CHILDREN’S HEALTH, THE NATION’S WEALTH

ASSESSING AND IMPROVING CHILD HEALTH

Committee on Evaluation of Children’s Health

Board on Children, Youth, and Families

Division of Behavioral and Social Sciences and Education

NATIONAL RESEARCH COUNCIL AND INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS
Washington D.C.
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Children’s Health, The Nation’s Wealth: Assessing and Improving Child Health CHILDREN’S HEALTH, THE NATION’S WEALTH ASSESSING AND IMPROVING CHILD HEALTH Committee on Evaluation of Children’s Health Board on Children, Youth, and Families Division of Behavioral and Social Sciences and Education NATIONAL RESEARCH COUNCIL AND INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES THE NATIONAL ACADEMIES PRESS Washington D.C. www.nap.edu

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Children’s Health, The Nation’s Wealth: Assessing and Improving Child Health THE NATIONAL ACADEMIES PRESS 500 Fifth Street, N.W. Washington, DC 20001 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. This study was supported by contract number 282-99-0045, task order number 6 between the National Academy of Sciences and the Department of Health and Human Services. Supplementary funding for a report synthesis and dissemination of the report and report synthesis was supported by contract number N-01-OD-4-2139, task order number 125. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the views of the organizations or agencies that provided support for the project. Library of Congress Cataloging-in-Publication Data Children’s health, the nation’s wealth : assessing and improving child health / Committee on Evaluation of Children’s Health, Board on Children, Youth, and Families, Division of Behavioral and Social Sciences and Education. p. ; cm. Includes bibliographical references and index. ISBN 0-309-09118-7 (hardcover) 1. Children—Health and hygiene—United States. 2. Child health services—United States. [DNLM: 1. Public Health—Child—United States. 2. Child Welfare—United States. 3. Data Collection—methods—United States. 4. Health Policy—Child—United States. 5. Research Design—United States. WA 320 C5379 2004] I. National Research Council (U.S.). Committee on Evaluation of Children’s Health. RJ102.C4895 2004 362.198′92′000973—dc22 2004016741 Additional copies of this report are available from National Academies Press, 500 Fifth Street, N.W., Lockbox 285, Washington, DC 20055; (800) 624-6242 or (202) 334-3313 (in the Washington metropolitan area); Internet, http://www.nap.edu. Printed in the United States of America. Copyright 2004 by the National Academy of Sciences. All rights reserved. Suggested citation: National Research Council and Institute of Medicine. (2004). Children’s Health, the Nation’s Wealth: Assessing and Improving Child Health. Committee on Evaluation of Children’s Health. Board on Children, Youth, and Families, Division of Behavioral and Social Sciences and Education. Washington, DC: The National Academies Press.

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Children’s Health, The Nation’s Wealth: Assessing and Improving Child Health THE NATIONAL ACADEMIES Advisers to the Nation on Science, Engineering, and Medicine The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Bruce M. Alberts is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Wm. A. Wulf is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Bruce M. Alberts and Dr. Wm. A. Wulf are chair and vice chair, respectively, of the National Research Council. www.national-academies.org

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Children’s Health, The Nation’s Wealth: Assessing and Improving Child Health COMMITTEE ON EVALUATION OF CHILDREN’S HEALTH GREG J. DUNCAN (Cochair), Institute for Policy Research, School of Education and Social Policy, Northwestern University RUTH E.K. STEIN (Cochair), Department of Pediatrics, Albert Einstein College of Medicine YOLIE FLORES AGUILAR, Children’s Planning Council, Los Angeles County CYNTHIA F. BEARER, Division of Neonatology and Mary Ann Swetland Center for Environmental Health, Department of Pediatrics and Neurosciences, Case Western Reserve University NEAL HALFON, Center for Healthier Children, Families and Communities, University of California, Los Angeles, Schools of Public Health, Medicine, and Public Policy and Social Research PETER S. JENSEN, Center for the Advancement of Children’s Mental Health, Department of Psychiatry, Columbia University DONALD MATTISON (Chair until June 2002), National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD (formerly March of Dimes) PETER R. SIMON, Rhode Island Department of Health, Providence BONITA STANTON, Wayne State University and Children’s Hospital (formerly Department of Pediatrics, West Virginia University) BARBARA STARFIELD, Bloomberg School of Public Health, Johns Hopkins University FREDIA S. WADLEY, Delmarva Foundation, Easton, MD (formerly Tennessee Department of Health) MICHELLE A. WILLIAMS, Department of Epidemiology, University of Washington CYNTHIA GARCIA COLL (Consultant), Department of Education, Brown University MARY ELLEN O’CONNELL, Study Director ANTHONY MANN, Senior Project Assistant WILLIAM SELEPACK, Senior Project Assistant

