Committee on Vital and Health Statistics is considering the Indian population, It should be noted,

however, that the Indian population and the Alaska

Natives are among the most economically retarded of the American mim)rit y groups. Characteristic of the population are the high birth

rates and the almost modern death rates that

yield high rates of natural increase. This international problem with which the U.S. Government

is concerned also exists within the United States,

The question for analysis and the feasibility

of analysis break logically and practically into

two studies. The first would be that of the Indian

in the conterminous United States. The second

would be that of the Alaska Native population.

If the Department of Health of Alaska required

racial designation such as Aleut, Eskimo, or

Indian on the vital records and the Bureau of the

Census required similar designations in the census of Alaska, studies of these population groups

would be possible. If census schedules and vital

records w&e linked, evaluation of the ethnic

designations and measurement of coverage would

be possible. The linked records and schedules

would permit incisive analysis of this small

but significant subgroup in the population.

Hawaiians, Chinese, and Japanese. —The

analysis of the population dynamics of the Alaska

Natives concerns indigenous groups remote from

the larger population. The analysis of the dynamics of the population of Hawaii and of the

Chinese and the Japanese in California concerns

the assimilation and integration of peoples of

diverse Asian backgrounds. In comparative demography the nobilities, the ages at marriage,

the limited fertility, and the very low mortality

of the Chinese and the Japanese in Hawaii and

California permit analyses both of the potentialities of the. peoples of China and Japan and of the

conditions associated with the realization of those

potentialities, Again the requirement for analysis is a comparable racial designation on vital

records and census forms. The designations are

now included in the registration forms of Hawaii;

Chinese and Japanese are noted in the forms of

California. The use of racial designations on census schedules and the collation of vital records and

census schedules would permit direct analysis

of this blending population in the Pacific. Such

collation would also permit the evaluation of the
comparability of the ethnic classifications in the

separate sources,

Migrant labor.– The problems of migrant

labor merit and receive special attention from

many agencies and committees. The neglected

sector is the relation of marriage and fertility

to the origin and persistence of the patterns of

migration, poverty, and deprivation. Exploration

of the direction of relations and the crucial points

in breaking the cycles of the generations should

receive priority in future analyses. Rather, marriage, natality, reproductive wastage, and family

dynamics should be major components in studies

of the economic and health status of the migrant

groups.

6, Essential Bases for Research and

Development

Resources for research may be defined as

present and potential sources of data. This

approach dominated the preceding discussion. In

a more basic sense, resources for research may

be defined as the professional personnel and facilities that constitute the research staffs of universities and research institutions. Pioneer studies on the interrelations of migration, vital

processes, and health are undertaken by these

researchers. Further advances that are outward

thrusts of inquiry, method, and knowledge are

likely to be based in universities or research

institutes or to involve their cooperation.

Today there is a growing need for increasingly intricate and intensive research. There are

increasing numbers of research specialists and

research facilities. There are new technologies

that permit analyses that have been impractical

in the past. There are professional statistical

organizations and research staffs in government.

These coincidences made feasible approaches to

research that would have been visionary a few

years ago.

Any dichotomy of governmental and academic

approaches and responsibilities has increasing

components of artifact. The National Center for

Health Statistics is considering increasing involvements with universities and research institutions,

This Committee’s sketch of areas of research

and the suggestions for priorities in research concerned a field of activities rather than a directive

to specific organizations within or outside Federal

or State Governments. The es sent ial bases for

development, research, and experimentation require not only the direct involvement of the National Center for Health Statistics but also its

stimulation of work in universities and research

institutions through grants and contracts.

,7, Plans and Programs for the 1970

Census Period

The responsibilities of the National Center

for Health Statistics dictate major emphasis on

data collection, tabulation, and analysis for the

years around the 1970 census. The fields in which

knowledge is needed most urgently include marriage, natality, and infant mortality in the populations formed largely of migrants and the children

of migrants. The field of concentration in the

period of the 1960 census was mortality; the

fields of concentration in the period of the 1970

census should be marriage, natality, and migration.

The advances of statistics and research, the

technological developments, and the widely ranging activities already in process are further

arguments for the feasibility and productivity of a

flexible program in the period when 1970 census

results and queries recently added to vital records are both available. There is emphasis on

migration in the 1970 census. Tabulations will be

oriented toward metropolitan distribution and

process; the problems of central cities and disadvantaged rural areas; and the relations of

racial, economic, and social variables to these

demographic components. The records of marriage, divorce, natalit y, and fetal death include

information on place of birth, ethnic group (including the Negro specifically), and educational

level.

