National Center for Health Statistics

Introduction to NCHS and 

Health, United States

Sheila Franco, Renee Gindi, Anne Mamish, and other members of the Health, 

United States Modernization Team

2023 Federal Committee on Statistical Methodology 

Research and Policy Conference 

October 24, 2023

1
Outline

 Introduce Centers for Disease Control and Prevention’s National Center for 

Health Statistics

 What is Health, United States?

 Why redesign?

 What will be covered in today’s session?

2
U.S. Principal Statistical Agencies

Chief 

Statistician,

OMB

National Center for 

Health Statistics National Center for 

Education Statistics

Economic Research 

Service

National Agricultural 

Statistics Service

Census Bureau

National Center for 

Science and Engineering 

Statistics

SSA, Office of Research, 

Evaluation, and Statistics IRS, Statistics of Income

Bureau of Economic 

Analysis

Energy Information 

Administration

Bureau of Justice 

Statistics

Bureau of Labor Statistics

Bureau of Transportation 

Statistics

3
Health, United States: Background

 Published by the National Center for Health Statistics since 1975

 Congressionally mandated report from the Secretary of Health and Human 

Services to the President and Congress 

 Educate and inform policymakers and the public about key health topics:

– Health status and determinants

– Healthcare utilization 

– Healthcare resources 

– Health expenditures and payers

4
Health, United States: Program Goals

 Educate and inform policymakers and the public about key health topics

 Bring together health information from multiple data sources

 Focus on trends over time

 Examine health disparities between population subgroups

5
NCHS Data Collections and Health, United States

National 

Vital 

Statistics 

System

National 

Survey of 

Family 

Growth

National 

Health 

Interview 

Survey

National 

Health and 

Nutrition 

Examination 

Survey

National 

Health Care 

Surveys

NCHS

Data 

Linkage

NonNCHS 

Data 

Sources

Health, United States brings reporting from these systems together with data 

from outside of NCHS for additional content and context.

6
7

Health, United States
Health, United States Components? 

 At a Glance table

 Highlights

 Chartbook with special feature 

 Trend tables 

 Appendices

• Data sources

• Definitions and methods

 PowerPoint chartbook figures

 PDF and excel trend tables

8
Health, United States: Uses

 Find a statistic

 Monitor trends in the nation’s health

 Set research and program priorities

 Develop policies and programs

 Evaluate progress toward meeting national health 

objectives

9
Why Redesign?

 Usability

 Findability

 Relevance

 Awareness

10
Session Goals

 Discuss the research NCHS conducted to inform the redesign

 Review the communication science and strategies that anchored the 

redesign

 Present the redesigned Health, United States suite of products

 Lessons learned

11
National Center for Health Statistics

Health, United States Redesign Research and Findings

Sheila Franco, Renee Gindi, Ji-Eun Kim, Zakia Nelson, Ashley Woodall, and 

other members of the Health, United States Modernization Team

2023 Federal Committee on Statistical Methodology 

Research and Policy Conference

October 24, 2023

12
Health, United States: Redesign Goals

Goals:

 Improve usability

 Improve findability

 Increase relevance

 Increase awareness

Design questions:

 What formats should be used to share information?

 What does a digital-first product look like?

 How do we modernize data access?

13
Health, United States Redesign Process

3
Stakeholder interviews

Market analysis

Literature review

Web user survey

 What do stakeholders think about the content, format, and 

dissemination of Health, United States?

 How do others (competitors, other agencies) provide data to 

their audience in terms of content and format?

 How is Health, United States being cited (used) in 

publications? What parts of the report are most cited?

 Who are the people trying to access Health, United States 

online? What are they trying to access? How do they want to 

access it? 

 What is Health, United States doing successfully? What parts 

of the report are the most viewed or downloaded? Web analytics

 How do policymakers, students, and researchers want to 

find, receive, and consume health information and data?

Audience research

15
Stakeholder Interviews

 Objective: Determine the features of a health statistics report that 

stakeholders need in terms of content, style, and dissemination. 

