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DEPARTMENTS OF LABOR AND HEALTH, EDUCATION, AND WELFARE, AND RELATED AGENCIES APPROPRIATIONS FOR FISCAL YEAR 1968

TUESDAY, APRIL 18, 1967

U.S. SENATE,
SUBCOMMITTEE OF THE COMMITTEE ON APPROPRIATIONS,

Washington, 'D.C. The subcommittee met at 10:05 a.m., in room 1223, New Senate Office Building, Hon. Lister Hill (chairman) presiding.

Present: Senators Hill, Byrd, and Bartlett.

NATIONAL HEALTH STATISTICS

STATEMENT OF FORREST E. LINDER, DIRECTOR; THEODORE D. WOOLSEY, DEPUTY DIRECTOR, NATIONAL CENTER FOR HEALTH STATISTICS; LOUIS R. STOLCIS, EXECUTIVE OFFICER, NATIONAL CENTER FOR HEALTH STATISTICS; WILLIAM H. STEWART, SURGEON GENERAL; G. R. CLAGUE, ACTING CHIEF FINANCE OFFICER, PUBLIC HEALTH SERVICE; AND JAMES B. CARDWELL, DEPUTY ASSISTANT SECRETARY, BUDGET

APPROPRIATION ESTIMATE

NATIONAL HEALTH STATISTICS For expenses of the National Center for Health Statistics in carrying out the provisions of sections 301, 305, 312(a), 313, 314(c), and 315 of the Act, [$9,312,000] $9,767,000.

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$220, 600

Explanation of changes New medical classification program.

The request will enable the Center to fulfill its commitment to accept and adopt the new recommendations of the international World Health Organization relating to the decennial revision of the International Classification of Diseases. It will also permit the Vital Statistics program to begin a more comprehensive classification of medical conditions listed on vital registration certificates. This comprehensive data is needed to study the interrelationships between the underlying cause and other secondary causes of death. Likewise, more comprehensive data on fetal deaths and live births will assist further medical research on diseases of the perinatal

period. National survey of family growth.

Little is known about family growth in the United States, although it has many implications on the health, welfare and economy of the country. A National Survey of Family Growth will obtain needed information on family dynamics by means of a nationwide survey. Through this survey it will be possible to identify those segments of our society experiencing population growth, as well as the reasons for this growth. Data from the survey will be used for analyzing and interpreting such population changes as the current decline in the rate of family growth. Also, data will be obtained on the social and economic conditions under which children grow to adulthood since such data are of national concern and high importance to planners of public health programs.

409, 900

Explanation of changes-Continued Special evaluative statistical studies --

_$1,000,000 There is a demonstrated need within the Public Health Service for a series of statistical studies to evaluate Federal program efforts at both the State and local levels. These special studies, to be conducted in close collaboration with other parts of the Public Health Service, will involve a series of in-depth studies of changes in the health status of specific populati groups attributable to identified inputs of health efforts. Types of studies to be supported include the relationship of changes in the health status of the elderly to their source of health care; health services and the health status of the poor; measuring improvements in the health status and the continuing health needs of population groups in areas with multiple problems; and the comparison of health services, environmental sanitation and the nutritional status for families living in areas of high infant mortality with those in

areas of low infant mortality. Rental of office space-

40,000 Rental of office space will be required for the new positions associated with the new medical classification program and the National Survey of Family Growth.

INTRODUCTION The development of sound public policy and formulation of program plans to meet critical needs in the field of public health require comprehensive and objective basic health data. The National Center for Health Statistics serves as the principal resource, both to the Federal government and the health community, in meeting the need for such data.

The Center utilizes two basic types of mechanisms to produce national vital and health statistics. The first of these is a group of nationwide health surveys providing comprehensive data on medical, demographic and economic aspects of health conditions and utilization of health services; the second is the vital statistics program based on the tabulation and analysis of data derived from the actual certifications of birth, death, marriage and divorce. The Center also provides assistance to others in the field of public health in areas such as survey design, statistical sampling and data processing methodology.

During the past year the Center has continued to emphasize its responsibilities for providing valid scientific data to its professional publics on a current basis. Attention again has been focused on the production and publication of reports, and the more effective distribution of these reports, with the result that 42 were published in 1966.

To further improve its operations, the Center has opened a field data processing laboratory. Although the space for occupancy hy the Center was only completed in early July, the laboratory is already carrying forward a field research program in survey methodology and conducting a comprehensive data preparation function which provides input data both to the vital statistics and hospital discharge survey programs of the Center. During the last several months other research activities, particularly in the area of systems research and design, have commenced and the data preparation activities are at their full strength.

The 1968 estimate reflects a net increase of $187,000 from 1967. This results from a $1,276,800 decrease for the non-recurring purchase of a computer and certain other items, and mandatory and program increases of $1,763,800. The latter is primarily in the areas of vital statistics activities and special evaluative statistical studies. The program increases will enable the Center to provide some meaningful data relating to mortality and perinatal mortality through the coding of multiple causes of death and fetal death; to carry out comparative studies relating to the Eighth Revision of the International Classification of Diseases; to meet the highly important needs of researchers and planners for substantive data relating to population dynamics: and to initiate a series of statistical studies intended for the specific evaluation of Federal program efforts at the State or local levels. The narrative justification which follows presents the Center's requirements within seven major program areas.

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The individual States have primary responsibility for maintaining registration systems for vital events. State laws govern the data requirements of vital registration certificates, provide for the enforcement of registration, and determine many of the procedures to be followed in State offices.

One of the most successful efforts in Federal-State cooperation has been in the area of vital statistics. Through cooperative efforts with the States, the Center administers a vital statistics program for the improvement and standardization of vital registration systems and for the analysis and publication of national data. Increasing uses of vital statistics have made it necessary to improve the efficiency of this program to ensure that accurate data are available for special analytical purposes. A recent development in greater efficiency was the establishment of a data processing laboratory. Functions relating to the preparation of computer input for the program are being conducted at this location. The accuracy of the work is extremely high and production rates exceed those attainable in the Washington area.

NEW MEDICAL CLASSIFICATION PROGRAM

In July 1965 the World Health Organization received recommendations from representatives of member countries gathered in Geneva regarding the decennial revision of the International Classification of Diseases. The World Health Organization is now incorporating these recommendations into a list of inclusive terms and an index. This action will have a decisive influence on the classification of diseases throughout the world in the decade beginning 1968. As a participant ir preparing the recommendations, the Center has a definite commitment to accept the Classification and to adopt it at a specified time. Failure to take necessary action would jeopardize the usefulness of health data for the United States, make data from the United States difficult to compare with data from other nations, and seriously impair the professional stature of the Center.

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