normal body size differ substantially in different parts of the world and over generations. Aspects of health, social, and cultural norms influence concepts of health as well as understanding of the causes and consequence of the variety of its aspects. When these notions translate into individual and group behaviors and attitudes, they can have a major effect on health.

Culture also provides a framework for the use of home remedies. For example, in some Hispanic and Asian communities, health is a balance between “hot” and “cold,” and an imbalance in favor of one can cause illness necessitating a remedy from the other to restore harmony (Risser and Mazur, 1995). Other cultural variations that can be misconstrued are the traditional practices of cupping and coining, which can be mistaken for child abuse (Hansen, 1998), and home remedies for such folk illnesses as caída de mollera (fallen fontanelle), mal ojo (evil eye), and empacho (intestinal blockage).

In addition, social or cultural views on health, as well as the circumstances of a given community, may affect the priorities of that community in terms of what is considered important. It is therefore critical for specific societies and communities to define the measures they deem most salient to their local circumstances and for those working to improve health to take into account cultural differences and the priorities of that community. For example, a low-income community in which food is scarce and healthy children are defined by carrying extra weight may not consider obesity a priority health problem compared with reducing other more immediate threats to health, such as crime.

Use of Data to Improve Children’s Health

How can the nation assess whether movement toward the goal of optimizing children’s health society-wide is being achieved? Without the capacity to measure and monitor progress, there is no way to know whether changes in policy make a difference toward improving children’s health. Lack of valid and reliable information impedes comparisons across time or place or in response to interventions. Without data to measure and monitor children’s health, the effect of changes in the social, cultural, and physical environment will remain unknown.

What is measured is often what gets attention. Conversely, aspects that are more difficult to assess are more likely be ignored. This report addresses the questions of whether what is measured is what ought to be measured; whether it is being measured in an appropriate manner; and whether information is being used in a way that will optimize children’s health.


Although the committee views the findings in this report as relevant to multiple audiences, federal, state, and local decision makers are considered to be the primary audience. The committee proposes strategies to address gaps in knowl-

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