For the first time in the 20th century, the

census of 1970 will include a direct question

on the presence, nature, and duration of disability.

One may also anticipate the inclusion of questions on health in the current population and

health surveys, followbacks of reported vital

events, and other special studies.

and

The concentration on marriage, fertility,

migration in the period of the 1970 census

13
has an immediate justification in todayts problems

of population, health, and welfare. In longer

perspective, this is an appropriate period for

advances in the comprehensive analysis of population dynamics. Natality cannot be analyzed

meaningfully apart from marital status, family

instability, and illegitimacy. Fetal, neonatal, and

infant losses are aspects of the reproductive

process, as of mortality. The changing relations

of mortality of men and women at various ages

may be described but not explained through

mortality statistics alone. Health and vitality

and disease and disability are related not only

to rates of dying but to reproduction and mobility.

Migrations and changing distributions ‘alter the

locus if not the levels of births and deaths and

complicate problems of vital rates.

The involvement of the National Center for

Health Statistics can be summarized in four

categorical statements:

1.

2.

3.

4.

Major advances in vital, health, and migration statistics are essential to the

analysis of the population dynamics of

present and future, overall and for areas

and groups within the population.

The analysis of levels and changes in

marriage, natality, mortality, and migration involve the interrelations of the

specific variables in population growth

and distribution with the demographic,

economic$ and social characteristics of

the population.

Measures of health and vitality should be

included within or related closely to the

vital statistics system.

Migration statistics should be components

in a system of population dynamics.

There are major problems in the evaluation,

tabulation, and utilization of information on the

vital record forms that is not now used or that

is used only sparsely. The problem of procedure

is the joint planning of tabulations from vital records and census enumeration. There is then

further exploration and decision as to what

current surveys or special procedures supplement the resources of the vital records system

and the census.

Outline of Resources

1. Vital Records

1.1

1.2

1.3

1.4

MaWage.-The certificate requires

information on the State of birth of

the bride and groom and of the father

and mother of each. Race is specified.

Queries include order of marriage

and, if previously married, type of

termination. Education is included

for groom and bride. The major problem is allocation by residence when

the system covers only 38 States.

Divorce or annulment. -l%is certificate includes State of birth of husband

and wife but not of parents. Place and

date of marriage are included, as is

date of separation by total number

of living children and by number of

children under 18. Number of the

marriage and type of dissolution of

previous marriage or marriages are

secured separately for husband and

wife.

Live bivth. —The certificate includes

State of birth of father and mother,

race of each, and whether or not the

birth was legitimate (38 States). Details on the birth include date, place,

and attendant; pregnancy care; weight

of infant; injuries; and malformations. There is a reproductive history, with the date of the last live

birth or fetal death together with

previous deliveries by the number

now living, those born alive and now

dead, and those born dead.

Fetal dea~h.—l%is certificate includes State of birth, race, and education of the father and the mother.

Reproductive history of the mother is

included, with date of last live birth,

date of last fetal death, and previous

deliveries by whether now living,

born alive but now dead, or born

dead.

14
1.5 Infant mo?’tdity. —’The tiformation

on infant death includes State of birth

of the infant but neither the States of

birth nor the education of the father

and the mother. Analysis in the context of reproduction requires matching with the birth certificate.

2. The 1970 Census

Information on age, race or nativity,

place of birth, and highest grade of school

completed is included in the census schedule as in vital records. The 1970 census

will have complete enumeration— a 25-per- ..>.—

cent sample, and ‘then—2<-“and 5-percent

samples; these latter will be comparable

to the 25-percent sample but not to each

other. The question of marital status is

included in the 100-percent enumeration

and marital history in the 5-percent sample. Marriage is defined de facto. Numbers of children ever born to women ever

married are included in the 25-percent

sample.

Migration or mobility questions on the

census forms are as follows: State or

country of birth (25 percent); country of

birth of parents (20 percent); mother

tongue (20 percent); year moved into

present house (20 percent); place of residence 5 years prior to census (20 percent);

place of work and means of transportation

(20 percent); year of immigration (5 percent).

