these data is published (see MacDorman et al., 2002). Another source of standardized reporting of data is the mandated reporting of communicable diseases, which is required of all health care providers and laboratories, to state health departments and, ultimately, the Centers for Disease Control and Prevention (CDC). This system is used to track major infectious diseases and their state and national trends. Outbreaks involving children and patterns of sexually transmitted diseases among adolescents are regularly monitored. In addition, the Maternal and Child Health Bureau (MCHB) has established 6 standard outcome measures that are reported for all states, as well as 18 performance measures.1

Survey data have the advantage of providing national estimates of self-reported or, more usually in the case of children, proxy-reported conditions in childhood. The United States collects a great deal of survey data about children, but few surveys are specifically designed to focus on measuring children’s health. For many decades the measurement of children’s health at the national and state levels has been included in measurement systems that have focused primarily on measuring adult health. This is particularly ironic since the current national system of health statistics had its origins at the early 1900s with assessment of the health of women and the birth of their children (Hutchins, 1997) yet has evolved to focus on adults. The preoccupation of the health care system during the latter part of the 20th century with the prevalence, impact, and cost of chronic diseases in adults and the elderly led to a predominant focus on specific chronic diseases. This focus on chronic disease, along with a long preoccupation with health care costs, has centered national health data collection on their prevalence, the utilization of services for managing them, and the current health expenditures associated with them. In many disease-oriented surveys, children appear to be healthy because of their low prevalence of chronic disorders commonly diagnosed in adults. This orientation and the relatively low price tag for the delivery of child health services have led to an incomplete understanding of children’s health (Schlesinger and Eisenberg, 1990). Until recently, there were only a few special one-time or periodic supplements, such as the Child Health Supplements to the National Health Interview Survey (NHIS) in 1981 and 1988 that focused on children’s health.

National Child Health Data Collection Efforts

Many federal agencies are now involved in collecting regular and periodic health information about children (see Box 4-1). The National Center for Health Statistics (NCHS), which is a part of the CDC, has several ongoing surveys that concern the health and health care use of children in the United States (Brown,



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