Appendix D
Summary of Previous Reports Dealing with
Racial and Ethnic Data
Approach
The Working Group on Racial and Ethnic Data reviewed recommendations and strategies
developed by previous internal and external advisory groups for the purpose of identifying high
priority racial and ethnic data issues that warrant the attention of the HHS Data Council, and to
make recommendations on how they might be addressed. Reports from the following groups
were reviewed:
- Secretary's Task Force on Black and Minority Health (1985)
- PHS Task Force on Minority Health Data
- Surgeon General's Hispanic/Latino Health Initiative
- National Asian Pacific American Families Against Substance Abuse, Inc.
The recommendations addressed the full spectrum of activities and resources needed to
support a comprehensive minority health data development program in the Department.
Although the recommendations overlapped considerably, in general, a number of recurrent issues
became apparent. The recommendations were divided into the following data issue categories:
- Funding
- Infrastructure
- Policy and Legislation
- Cooperative Efforts Among Federal, State, Local Agencies, Private Groups,
Researchers, etc.
- OMB/Identifiers/Subgroups
- Evaluation/Methodology/Quality
- Oversampling or Target Surveys
- Content/Relevance
- Analysis/Publication/Dissemination
- Training/Technical Assistance
- Representation
In each of the above categories, recommendations were further identified by the Working
Group as representing a continuing effort, ongoing and continuous need, short term need, and
long term need, defined as follows:
1. Continuing effort. HHS has started to address this recommendation, and the effort has
become an integral part of an agency's or other operational unit's mission and
procedures.
2. Ongoing and continuous need. HHS has begun to address this recommendation, but the
level of effort needs to be increased.
3. Short term need. The recommendation could be implemented in the near future with
few additional resources.
4. Long term need.. The recommendation requires significant resources to implement, or
would require significant changes in legislation, policy, methodology, or other
operations.
The recommendations assigned to the category "Other" were not characterized according to
level of effort.
A number of recommendations have already been addressed by the Department; other
recommendations require varying levels of resources for their implementation. The Working
Group paraphrased and updated some recommendations to reflect activities that took place
between the time of publication and the present and occasionally added cross-references and/or
other comments. The specific recommendations within the 12 data issue categories are listed
below.
1. Funding
1985: Task Force on Black and Minority Health
Long term
PHS should support targeted, smaller scale surveys and studies to develop data for minority
populations and, especially, subpopulations. For most smaller minority subpopulations, this
approach should be the primary method for data development. Such studies should employ
measurement approaches which will make them comparable to national estimates for the
general population. To support these studies, the NCHS Disadvantaged Minority Health
Improvement Grant Program should be supported at an adequate level.
1993: Surgeon General's National Hispanic/Latino Health Initiative
Partially overtaken by events; review for current status
During current Federal and State budget appropriations hearings, request additional funds to
take advantage of the resources being developed for the third National Health and Nutrition
Examination survey. These funds should be used: (1) to update the data collected on Puerto
Ricans and Cubans during the Hispanic Health and Nutrition Examination survey, and (2)
collect, for the first time, detailed health data on other Caribbean and Central and South
American subgroups in areas where they are geographically focused.
Compare to commentary on recommendation immediately above
During Federal and State budget appropriations hearings, request additional funds to take
advantage of the resources already developed for the third National Health and Nutrition
Examination Survey. These funds should be used to: (1) update the data collected on the
Puerto Rican community in the New York City metropolitan area during 1984, and (2)
collect, for the first time, detailed health data on Caribbean and Central and South American
subgroups. Appropriation of funds should not wait for the fourth National Health and
Nutrition Examination Survey. Taking advantage of already trained staff and existing
questionnaire and other survey materials from the current survey (to be completed in 1994)
should result in an economy of scale.
Ongoing and continuous need
Allocate funds in Federal, State and local health programs to pay for data collection, analysis
and dissemination of Hispanic/Latino health data so that progress in improving
Hispanic/Latino health status, and ultimately the health status of the Nation, can be tracked.
Government agencies that use these data, but do not produce data, should share in the
expenses of data collection, analysis and dissemination.
Short term
Employ culturally and linguistically appropriate interviewing techniques at all times when
conducting surveys on Hispanic/Latino health issues. For example, dependence on telephone
interviews is inappropriate for Hispanic/Latino communities with high rates of telephone
non-coverage.
