Monitoring the Nation's Health: Contemporary Challenges for the Vital Statistics System in the 21st Century

In the United States, natality statistics have historically been used for civil registration and public health, including legal documentation; monitoring population growth; surveillance of vital and sentinel health events; monitoring of key health indicators; and tracking health in key subgroups. For the first time in more than three decades, the U.S. does not have a contemporary, comprehensive picture of natality, due to the problems in implementing the 2003 revision. The purpose of the 2003 revision was to improve the data needed to address important public health issues such as racial and ethnic disparities, increasing rates of preterm births and cesarean sections and possible adverse outcomes after infertility treatment. Currently, with the planned fiscal support for the collection of only core items (e.g. birthweight, gestation, and demographics), the vital statistics infrastructure will be substantially further eroded. Other countries have made a national commitment to track their citizens' health across the lifespan through extensive linkages of their vital statistics systems, national registries, and a range of morbidity indicators. Current linkages of the birth certificate and selected national health surveys are only to mortality data. Ideally, we should also develop national databases linked to morbidity indicators, such as birth defects registries, cancer registries, hospital discharges, as well as specific programs. Such linkages, which might include for example linking live births to deaths beyond infancy would provide a more comprehensive view of maternal and child health at individual and population-based levels. These and other areas will be explored in this presentation.