 The interview questions were designed to determine how stakeholders 

use Health, United States or similar reports, and identify areas of the 

report that could be redesigned.

 24 stakeholder interviews were conducted among: 

– Congressional staff members

– Federal, state, and local government agencies

– Academic institutions

– Public health organizations 16
Stakeholder Interviews—Con.

 Stakeholders were asked a standard set of questions depending on their 

familiarity with Health, United States, such as: 

1. What kinds of questions require you to look for health statistics?

2. What do you like about Health, United States? Are there particular sections, 

content, or features that you find particularly helpful?

3. What do you dislike about Health, United States?

4. What do you wish Health, United States (or NCHS more generally) were able 

to offer that is currently unavailable?

17
Stakeholder Interviews: Findings

 What format should be used to share information?

18

“Get away from the PDF 

format because it’s not as 

searchable and won’t be 

retrieved in Google searches.”
Stakeholder Interviews: Findings—Con.

 What does a digital-first product look like?

19

Interested in a “table of contents” of

health data by topic, from which a 

user can click into topics in any of the 

health reports, and information would 

be indexed in a way that one could 

look at the topic and go straight to the 

data rather than wading through the 

PDF reports.
Stakeholder Interviews: Findings—Con.

 How do we modernize data access?

20

Stakeholders mentioned a preference for creating custom 

views of the data

“Website-driven and interactive”

“Things that are maximally flexible. Picking variables in 

interactive Excel spreadsheets with details is really useful.”

“Interactivity to create user-defined tables, very simple in 

technical terminology”
Web User Surveys

 Objective: Learn more about HUS web audience, including who they are, 

what kind of work they do, what aspects of the HUS report they are 

looking for, what are their preferred ways to access to health statistics.

 Dependencies: 

– OMB approval

– Web survey design 

– Communications and technology collaboration

21
Web User Surveys

 NCHS Web Satisfaction Surveys, 2017–2019

– 14 questions: mostly multiple choice and likert scale

– Fielded 3 months per year on NCHS website

 Health, United States Web User Survey, 2019–2020

– 12 questions: multiple choice, likert scale, ranking, and open-ended 

– Estimated 10 minutes

– Fielded for 3 months on Survey Monkey

 Health, United States Pop-up Web Survey, 2020

– 2 questions: multiple choice only

– Estimated 10–15 seconds

– Fielded for 3 months on 4 products on the Health, United States website

22
Web Surveys: Findings

More than half of 

responses were from 

students or 

those in health-related 

fields

23

0

20

40

60

80

100

HUS Pop-Up Web

Survey

HUS users All users

NCHS Web User Satisfaction Survey
Web Surveys: Findings—Con.

 Policymakers and media are important audiences for Health, United 

States, but they made up only a small percent (around 3%) of responses

 More than 80% of responses indicated the Health, United States products 

were helpful

24
Literature Review

 Objective: Understand who is citing HUS (government/academic/other), 

what sections are cited (chartbook, special feature, trend tables, 

highlights), and what topics are cited (special feature/core) to determine 

the utility of specific components of the report

 This project aimed to develop a catalog and tagging system that can be 

automated and run on a periodic basis

25
Literature Review: Findings

 Health, United States citations 

were found in 2,626 articles

 Trend tables were the most 

often cited Health, United 

States product (83%)

26

Trend tables

Chartbook

Other

0 20 40 60 80 100

Percent

HUS citations 

by product
Literature review: Findings—Con.

