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Children’s Health, The Nation’s Wealth: Assessing and Improving Child Health
ports of national comparative data regarding specific health problems, such as infant mortality and low birthweight. Another local data collection enhancement has grown out of the recent focus on the development of healthy cities and communities, which has focused on promoting population health and launching community-wide health improvement initiatives. Similar offshoots specifically focused on children’s issues have resulted in development in many localities of community health reports (Halfon et al., 1998; Fielding et al., 1999), made possible by increasing data and information processing and dissemination at the local level. Many of these community health reports focus on children and family health issues, and in many locations across the United States these reports have also been based on new data collection or data synthesis projects.
A network of children’s preventive services tracking registries is now operating in six states and New York City as a result of a Robert Wood Johnson Foundation initiative, All Kids Count.5 These data systems are developing the prototypes for a nationwide system of integrated population-based registries that could be linked with primary care providers to ensure that all children have a “medical home” and that public health officials and other policy makers have population-based data on all children. The rationale for some of these efforts is to demonstrate that local data systems could support the reports of health care providers in activities to promote the health and development of children (Halfon and Hochstein, 2002). These initiatives are very promising. However, it is important to note that only a relatively small proportion of communities are involved or assessing indicators or measures in the same way.
IMPROVING MEASUREMENT OF CHILDREN’S HEALTH
In looking at the current compilation of information about children’s health in terms of the committee’s conceptual framework, we outline data collection efforts by domain and then look further at the steps that should be taken to improve measurement strategies. While we have chosen to organize this discussion into three discrete domains, it must be emphasized that there is no single universally accepted approach to the delineation of domains of health. Thus to some extent the division is always somewhat arbitrary. Nevertheless, in our view the domains we identified are consistent with current thinking as reflected in the recently adopted International Classification of Functioning as it applies to children (Simeonsson et al., 2003) and with current research in this field.
Existing sources of data contain many items related to aspects of children’s health as conceptualized in this report, although not organized around the specific domains suggested below. Most current indicators of health are in fact proxy measures, single items that do not clearly fall into a single domain or cannot be combined to measure the domains fully.