multiple individual and environmental influences necessary to improve understanding of the interactive nature of health influences. Data on functioning and health potential, integral to a broader conceptualization of health, are particularly deficient. Biomarkers and environmental samples, important measures of environmental toxins, are not usually included in survey studies. Oversampling to ensure sufficient numbers of respondents in racial, ethnic, and socioeconomic subgroups is common in many but not all general population surveys, and most instruments and measures are not validated with major population subgroups.

It is unlikely that the nation will scrap its existing system of children’s health measurement and design an entirely new system. However, improvements to existing measurement systems, coupled with continued rigorous research, can provide a solid foundation for analysis and action related to children’s health. The committee recommends immediate action in several areas:

  • Improved data collection in selected national surveys;

  • Improved monitoring of the origins and development of health disparities among children and youth;

  • Continued collection of local-area data and linking of those data with other data sources;

  • Increased inclusion of geographic identifiers in health-related surveys and administrative data;

  • Improved access to survey and record-based sources of health information by the research and planning communities; and

  • Increased federal support of state and local monitoring of children’s health and its influences.

Longitudinal surveys are needed to determine the relative contribution and roles played by individual and contextual characteristics in overall health. Such surveys should be a priority of federal and foundation funders. Comprehensive data collection projects also should oversample disadvantaged groups; begin to track children early in life; conduct frequent interviews and assessments with these children throughout childhood and into adulthood; measure assets as well as deficits; provide comprehensive measurement of all contexts that affect children’s health; measure gene-behavior-environment and other contextual interactions; and chart health and disease trajectories and the relative contribution of various influences on health outcomes.

Data Collection in Select National Surveys

Existing data collection vehicles can be modified to provide more useful data over time (e.g., repeated cross-sectional data) and more comprehensive information. As a short-term response, this could include follow-back studies and addi-



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