Short term
Identify and develop funding mechanisms for survey methodologies to study Hispanic/Latino
subgroups. Additional funds should be allocated to the National Center for Health Statistics'
Minority Health Statistics Grant program and census survey research programs to support
targeted research to develop appropriate, culturally competent, and linguistically sensitive
survey methodology to study subgroups of Hispanics/Latinos. Consideration should be given
to the undocumented and recent immigrants.
Short term
Increase funding by county, State and Federal health departments and agencies to provide
technical assistance and training for data collection and analysis of Hispanic/Latino health
data.
Long term
Fund county, State and Federal Hispanic/Latino health research and data analysis training
centers.
Ongoing and continuous need
Provide support for local, State, regional and national Hispanic/Latino health data forums,
conferences and workshops.
Short term
Develop funding incentives to increase the use of Hispanic/Latino health databases by public
and private entities.
2. Infrastructure
1992: PHS Task Force on Minority Health Data
Ongoing and continuous need
The Office of Minority Health should strengthen its leadership and policy coordination
activities in the area of minority health data across all PHS agencies and activities.
Short term
OMH should establish an ongoing Minority Health Data Advisory Committee. The
committee would serve as the PHS-wide forum for continuing communication, coordination,
planning and oversight of minority data activities within PHS. The Committee should
develop a long term plan for addressing the most important health data gaps for minority
populations.
Short term
Each PHS agency should designate an agency-wide contact person for minority health data.
The individual would serve as the principle resource person regarding minority data plans,
issues and activities within the agency, and would serve as a liaison to other agencies.
Short term
The National Center for Health Statistics should establish an organizational unit devoted to
minority populations. The unit should be adequately staffed and serve as the central focus for
technical leadership, planning, analysis and dissemination of general purpose statistics on
minority populations across all Center programs.
Short term
Identify a person in each agency or organization who collects and disseminates data to serve
as the principal point of contact for Hispanic/Latino data analysis.
Establish local, State, regional and national Hispanic/Latino health data clearinghouses.
3. Policy and Legislation
1985: Task Force on Black and Minority Health:
Ongoing and continuous need
Develop mechanisms for matching individual records from among government data sets,
within and between Departments, for health and statistical research purposes. HHS should
encourage and support legislative changes to allow such matching to occur with the
appropriate safeguards.
1993: Surgeon General's National Hispanic/Latino Health Initiative
Long term. Review for applicability (maybe by General Counsel)
Establish Federal, State and local laws to ensure confidentiality of respondents and to provide
absolute protection of respondents from use of the identifying information by law
enforcement and immigration authorities.
No authority
Pass State laws requiring the collection of data on Hispanics/Latinos, especially in States
with large Hispanic/Latino populations. The California legislation can be used as a model.
Compare to commentary on two recommendations immediately above
Establish Federal, State and local laws to ensure confidentiality of respondents and to provide
absolute protection of respondents from use of the identifying information by law
enforcement and immigration authorities. Such laws should not restrict the linkage of data
sets for the purposes of aggregate epidemiologic analyses and program development.
Short term
To improve the research base on minority health, PHS should consider applying the current
NIH-ADAMHA research grants policy on inclusion of minorities in extramural research
activities to all PHS agencies.
Ongoing and continuous need
To promote wider availability of minority data, OMH should consider the establishment of a
full service, minority health data resource center or archive to assist Federal and outside data
users in obtaining needed minority data. Modeled after similar data resource centers in other
areas, e.g., aging, the center would provide a national resource for major data sets dealing
with minority health, analyses and publications, as well as technical assistance.
1993: Surgeon General's National Hispanic/Latino Health Initiative
Long term
Tie the release of Federal funds to States to the collection and reporting of Hispanic/Latino
ethnicity data. Data collection and reporting should include both documented and
undocumented Hispanics/Latinos.
Ongoing and continuing
Vague; but improvements are ongoing and continuing
Set timelines for improving data collection for Hispanics/Latinos.
Vague; but improvements are ongoing and continuing
Include the improvement of Hispanic/Latino data collection, analysis and dissemination in
Federal, State and local strategic plans, such as Healthy People 2000, Minority Health
Activities, and Primary Care Access Plans.
