not permit examination of changes (improvements or decrements) in children’s health from a dynamic perspective, as conceptualized in this report. Healthy People 2010 provides a large number of indicators that reflect particular aspects of health—for example, behaviors influencing health, mental health, injuries, and vaccination status—but it does not offer a model for assessing the interaction or accumulation of these indicators in children or groups of children. There has been little work on how indicators of health can be combined to form a composite of health at the individual or population level or to profile health and changes in health at the population level across the group of indicators. Similarly, developmental concepts (e.g., rates of change in health potential over time) are not incorporated in the 2010 goals or objectives. The effects of policy changes cannot be adequately assessed without tracking the way these changes and their consequences affect children’s developmental trajectories.

A number of other countries are ahead of the United States in monitoring both health overall and children’s health in particular. In England, Canada, and Australia, major efforts have been undertaken to monitor the health of children over time. Although health was conceptualized in conventional ways using such indicators as mortality and morbidity, rather than in a dynamic manner, a recent effort carried out in the Canadian province of Manitoba (Manitoba Centre for Health Policy, 2002) provides lessons for future U.S. efforts. Data were organized by regions of the province, with each region characterized by an overall measure of health—premature mortality—and the areas ranked from high to low. These rankings were similar to the areas’ ranking by socioeconomic status measures, reflecting worse health in more socially deprived areas. Areas were also ranked on the basis of mortality rates, adolescent reproductive health, acute and chronic conditions, and injury rates and these rankings were compared against the overall rankings. In this way, areas that performed better or worse than expected given their overall health status (i.e., premature mortality) were identified, making it possible to link particular policies (including those relating to health services) in different areas to level of performance on various health indicators. This is an important example of using ongoing data collection for monitoring children’s health. It represents public commitment to children and demonstrates the feasibility of implementing such an effort on a large scale.

In Vancouver, British Columbia, Canada, a major initiative has been launched to measure and link measurement of children’s health, development, and educational achievement for all school-age children to all existing programs and policies that affect these outcomes. Through the nationally sponsored Canadian Human Early Learning Partnership, this pilot project in Vancouver has mapped differences in children’s health and social outcomes at the neighborhood level and related those differences to the availability and delivery of different health education and social service programs (Hertzman, McLean, Kohen et al., 2002). While representing a step toward a more extensive, ongoing, and integrated data system to measure and monitor the longitudinal health and edu-



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