improvements in the quality of health care and other services so they can contribute to better health outcomes for children and adolescents.

Progress has been made in selected areas to improve measures of health and health care quality for younger populations, and interest is growing in developing standardized measures that could yield the information needed in these areas. The time is ripe, therefore, for a comprehensive strategy that can make better use of existing data, offer a basis for integrating or linking different data sources, develop new data sources and data collection methods for difficult-to-measure indicators and difficult-to-reach populations, and put a system in place for continuously improving the measures and the measurement system.

Several factors make this a particularly opportune time to mount an effort to strengthen existing measures and improve areas that require increased attention. First, Congress has emphasized improving health care quality as a strategy for obtaining greater value from public investments in health care services. Second, the health and health care of children and adolescents have become a particular focus as younger populations enrolled in public health plans such as Medicaid and the Children’s Health Insurance Program (CHIP) have grown significantly. Third, the percentage of U.S. children and adolescents (under age 18) who live in poverty increased from 18 percent in 2007 to an estimated 20.7 percent (or 15.5 million children) in 2009 (DeNavas-Walt et al., 2010). The percentage is even higher among younger children (under age 6) and among children in selected geographic areas, such as rural communities or central city regions (Mattingly and Stransky, 2010).

Taking additional steps to improve health status and ensure quality health care for all U.S. children and adolescents is essential to achieving both optimal individual health and a healthy future for the nation. The health status of children and adolescents not only is an important determinant of their well-being, but also contributes to their school performance and their ability to become successful, productive, and healthy adults. Moreover, because children are dependent upon their adult caregivers, their families also bear the burden of inadequacies in access to and quality of health care services. Yet there are many indications that health and health care quality for the nation’s youth fail to measure up to child and adolescent health outcomes and standards of care in many other developed countries (OECD, 2010a). Despite a broad array of efforts and significant investments in children’s health, U.S. children and adolescents lag well behind their counterparts in other industrialized nations. According to UNICEF’s report, Child Poverty in Perspective: An Overview of Child Well-Being in Rich Countries, the United States was in the bottom third of the rankings for material well-being, health and safety, educational well-being, family and peer relationships, and behaviors and risks (UNICEF, 2007). One pos-



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