U S Vital Statistics System

The publication is an international standard on the design and operation of an efficient and accurate vital statistics system at national level. It provides guidelines on collection, compiling and disseminating vital statistics. More specifically it contains (a) basic principles for a vital statistics system; (b) uses of vital statistics and civil registration records; (c) topics to be covered in a vital statistics system; (d) sources of vital statistics and how they function; (e) quality assurance in the vital statistics system and (f) strategies in improving civil registration and vital statistics systems in countries. It also informs policy makers and the general public on the importance of vital statistics and hence further improving the vital statistics system.

Vital statistics, the records of birth and death, are a critical national information resource for understanding public health. Over the past few decades, the specific program that gathers the data has evolved into a complex cooperative program between the federal and state governments for social measurement. The Vital Statistics Cooperative Program (VSCP) is currently maintained by the National Center for Health Statistics (NCHS). The U.S. vital statistics system relies on the original information reported by myriad individuals, channeled through varying state and local information systems, and coordinated and processed by a federal statistical agency that has experienced relatively flat funding for many years. The challenges facing the vital statistics system and the continuing importance of the resulting data make it an important topic for examination. A workshop, held by the National Academies and summarized in this volume, considered the importance of adequate vital statistics. In particular, the workshop assessed both current and emerging uses of the data, considered the methodological and organizational features of compiling vital data, and identified possible visions for the vital statistics program.

Let us not go over the old ground, let us rather prepare for what is to come. —Marcus Tullius Cicero Improvements in the health status of communities depend on effective public health and healthcare infrastructures. These infrastructures are increasingly electronic and tied to the Internet. Incorporating emerging technologies into the service of the community has become a required task for every public health leader. The revolution in information technology challenges every sector of the health enterprise. Individuals, care providers, and public health agencies can all benefit as we reshape public health through the adoption of new infor- tion systems, use of electronic methods for disease surveillance, and refor- tion of outmoded processes. However, realizing the benefits will be neither easy nor inexpensive. Technological innovation brings the promise of new ways of improving health. Individuals have become more involved in knowing about, and managing and improving, their own health through Internet access. Similarly, healthcare p- viders are transforming the ways in which they assess, treat, and document - tient care through their use of new technologies. For example, point-of-care and palm-type devices will soon be capable of uniquely identifying patients, s- porting patient care, and documenting treatment simply and efficiently.

The delivery of high quality and equitable care for both mothers and newborns is complex and requires efforts across many sectors. The United States spends more on childbirth than any other country in the world, yet outcomes are worse than other high-resource countries, and even worse for Black and Native American women. There are a variety of factors that influence childbirth, including social determinants such as income, educational levels, access to care, financing, transportation, structural racism and geographic variability in birth settings. It is important to reevaluate the United States' approach to maternal and newborn care through the lens of these factors across multiple disciplines. Birth Settings in America: Outcomes, Quality, Access, and Choice reviews and evaluates maternal and newborn care in the United States, the epidemiology of social and clinical risks in pregnancy and childbirth, birth settings research, and access to and choice of birth settings.