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Children’s Health, The Nation’s Wealth: Assessing and Improving Child Health BOARD ON CHILDREN, YOUTH, AND FAMILIES MICHAEL I. COHEN (Chair), Department of Pediatrics, Albert Einstein College of Medicine JAMES A. BANKS, Center for Multicultural Education, University of Washington, Seattle ROBERT BLUM, William H. Gates Sr. Chair, Department of Population and Family Health Sciences, Bloomberg School of Public Health, Johns Hopkins University THOMAS DEWITT, General and Community Pediatrics, Children’s Hospital Medical Center of Cincinnati MARY JANE ENGLAND, Regis College, Weston, MA BRENDA ESKENAZI, School of Public Health, University of California, Berkeley MINDY THOMPSON FULLILOVE, Department of Psychiatry, Columbia University PATRICIA GREENFIELD, Department of Psychology, University of California, Los Angeles RUTH T. GROSS, Department of Pediatrics, Stanford University NEAL HALFON, Center for Healthier Children, Families and Communities, University of California, Los Angeles, Schools of Public Health, Medicine, and Public Policy and Social Research MAXINE HAYES, Washington State Department of Health, Olympia MARGARET HEAGARTY (retired), Harlem Hospital Center, Columbia University RENÉE R. JENKINS, Department of Pediatrics and Child Health, Howard University HARRIET KITZMAN, School of Nursing, University of Rochester SANDERS KORENMAN, School of Public Affairs, Baruch College, City University of New York HONORABLE CINDY LEDERMAN, Circuit Court Judge, Juvenile Division, Dade County, FL ELENA NIGHTINGALE, Institute of Medicine GARY SANDEFUR, Department of Sociology, University of Wisconsin-Madison RUTH E.K. STEIN, Department of Pediatrics, Albert Einstein College of Medicine ELLEN WARTELLA, College of Communication, University of Texas, Austin CATHERINE DeANGELIS (liaison from Institute of Medicine Council), American Medical Association, Chicago ROSEMARY CHALK, Board Director WENDY KEENAN, Senior Project Assistant

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Children’s Health, The Nation’s Wealth: Assessing and Improving Child Health Acknowledgments This report is the work of the Committee on Evaluation of Children’s Health, a project of the National Research Council (NRC) and the Institute of Medicine. The expertise and hard work of the committee was advanced by the help of our sponsor, able consultants and staff, and the input of outside experts. The funding for this project was provided by the Office of Disease Prevention and Health Promotion of the U.S. Department of Health and Human Services. Woodie Kessel served as project officer and provided valuable insights and guidance in framing the project. The National Institute of Child Health and Human Development provided supplementary funding to print and disseminate the report and a report brief summarizing the report’s findings. The committee’s early meetings included presentations by experts in a range of disciplines as well as representatives from other federal government offices: Duane Alexander, National Institute of Child Health and Human Development; Brett Brown, Child Trends; Merry Bullock, American Psychological Association; John Cohrssen, Public Health Policy Advisory Board; Jose Cordero, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention; Michael Donnelly, Integrated Health Information Systems, Centers for Disease Control and Prevention; Lauren Fasig, Society for Research in Child Development; Lynn Goldman, Children’s Environmental Health Network; Wayne Holden, OCR Macro; Eric Kodish, Rainbow Center for Pediatric Ethics; Kristin A. Moore, Child Trends; Tom Sinks, National Center for Environmental Health, Centers for Disease Control and Prevention; Sandra Tirey, American Chemistry Council; Peter van Dyck, Maternal and Child Health Bureau, Health Resources and Services Administration; Rachael Wallace, Children’s National