 Health, United States topics were 

categorized into 55 major themes

 The top three themes accounted 

for 66% of all citations

 The most cited topics were:

– Obesity/overweight

– Prescription drug use

– Leading causes of death

– Mortality 

27

4

4

6

8

8

19

27

29

67

76

81

Injuries and Premature Death

Mental Health

Infectious Diseases

Dental Health

Health Care Resources

Health Expenditure and Payers

Health Determinants

Behavioral Risks

Mortality and Natality

Health Utilization

Chronic Conditions

Number of citations

Major Citation Themes
Web Analytics

 Objective: Gain familiarity with the Adobe Analytics platform and leverage 

Adobe Analytics metrics to answer questions about popular features and 

content in Health, United States

 As Health, United States moves towards a stronger digital-first program, 

creating a process for integrating Adobe Analytics into decision-making 

will be central to the product’s success

 The volume of visits and downloads from the Health, United States 

website, as well as supplemental data sources like CDC Stacks were 

assessed

28
Web Analytics: Findings

29

Views to the topic-based Data Finder outpaced PDF downloads starting 

with the release of Health, United States, 2018.
Audience Research

 Objective: Examine existing literature to determine how policymakers, 

students, and researchers prefer to find, receive, and consume health 

information and data.

 Literature search was limited to academic articles found on search engines 

like PubMed and Google Scholar using a combination of search terms, 

such as:

– “audience + information preferences”

– “audience + data discovery”

– “audience + information retrieval”

– “audience + information dissemination” 30
Audience Research: Findings

31

What does a digital-first product 

look like?

 PDF is good for in-depth 

reading and can be saved later 

as a lasting resource

 HTML is good for immediate 

discovery of content (search) 

and linking to additional 

information

What format should be used to 

share information?

 “Researchers do not frequently 

use author names; rather, 

keyword searching, followed by 

detailed browsing through very 

long results lists, are more 

frequent strategies [....] Other 

social scientists search by short 

keyword queries or social 

—Aalbersberg (2013) construct.” —Gregory (2019)
Market Analysis

 Objective:

– Review successful statistical reports and websites with high uptake

– Identify valuable design elements for incorporation into HUS prototypes

– Stay updated on technology trends for visualization enhancement

 Activities:

– Search for effective examples of statistical reports, data portals, and tools

– Analyze content and format characteristics of identified examples

– Store and categorize successful examples for reference

32
Market Analysis—Con.

 Outputs:

– Comprehensive database of effective statistical reports, data portals, and tools

– Database filterable by content and format elements

– Report or presentation highlighting content and format characteristics of top 

examples

– Matrix categorizing examples by feasibility

33
Market Analysis: Findings

34

What does a digital-first product 

look like?

What format should be used to 

share information?

Over half of the products with a report 

component were optimized for online 

display. Many of these still had PDF 

components.

~45% of the data products reviewed 

gave users the ability to find or explore 

the data dynamically
Market Analysis: Findings—Con.

Examples of popular format or design features:

 Find information by topic or indicator

— Search bar – city health dashboard

— Tabs, icons organized by topic or indicator –U.S Cancer Statistics

— Step-by-step query (question and answer layout) – AtlasPlus

— Drop-down menus for data visualization – Peterson-Kaiser Health 

System Tracker

 Icons or links to get to technical notes next to each figure – OECD.Stat

 Shareable resources – NCI Annual Report to the Nation 35

Interactive Shareable More 

Accessible
Conclusion

36

Web user Web analytics

survey

Literature 

review

Audience 

research

Stakeholder 

interviews

Market 

analysis

Health, United States redesign’s systematic approach helped us understand 

who was using the report, what topics and analyses were most frequently 

used, and why stakeholder chose to use these data 
Conclusion: Next Steps

37

Create a suite of 

digital-first 

Health, United 

States products

1

Provide data more 

frequently

2

Transform trend 

tables into 

machine-readable 

datasets

3

Make data 

available on open 

platforms 

(data.cdc.gov)

4

Add interactivity 

for customized 

exploration

5

Integrating across health topics and data systems to examine trends in health statistics
National Center for Health Statistics

Using communication science to redesign Health, 

United States products, develop dissemination 

strategies, and monitor user engagement

Christine Jones, Nora Castro, Melanie Collins, Zakia Nelson, Ashley Woodall, 

and other members of the Health, United States Modernization Team

2023 Federal Committee on Statistical Methodology 

Research and Policy Conference

October 24, 2023

38
Agenda

 Introduction 

 Annual Perspective report

 Topic-based web pages

 Web and report metrics

 Promotion 
Health, United States

Data from Health, United States are available 

in two primary formats:

 Annual Perspective report

 Website

– Topic-based webpage

– Data finder
Annual Perspective 

Changes made to improve the Health, 

United States annual report:

 Less content with more focused messaging

 More white space, bullets, and descriptive 

headers

 New “At a Glance” feature
Annual Perspective—Con. 