Short term
Develop and disseminate written guidelines for confidentiality. Such guidelines should
include a requirement for a detailed rationale for collecting and using data items. In addition,
the guidelines should include a procedure for true informed consent in obtaining data from
Hispanics/Latinos.
Clarification of intent and status needed
NIDA, NIAAA, and the new NIH Office of Alternative Medicine [should] be given a
mandate from the Secretary to implement a comprehensive action plan to fund appropriate
research on alcohol, tobacco, and other drug and related problems for the Asian and Pacific
Islander populations. NIDA must find a way to produce drug abuse research regarding Asian
and Pacific Islanders.
Short term
Enforce OMB Directive 15 and Public Law 94-311 among Federal agencies. Educate Federal
agencies about the use of OMB Directive 15 for inclusion of Hispanics/Latinos (and
Hispanic/Latino subgroups) in data systems, and in federally funded intramural and
extramural research programs.
4. Cooperative Efforts Among Federal, State and Local Agencies, Private Entities,
Researchers, Etc.
1985: Task Force on Black and Minority Health:
Ongoing and continuing effort
HHS should undertake activities, which would improve existing sources of health data, such
as: enhancing cooperative efforts with the States in recording vital statistics, incorporating
specific racial/ethnic identifiers in databases, and oversampling selected minorities in
national surveys. Furthermore, HHS should support innovative uses of currently available
data consistent with the Privacy Act and confidentiality constraints. Analyses such as cross-comparisons from different data sets and specialized studies should be encouraged because
they can contribute to understanding the health status and needs of minority populations.
Ongoing and continuing effort
The 1989 revision of the standard registration certificates for births and deaths include Hispanic
identifiers
Assign high priority to cooperative efforts between HHS and the States directed at
developing standardized Hispanic identifiers in vital statistics records (death, birth, marriage,
and divorce certificates).
Ongoing and continuous effort
Strengthen and expand cooperative efforts to train personnel to complete vital statistics
records accurately (particularly with regard to correct coding of causes of death and
racial/ethnic identifying items).
Ongoing and continuous need (where feasible)
Maintain specific racial/ethnic identifiers when processing original data. For those data
collected cooperatively from the States by agencies such as CDC and NCHS, efforts should
be increased to overcome barriers to obtaining data with standardized racial/ethnic identifiers.
Completed 1990
Feasibility for 2000 questionable
Work with the Bureau of the Census to improve health-related, minority-specific data
collection for the 1990 census.
Completed (NCHS linked file of infant births and deaths)
Strengthen and expand efforts between the Department and the States to develop a national
database of linked birth and death records for analyzing Hispanic mortality.
1992: PHS Task Force on Minority Health Data
Long term
Intercensal estimates of four broad population groups now available; feasibility of subpopulation
and other demographic variables questionable
CDC/NCHS should work with the Bureau of the Census to develop intercensal population
estimates on a national and State basis for racial and ethnic minority populations and
subpopulations to serve as denominator data. In addition, CDC/NCHS should work with the
Bureau of the Census to develop national and State-level estimates of social and economic
characteristics of racial and ethnic minority populations for intercensal years.
Refer to IHS
IHS, in collaboration with NCHS, should explore with appropriate States the potential for
adding information on principal Indian Tribe or Alaska village on the birth and death
certificates of appropriate States.
1993: Surgeon General's National Hispanic/Latino Health Initiative:
Ongoing and continuous effort
Conduct a national conference--cosponsored by the National Center for Health Statistics,
other parts of the Centers for Disease Control and Prevention, the Commerce Department, the
Department of Justice, the Environmental Protection Agency, and other Federal agencies--
to improve the coordination of data collection, analysis and dissemination, with the goal
being to reduce the burden of voluntary and mandatory reporting by the States, and to
improve the consistency of reporting of racial/ethnic origin. Recommendations based on the
findings from the 1993 PHS Task Force on State and Community Data should be used to help
develop the agenda for the conference. Among the products of this conference should be
guidelines for comparability and plans for providing, on a continuous basis, technical
assistance and resources to State and local agencies responsible for data collection. This
conference should take place by 1995 at the latest to ensure that tracking of Healthy People
2000 objectives can be based on consistent and accurate data.
Short term
Use existing data systems (e.g., Bureau of the Census and the National Center for Health
Statistics) to establish cooperative agreements with States to develop standard State and local
health status profiles for Hispanic/Latino communities.