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Children’s Health, The Nation’s Wealth: Assessing and Improving Child Health Medical Center; and Randolph Wykoff, Office of Disease Prevention and Health Promotion, U.S. Department of Health and Human Services. The committee commissioned papers that provided information incorporated into this report from Eric Kodish and Rachael Wallace; Howard Frumkin, Emory University; and Elizabeth Vandewater, University of Texas. We wish to thank Brett Brown for providing the framework and core information on data sources included in Appendix A and Greg Stevens of the Center for Healthier Children, Families and Communities, University of California at Los Angeles (UCLA), for preparing the analysis of major national surveys included as Appendix B. In addition, several experts helped prepare background or related materials that were incorporated into this report, and we wish to acknowledge their advice and assistance: Lee Pachter, St. Francis Hospital and Medical Center; Deborah Klein Walker, Abt Associates (formerly Center for Health Information, Statistics, Research and Evaluation, Massachusetts Department of Public Health); and Ellen Wartella, College of Communication, University of Texas, Austin. Matthew Zerden, a research associate at the UCLA Center for Healthier Children, Families and Communities, provided valuable assistance in confirming references. Camelia Arsene and Jennifer Roberts, National Academies interns, helped manage and identify references and provided valuable research assistance. This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the NRC’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report: Beverly Bauman, Department of Emergency Medicine and Department of Pediatrics, Oregon Health and Sciences University; Janet Currie, Department of Economics, UCLA; Allen J. Dietrich, Community and Family Medicine, Dartmouth Medical School; Andrew S. Doniger, Monroe County Health Department, Rochester, NY; Lynn R. Goldman, Occupational and Environmental Health, Johns Hopkins Bloomberg School of Public Health; Tamara Halle, Early Childhood Development, Child Trends, Washington, DC; Marie C. McCormick, Department of Society, Human Development and Health, Harvard School of Public Health; Susan Redline, Pediatrics, Medicine, and Epidemiology and Biostatistics, Case Western Reserve University and Rainbow Babies and Children’s Hospital, Cleveland, OH; Lynn Singer, Provost’s Office and Department of Pediatrics and Psychiatry, Case Western Reserve University and Rainbow Babies and Children’s Hospital, Cleveland, OH; Richard D. Todd, Child and Adolescent Psychiatry, Washington University School of Medicine; and Deborah Klein Walker, Abt As-

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Children’s Health, The Nation’s Wealth: Assessing and Improving Child Health sociates (formerly Center for Health Information, Statistics, Research and Evaluation, Massachusetts Department of Public Health). Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations nor did they see the final draft of the report before its release. The review of this report was overseen by Aletha C. Huston, Human Development and Family Science, The University of Texas at Austin, and John C. Bailar, III, Department of Health Studies (emeritus), University of Chicago. Appointed by the NRC, they were responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution. The committee appreciates the support provided by members of the Board on Children, Youth, and Families under the leadership of Michael I. Cohen. We are grateful for the leadership and support of Michael Feuer, executive director of the NRC’s Division of Behavioral and Social Sciences and Education; Jane Ross, director of the Center for Economic, Governance, and International Studies; Rosemary Chalk, director of the Board on Children, Youth, and Families and her predecessor, Susan Cummins; and Susanne Stoiber, executive officer of the Institute of Medicine. Finally, the committee benefited from the support and assistance of several members of the National Academies staff. Bill Selepack (until April 2002 and between October 2002 and April 2003) and Anthony Mann (between April and October 2002 and since April 2003) managed all administrative aspects of the project. The research needs of the project were greatly aided by the able assistance of William McLeod of the Institute of Medicine library. Final preparation of the report, including incorporating edits, helping to respond to review comments, and finalizing references, was handled with grace, competence, and patience by Elizabeth Townsend and Neesha Desai. We are indebted to Christine McShane who provided superb editorial guidance, Yvonne Wise, who helped prepare the report for publication, and Kirsten Sampson Snyder, who guided the report through the review and release process. Greg Duncan, Cochair Ruth E.K. Stein, Cochair Mary Ellen O’Connell, Study Director Committee on Evaluation of Children’s Health

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Children’s Health, The Nation’s Wealth: Assessing and Improving Child Health Contents     Executive Summary   1 1   Introduction   13 2   Children’s Health: A New Conceptual Framework   28 3   Influences on Children’s Health   45 4   Measuring Children’s Health   91 5   Measuring Influences on Children’s Health   116 6   Developing State and Local Data Systems   164 7   Conclusions and Recommendations   192     References   211     Appendixes     A   Datasets for Measuring Children’s Health and Influences on Children’s Health   253 B   Gaps Analysis of Measures of Children’s Health and Influences on Children’s Health in Select National Surveys   262 C   Selected Indicators from National Children’s Data Syntheses   288 D   Glossary   302 E   Acronyms   305 F   Biographical Sketches of Committee Members and Staff   308     Index   315

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