Excerpt from 

Health 

United 

States, 

2020-2021: 

Annual 

Perspective 

Excerpt from 

Health, 

United 

States, 2019
Topic-based Webpage on Health, United States Website

Created a new topic-based 

webpage for Health, United States. 

This new HTML addition improves 

data discovery and has several 

other benefits:

 HTML is easier to update

 HTML is smart-phone and tablet 

friendly

 Data are easier to find and use

 HTML provides better usage 

analytics
Web Metrics

 Total website visits (August 2022-August 2023): 

598,710

Frequently among NCHS’ top 10 most visited sites 

 Data finder visits (August 2022-August 2023): 347,876

 Most searched health topics: 

• Healthcare expenditures 

• Heart disease prevalence

• Heart disease deaths

• Births

• Hospitalization 

• Illicit drug use 
Report Metrics

 Health, United States, 2020-2021: Annual Perspective report downloads 

(January 2022-August 2022): 10,626

Health, United States, 2019 annual report downloads (March 2021-

September 2021): 8,639

 Percentage of unique monthly visitors to the website increased 54% in 

January—the month the Annual Perspective was released
Promotion 

Marketing strategies used to increase the reach and impact of Health, United 

States:

Sent Adobe Campaign and Health, United States listserv notification to

29,000 subscribers

Notified Congress

Distributed a press release and media advisory to more than 500 

reporters 

Promoted website and report on social media 

Presented a webinar to 280 attendees

Summary 

Communication science methods used to improve Health, United States:

 Redesigned the Annual Perspective report to make it more engaging, readable, 

and visually appealing

 Released more information in html format to increase discoverability and 

usability and to obtain better, more informative metrics

 Created a strong brand identity for Health, United States to increase recognition 

and trust among users

 Promoted Health, United States in different ways to increase impact and reach
National Center for Health Statistics

Reporting on the Nation’s Health in 

Health, United States

Renee Gindi, Sheila Franco, Elizabeth Heitz, Zakia Nelson, Ashley Woodall, 

and other members of the Health, United States Modernization Team

2023 Federal Committee on Statistical Methodology 

Research and Policy Conference

October 24, 2023

49
Outline

 New design for Health, United States products

 Findings from Health, United States, 2020–2021

 What’s next for Health, United States?