New questions on labor force status 5

years ago (25 percent) and occupation and

industry 5 years ago (5 percent) permit

the allocation or reallocation of college

students, the Armed Forces, and work

groups to secure the most appropriate

denominators for vital rates of various

types.

A question on the presence and duration

of disability introduces direct health query

into the census and provides an empirical

3.

4.

5.

6.

test of the quality and value of the data

thus secured.

The housing questions include six items

used by the Housing and Urban Development to delineate areas for housing programs: water supply, toilet, bathtub or

shower, complete kitchen facilities, heating equipment, and rent or value.

National Health Survey and Current Population Survey

The inclusion of migration or mobility

questions in the National Health Survey

and the inclusion ,of health and mobility

questions in the Current Population Survey supplement vital statistics and the

census enumeration, The regular Employment E2wnings and Monthly Report on the

Labov Force, which is the core of the

Current Population Survey, includes illness or disability as reason for not working.

Followback Queries

The retrospective query of vital reports

may supplement information and evaluation.

State Vital Record Systems

Analyses from the vital records systems

of the States are relevant to future developments of the national systems. For

instance, California and Alaska ask about

length of residence in the State. There

has been work in California on the use of

Spanish surnames in vital records.

Special Surveys, Queries, and Studies in

States

State or municipal health departments,

perhaps in cooperation with universities

and research institutes, may undertake

studies not feasible at regional or national

15
7.

8.

levels. For instance, North Carolina might

develop studies of the data and the dynamics of marriage, fertility, andlegitimacy in the native white and Negro populations.

Other Government Surveys or Series

An illustration: an ADC (Aid to Dependent

Children) survey was conducted in 1967.

Another may be undertaken in 1970. If so,

there could be supplementation with the

tabulations and analyses of marriage,

family formation, fertility, pregnancy

wastage, and illegitimacy in the general

and in this special population.

Universities and Research Institutions

The major developments of population

research and training centers and the increases in demography in university departments, including public health, provide sources for analysts who would

utilize the data generated by the special

activities of the 1969-71 census period.

Representatives should be included in the

planning of the activities.

Procedures

Tabulations of the usual types of vital statistics for areas within central cities and standard

metropolitan statistical areas require that the

geographic codes of the census be used in the

relevant vital statistics records. Tabulations of

the information on place of birth require assessment of the quality of the information on the basis

of previous tabulations and uses of these data.

Tabulations of the information OP educational

levels require evaluation of the completeness and

accuracy of the data. If detailed data on reproductive patterns and histories are to be secured

from birth reports, special efforts should be

made to insure completeness and care in the

filling out of birth records. Similar attention

should be given to legitimacy status in States

where the information is collected.

These considerations indicate that the National Center for Health Statistics and State registrars should be asked to assess the adequacy

of data

tions:

1.

2.

3.

4.

5.

and where feasible take the following acUse geographic codes for address of residence at time of vital event.

Code place of. birth.

Code educational level.

Request the completion of all items on

present and previous deliveries and on

legitimacy in the natality reports,

Emphasize the importance of completeness and accuracy in all items noted

above, plus the specific designation of

race.

Types of Products

1. Tabulation of Vital Records.

1.1

1.2

1.3

. 2. The

Tabulations of the usual types of marriage, divorce, and natality data, with

allocations to geographic subareas

within metropolitan areas and with

sufficient detail by age and other

relevant demographic characteristics to permit refined measures.

Tabulations of vital statistics variables by migrant status as indicated

by State of birth, with major emphasis

on places of origin of the metropolitan

in-migrants and places of residence

of the out-migrants from rural areas.

The prime focus involves the exodus

of Negroes from the South and the

marriages and births of Negroes in

metropolitan areas whether born locally, elsewhere in the North and

West, or in the South.

Tabulations of marriage and natality

by educational level, place of residence, and place of origin.

Linka~e of Infant Death ReDorts With

Birth Records.

2.1 Tabulations of fetal deaths, neonatal,

and later infant mortality by place

16
2.2

2,3

of residence and place of origin for

Negro and white populations.

Tabulations of fetal and infant deaths

by educational levels of the parents.

Tabulations of infant deaths by age in

relation to the reproductive history of

the mother and various characteristics of the parents.

3. The Matching of Census Schedules for Infants Born Near the Census Date With

Birth Records.

