February 28, 2003

The Honorable Tommy G. Thompson
Department of Health and Human Services
200 Independence Avenue SW
Washington, D.C. 20201

Dear Secretary Thompson:

The National Committee on Vital and Health Statistics (NCVHS) has become concerned about what we consider to be a threat to the backbone of our nation’s health statistics system. The health community relies on the Centers for Disease Control and Prevention’s (CDC) National Center for Health Statistics (NCHS) to provide essential data on the nation’s health and healthcare. NCHS data systems provide a foundation for our nation’s health intelligence – identifying new health concerns, tracking progress in improving population health, and providing opportunities for research that helps us better understand health risks and outcomes. The constancy of NCHS efforts to monitor the nation’s health over 40 years has enabled us to understand changes in our health and healthcare over time and has provided us the basis for addressing current and emerging health issues. This ability to address both current and emerging health issues is critical to an effective and quick response in the event of bioterrorism.

We are concerned that the President’s budget for FY 2004 does not adequately support these important efforts, and may represent a setback to efforts to build a strong, technologically sophisticated health information infrastructure.

Two recent reports from the NCVHS include strong recommendations to strengthen HHS’ efforts in health statistics and information infrastructure. In particular, the report “Shaping a Health Statistics Vision for the 21st Century” anticipates a strengthened NCHS, building on its core survey mechanisms to produce rapid statistical information to inform policy and public health practice. Building on NCHS’ existing strengths, the “Vision” recommendations anticipated a stronger NCHS role in making the nation’s overall statistical efforts more effective and efficient.

The FY 2004 budget moves in the wrong direction. It will undermine the viability of NCHS’ core programs and slow efforts to build more technologically sophisticated systems. We are concerned not only that HHS may lose valuable data in the short run, but also that investments designed to streamline and integrate HHS’ overall statistical program will suffer.

The President’s budget signals three areas of particular concern. First, it appears that NCHS, along with the HHS Data Council, will need to consider unacceptable tradeoffs between essential long-term investments and, in the short run, the continuation of efforts to collect sufficient data on high priority topics through the National Health Interview Survey (NHIS). This survey, a cornerstone of our nation’s health statistics system, produces important national information on health behaviors, insurance, access to care, and racial and ethnic disparities. It also serves as the national benchmark for more targeted surveys in states and the private sector, and for integrated survey efforts across HHS. A reduction in the sample size of NHIS will frustrate efforts to monitor the health of minorities, the disadvantaged, and the disabled. NCHS, at the urging of the NCVHS and the user community, has developed plans to update the technology of this survey in order to provide more rapid results, as well as to update the sample that allows the NHIS to accurately reflect the diversity of the US population. These efforts are essential and should be supported. HHS should make every effort to provide sufficient funding to ensure that data collection and analyses are not interrupted or reduced to an unacceptable effort in the short run.

Second, states are engaging in efforts to update the national vital statistics system, on which we rely for data on life expectancy, causes of death, teen pregnancy, out of wedlock birth, and other key health indicators. NCHS, the Federal partner in this intergovernmental effort, is working with states to convert the system to a web-based technology platform that will give us data quicker and in higher quality. Yet NCHS has been given virtually no resources for investments in technology development or assisting states with implementation; as a result, it will be years before we see results from this important effort.

Third, the budget for NCHS proposes significant reductions in information technology funding at a time when NCHS is taking positive, overdue steps to invest in the technology of its data systems, as in the above examples. Cutbacks of this magnitude will inevitably lead to lost capacity for NCHS, hurt timeliness of data for users, and constitute a lost opportunity to move the Department and its partners to a more sophisticated technology infrastructure.

The Populations Subcommittee has recently been holding hearings on the collection of population-based and administrative health data for ethnic and non-English speaking populations. Such data, for both states and the nation, are critical for eliminating health disparities, a major goal of HP 2010. Adequate funding for NCHS, a leader in the development of these data, is essential to address health disparities. The Subcommittee will forward final reports and recommendations on these areas in the future.

The additional resources that would be needed to help NCHS maintain its programs and advance its information technology closer to the cutting edge are small in comparison to our public and private investment in health, but will greatly facilitate addressing our most pressing information needs. The NCVHS urges your consideration of these critical needs.



John Lumpkin, M.D., M.P.H.
Chair, National Committee on Vital and Health Statistics

cc: HHS Data Council, Co-Chairs