50
Introducing the Redesigned Health, United States

Website

Presents Health, United States 

analyses and data by topic

Annual Perspective

Integrates Health, United States 

analyses to explore a single theme

51
Health, United States: Included in the 2020–2021 

Edition

 23 topic pages with key findings, 

featured charts, and data downloads

 43 updated trend tables available for 

download in the Data Finder

 96 sources and definitions pages

describing data sources, methods, 

and terms used in Health, United 

States

52
New: Find Analyses by Health Topic

53
New: National Trends and Trends by Selected Groups

54
New: Visual Trend Summary

55
New: Links to Data Tables and Definitions

56
New: Searchable Sources and Definitions

57

Sources and definitions

Search or filter to learn about

 Data sources

 Statistical methods

 Definitions of terms
New: Browse 5 Years of Health, United States Tables

Data finder

 Search all report editions 

since 2016

 Filter by 90+ health topics 

and 20+ population 

subgroups

 Trend tables available in 

Excel and PDF formats

58
New: Infographics

Infographic gallery

 Infographics presenting 

3 health areas from the 

Annual Perspective

 Multi-panel and single panel 

graphics for sharing in varied 

settings

59
Health, United States, 2020–2021: Annual Perspective

 New Health, United States publication explores one 

theme across multiple health topics and data 

sources

– Integrates selected analyses from other Health, United 

States products

– Improves relevance by meeting the needs of multiple 

audiences

60
Health, United States, 2020–2021 Annual Perspective 

Focus on Health Disparities

 The 2020–2021 edition theme is health disparities

 Health disparities are differences in health 

outcomes that are closely linked with 

sociodemographic, economic, or environmental 

disadvantage 

– The 2020–2021 Annual Perspective examines 

disparities by sex, race and ethnicity, insurance 

status, poverty level, and education

61
Health, United States, 2020–2021: Annual Perspective

Health Areas Covered

Substance 

use

Risk factors 

and mortality

Oral health

Hospital 

utilization

HIV and 

sexually 

transmitted 

diseases

Health 

insurance and 

access

Cancer

Heart disease

Risk factors 

and mortality

62
Risk Factors and Mortality: Disparities by Sex

Risk factors 

and mortality

Healthcare 

utilization

National Ambulatory Medical Care Survey (NAMCS)

National Hospital Ambulatory Medical Care Survey (NHAMCS)

Substance use National Health Interview Survey (NHIS)

National Survey on Drug Use and Health (NSDUH)

Mortality National Vital Statistics System (NVSS)

63
Males die younger, have higher substance use, and 

fewer health care visits

64
Males were more likely than females to die from the 

five leading causes of death

65
Males were more likely than females to die from the 

five leading causes of death: Heart disease

66
Males were more likely than females to die from the 

five leading causes of death: Cancer

67
Males were more likely than females to die from the 

five leading causes of death: Trend table

68
Males died three times as often from suicide

69
Males died three times as often from suicide – Con.

70
Greater Granularity on Suicide Deaths Topic Page

71
Greater Granularity on Suicide Deaths Topic Page – Con.

72
Greater Granularity in Suicide Deaths Trend Table

73
More males than females reported current use of 

tobacco, drugs, and alcohol

74
More males than females reported current use of 

tobacco, drugs, and alcohol – Con.

75
Fewer physician and emergency department visits were 

made by young men than young women

76
Fewer physician and emergency department visits 

were made by young men than young women –Con.

77
Health, United States: More to Explore

Health, United States is a suite of products for exploring trends in health data

Topic pages with key findings, featured charts, and trend analyses

Trend tables by demographic and socioeconomic populations

Infographics of disparities in related health measures

Annual Perspective integrating selected analyses from the Health, 

United States topics presented online

78
Health, United States Redesign Impact 

Improvements for users include:

 Usability: Organizing by topic to navigate quickly; 

digital-first product allows for more trend analyses

 Findability: Topic-specific web pages provide more 

relevant search engine results 

 Relevance: Continues to focus on trend analysis and 

integration across data sources, while developing 

innovative ways to communicate findings

 Awareness: Strong page view and download 

metrics 79
Next Steps

80

Create a suite of 

Digital-first 

Health, United 

States products

1

Provide data more 

frequently

2

Transform trend 

tables into 

machine-readable 

datasets

3

Make data 

available on open 

platforms 

(data.cdc.gov)

4

Add interactivity 

for customized 

exploration

5

Integrating across health topics and data systems to examine trends in health statistics
Health, United States Modernization Team

 Shilpa Bengeri

 Nora Castro

 Melanie Collins 

 La-Tonya Curl

 Barnali Das

 Sheila Franco

 Renee Gindi

 Nancy Han

 Liz Heitz

 Christine Jones

 Ji-Eun Kim

 Florence Lee

 Fen Li

 Anthony Lipphardt

 Michelle Liu

 Jennifer Moore

 Jessica Morgan (CTR)

 Zakia Nelson (CTR)

 Tatiana Nwankwo

 Dagny Olivares 

 Kyung Park 

 Tommy Seibert 

 Jane Sudol 

 Danielle Taylor

 Brian Tsai

 Ashley Woodall

81
Contacts

See all the materials:

www.cdc.gov/nchs/hus

Join the listserv:

www.cdc.gov/nchs/hus/about.htm

Contact us:

healthus@cdc.gov

82