3.1

3.2

3.3

3.4

3.5

The basic goal would be the testing

for completeness of birth registration, particularly in the Negro population. Careful design would permit

analytical use.

If infant deaths are linked to birth

records, the matching of census

schedules, for infants and birth records provides census data for the

infant and the family, detailed mortality information, reproductive histories, and legitimacy status.

The comparison and evaluation of information on age, race, marital status, place of birth, and educational

level in census enumeration and vital

records is thus feasible.

The evaluation of data from census

queries on children ever born to

women ever married on the basis of

births reported from all women giving birth without reference to marital

status is essential.

The analytical possibilities of

matched and fully utilized natality

reports and census enumerations are

so diverse and potentially so productive that no statements are required beyond the noting of the fact.

Statistical Publications and Studies

The various tabulations would permit many

types of analyses now and in future years. Special

tabulations or access to tapes should be available

to responsible users. Thus the program would include

1.

2.

3.

Statistical publications, perhaps in part as

a joint series with the Bureau of the Census.

Tapes or other access to data.

Special studies or monographs.

It would not be appropriate to outline a monograph series in advance of the work of the committee that develops the project. The Subcommittee on Migration and Health Statistics viewed

the analytical publications as a series of special

studies in significant fields. In many fields,

monographs on the total population of the United

States- would mean reduction to least common denominators. Geographic coding for metropolitan

areas will not be nationwide. Illegitimacy is not

noted in all States. The marriage-registration

area is not nationwide. Moreover, there are social,

cultural,’ and regional dimensions to population

dynamics. Social change is not a uniform process.

The special statistical activities in the current health and population surveys and other

sources will be undertaken in light of the analytical

problems judged most significant. They will be

related to the analyses that are projected. ;

000

%? U, S, GOVERNMENT PRINTING OFFICE: 1068-042042/2S

17
,

OUTLINE OF REPORT SERIES FOR VITAL AND HEALTH STATISTICS

Public Health Service Publication No. 1000

Series 1.

Series 2.

SeVies 3.

Sevies 4.

Series 10.

Series 11.

Series 12.

Sevies 13.

Sertes 14.

SeVies 20.

SeYies 21.

Series 22.

PrognLms and collection procedures.—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.

Data eL~aluation and methods reseavch. —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.

Aua[ytical studies. -Reports presenting analytical or interpretive studies hased on vital and health

statistics, carrying the analysis further than the expository types of reports in the other series.

Documents and committee reports. - 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. *

Data fvom the Health Interuiezo Suwe~. —.Statistics on 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.

Data fvom the Health Examination Suvcey. — l)ata from direct examination. testing, and measurenlent of national samples of the population provide the basis for two types of reports: (1) estimates

of the medically defined prevalence of specific diseases in the United States and the distributions of

the population with respect to physical, physiological, and psychological characteristics; and (2)

.wllysis of relationships among the various measurements without reference to an explicit finite

universe of persons.

Data from the Institutional Population Su)-Leys. —Statistics relating to the health characteristics of

persons in institutions, and on medical, nursing, and personal care received, based on national

samples of establishments providing these services and samples of the residents or patients.

Data from the Hospital Disclla)-ge Suwey. —Statistics relating to discharged patients in short-stay

hospitals, based on a sample of patient records in a national sample of hospitals.

DUtO on health wsowces: manpowev and facilities, —Statistics on the num~rs, geowaphic distribution, and characteristics of health resources including physicians, dentists, nurses, other health

manpower occupations, hospitals, nursing homes, and outpatient and other inpatient facilities.

Data on ~no~taLity. -Various statistics on mortality other than as included in annual or monthly

report s— special analyses by c~use of death, age, and other demographic variables, also geographic

and time series analyses.

Data on natality, )narviage, a>LddiL’o?’ce.—Various statistics on natality, marriage, and divorce other

than as included in annual or monthly reports—special ana]vses by demographic variables, also

geographic and time series analyses, studies of fertility.

Data from the National Natality and ,Mo].ta~ity SurL:eys. — Stati sties on characteristics of births and

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

includin~ such topics as mortality by socioeconomic class, medical experience in the last year of

life, characteristics of pregnancy, F’t”.

For a list of titles of reports published in these series, write to: office of Infornution

~r:Ltiotl:il [:ellt<.r for Hcdlth St.ltistics

U.S. Public’ fkalth Service

VJ,~shington, D.C. 20201