Ongoing
Collaborate with church groups, media sources, public figures, and leaders of
multidisciplinary professional associations to inform the American public regarding
Hispanic/Latino health data issues.
5. OMB/Identifiers/Subgroups
1985: Task Force on Black and Minority Health
Ongoing and continuing effort
HHS should undertake activities, which would improve existing sources of health data, such
as: enhancing cooperative efforts with the States in recording vital statistics, incorporating
specific racial/ethnic identifiers in databases, and oversampling selected minorities in
national surveys. Furthermore, HHS should support innovative uses of currently available
data consistent with the Privacy Act and confidentiality constraints. Analyses such as cross-comparisons from different data sets and specialized studies should be encouraged because
they can contribute to understanding the health status and needs of minority populations.
Ongoing and continuing effort
The 1989 revision of the standard registration certificates for births and deaths include Hispanic
identifiers
Assign high priority to cooperative efforts between HHS and the States directed at
developing standardized Hispanic identifiers in vital statistics records (death, birth, marriage
and divorce certificates).
Short term
Require all HHS agencies that collect health data from individuals to include racial and
ethnic identifiers, as defined by OMB. Where possible and desirable, further breakdown
within racial and ethnic categories should be recorded, e.g., national origin of Hispanics and
Asian/Pacific Islanders.
Ongoing and continuing effort (where feasible)
Maintain specific racial/ethnic identifiers when processing original data. For those data
collected cooperatively from the States by agencies such as CDC and NCHS, efforts should
be increased to overcome barriers to obtaining data with standardized racial/ethnic identifiers.
1992: PHS Task Force on Minority Health Data
Ongoing and continuous need
PHS should publicize and reissue the current Standards for the Collection and Analysis of
Racial and Ethnic Data in Federal Agencies (OMB Statistical Policy Directive 15). The
standards outline a minimum of racial and ethnic categories and definitions required for use
in all Federal data collection activities which include race items.
Long term
PHS should develop and encourage the use of a supplemental set of standards for classifying
racial and ethnic subpopulations (Mexican-American, Chinese, etc.) for use in appropriate
PHS data activities.
Completed and continuing effort
CDC/NCHS should develop procedures to promote uniform recording, coding and analysis
of vital statistics data on additional racial and ethnic minority populations and subpopulations
in the U.S. Building on the success achieved in the Hispanic area, NCHS should encourage
all States to adopt similar reporting and coding policies for Asian and Pacific Islander vital
events, and should follow as closely as possible the eight Asian and Pacific Islander
subpopulation categories used in the 1990 census.
Refer to IHS
IHS, in collaboration with NCHS, should explore with appropriate States the potential for
adding information on principal Indian Tribe or Alaska village on the birth and death
certificates of appropriate States.
Short term where feasible without retooling
The OMB standard item on race and ethnicity should be included in all uniform health data
sets developed or sponsored by PHS agencies.
Short term where feasible without retooling
All PHS agencies should examine existing and planned program management data systems,
whether for research, training or services program administration, for their potential to
provide improved data on minority groups. For data systems which do not include
information on race and ethnicity, the standard racial and ethnic reporting categories should
be incorporated into the next planned revision of the respective system. This Initiative should
be monitored through the OMB clearance process.
1993: Surgeon General's National Hispanic/Latino Health Initiative
Ongoing and continuous need
Include Hispanic/Latino and Hispanic/Latino subgroup identifiers in all surveys and forms,
and provide for adequate sample sizes for detailed analysis to establish new baselines and
subobjectives for Healthy People 2000.
Short term where feasible; partially ongoing and continuous efforts
Include Hispanic/Latino and Hispanic/Latino subgroup identifiers in all surveys and forms
(e.g., birth and death certificates, patient discharge forms, and forms from primary and
ambulatory care clinics). Analysis and dissemination should be subgroup specific for State
and local communities with a significant (5 percent or greater) Hispanic/Latino population.
Short term
Enforce OMB Directive 15 and Public Law 94-311 among Federal agencies. Educate Federal
agencies about the use of OMB Directive 15 for the inclusion of Hispanics/Latinos (and
Hispanic/Latino subgroups) in data systems, and in federally funded intramural and
extramural research programs.
Appears to be not feasible
Develop a clear definition of the term "Hispanic/Latino" incorporating the concept of
subgroup populations, to be uniformly implemented in county, State and Federal health
department and agency data collection and analysis activities.
1993: National Asian Pacific American Families Against Substance Abuse, Inc.
(12/17/93 memo to Peter Edelman)
Refer to NIDA
The pertinent HHS studies that collect health data, including the Center for Substance Abuse
Prevention's "National Household Survey" and "National High School Seniors Survey
(should) be modified to include data on specific Asian and Pacific Islander groups.
6. Evaluation/Methodology/Quality
1985: Task Force on Black and Minority Health
Ongoing and continuing effort
Strengthen and expand cooperative efforts to train personnel to complete vital statistics
records accurately (particularly with regard to correct coding of causes of death and
racial/ethnic identifying items).
Ongoing and continuing effort
Establish a mechanism to evaluate the quality of information on death certificates to
determine if guidelines for completing the items on the certificate are followed.
Ongoing and continuous need (see Legislature section)
Develop mechanisms for matching individual records from among government data sets,
within and between Departments, for health and statistical research purposes. HHS should
encourage and support legislative changes to allow such matching to occur with the
appropriate safeguards.
1992: PHS Task Force on Minority Health Data
Ongoing and continuing effort
The Parklawn Health Library and the Office of Minority Health (OPHS) have developed an
annotated bibliography of the literature relating to the measurement of race and ethnicity in
health statistics.
As a basis for improvement, PHS should develop a review of the literature relating to
methods, issues, and findings in the measurement of race and ethnicity in health statistics
activities. Based on the literature review, PHS should convene a workshop or conference
devoted to issues in, and the development of, a research agenda relating to the measurement,
analysis and dissemination of racial and ethnic minority health data.
Ongoing and continuing effort
NCHS and OPHS are collaborating in a study of racial and ethnic classification of Hispanic and
multiracial mothers.
CDC/NCHS, in collaboration with OMH, other PHS agencies and the Bureau of the Census,
should undertake a program of methodological research into issues associated with the
measurement of race and ethnicity in surveys and research.
Ongoing and continuous need
PHS should implement a strategy for developing data on racial and ethnic minority
populations and subpopulations which consists of several approaches--improving vital
statistics, oversampling in national surveys where feasible, conducting follow-up and dual
frame type sampling approaches for special surveys, and sponsoring targeted studies for
developing data on subpopulations where oversampling is not feasible or cost effective.
Ongoing and continuing effort
CDC/NCHS should continue its evaluation of the quality of reporting of race and ethnicity in
the National Vital Statistics program as a basis for improvements in these areas. In particular,
CDC/NCHS should work with IHS to improve the accuracy of American Indian race
reporting on death certificates.
Ongoing and continuing effort
NCHS should evaluate the quality and completeness of racial and ethnic data obtained from
surveys based on health records, and develop recommendations relating to more accurate,
complete and detailed information on race and ethnicity in health record-based surveys.
Ongoing and continuous need
PHS should support methodological studies on issues associated with the collection, analysis
and dissemination of data on minority populations. In addition to general methodological
issues, attention should be directed to language and cultural factors, as well as health status
and health care issues unique to certain minority subpopulations.
Short term
Address previous and current efforts; feasibility
NCHS should develop a monograph focusing on guidelines and approaches to small area
analysis using national data sets as well as more localized approaches. This monograph
should include methodological research on health status measures and indicators for minority
populations.
1993: Surgeon General's National Hispanic/Latino Health Initiative
Short term (refer to Section 2, Infrastructure)
Employ culturally and linguistically appropriate interviewing techniques at all times when
conducting surveys on Hispanic/Latino health issues. For example, dependence on telephone
interviews is not appropriate for Hispanic/Latino communities with high rates of telephone
non-coverage.
Ongoing and continuing effort
Develop incentives to increase the quality and quantity of Hispanic/Latino health databases.
Review data sets continuously for inconsistencies; errors in reporting, coding and keying; and
other issues that affect quality. Development plans for databases should include financial,
technical and training resources for establishment and maintenance of quality control
programs.
Ongoing and continuous need (where feasible)
Develop standardized forms for data collection on Hispanics/Latinos.
7. Oversampling or Target Surveys
1985: Task Force on Black and Minority Health
Ongoing and continuous need
HHS should undertake activities which would improve existing sources of health data, such
as: enhancing cooperative efforts with the States in recording vital statistics, incorporating
specific racial/ethnic identifiers in databases, and oversampling selected minorities in
national surveys. Furthermore, HHS should support innovative uses of currently available
data consistent with the Privacy Act and confidentiality constraints. Analyses such as cross-comparisons from different data sets and specialized studies should be encouraged because
they can contribute to understanding the health status and needs of minority populations.
Ongoing and continuous need (See above)
Oversample selected minorities in national surveys of health indicators or conduct targeted
studies on minority health problems, as appropriate.
1992: PHS Task Force on Minority Health Data
Ongoing and continuous need
PHS should implement a strategy for developing data on racial and ethnic minority
populations and subpopulations which consists of several approaches--improving vital
statistics, oversampling in national surveys where feasible, conducting follow-up and dual
frame type sampling approaches for special surveys, and sponsoring targeted studies for
developing data on subpopulations where oversampling is not feasible or cost effective.
Ongoing and continuous need
Blacks and Hispanics are oversampled in NHIS
Oversampling for racial and ethnic minorities should be considered in the planning of all
major recurring surveys sponsored by agencies of the PHS. Specifically, the National Health
Interview Survey, the primary source of national data on self-reported health status, illness,
disability and use of health care in the U.S. should oversample blacks and Hispanics in
greater numbers than is currently done.
Short term
Status?
In the planned sample redesign of the National Health Interview Survey scheduled for 1996,
attention should be directed to opportunities for oversampling Asian or Pacific Islanders and
American Indians or Alaska Natives. If this is not feasible, NCHS should explore other
methods of increasing the availability of data for these minority populations. Other potential
survey candidates for oversampling opportunities (for Hispanics and Asians) include the
planned third cycle of the National Medical Expenditure Survey, future cycles of NHANES,
the National Survey of Family Growth and the National Health Care Survey.
Short term
Where oversampling is not feasible because of small population sizes or other issues,
consideration should be given to the initiation of special surveys based on follow back
approaches, special sampling frames and other augmentation approaches using methods
comparable to national surveys which would support reliable estimates for minority
populations and subpopulations. Research should also be directed at the development of more
efficient methods for sampling minority populations.
Short term
Funding addressed in section 2, Infrastructure
PHS should support targeted, smaller scale surveys and studies to develop data for minority
populations and, especially, subpopulations. For most smaller minority subpopulations, this
approach should be the primary method for data development. Such studies should employ
measurement approaches which will make them comparable to national estimates for the
general population. To support these studies, the NCHS Disadvantaged Minority Health
Improvement Grant Program should be supported at an adequate level.
Long term
While the NCHS Disadvantaged Minority Health Improvement Grant Program will be the
focal point for support of targeted minority health data development efforts, all PHS agencies
supporting epidemiological, behavioral and health services research through extramural
grants to individuals, institutions and centers should support minority data development
activities through these mechanisms. To promote policy coordination, OMH should review
all extramural research grant solicitations dealing with minority health issues.
1993: Surgeon General's National Hispanic/Latino Health Initiative
Short term
Feasibility beyond National level questionable
Include consideration of the heterogeneity of the Hispanic/Latino population in all county,
State, and Federal health department data collection and research designs. Oversampling has
been identified as a feasible method for highly concentrated Hispanic/Latino subgroups;
develop other survey methodologies to collect data for geographically dispersed
Hispanic/Latino subgroups.
8. Content/Relevance
1985: Task Force on Black and Minority Health
Short term
HHS should undertake activities, which would improve existing sources of health data, such
as: enhancing cooperative efforts with the States in recording vital statistics, incorporating
specific racial/ethnic identifiers in databases, and oversampling selected minorities in
national surveys. Furthermore, HHS should support innovative uses of currently available
data consistent with the Privacy Act and confidentiality constraints. Analyses such as cross-comparisons from different data sets and specialized studies should be encouraged because
they can contribute to understanding the health status and needs of minority populations.
Completed in 1990; feasibility for 2000 questionable (See section 4, Cooperative efforts)
Work with the Bureau of the Census to improve health-related, minority-specific data
collection for the 1990 census.
1992: PHS Task Force on Minority Health Data
Ongoing and continuous need
Health United States is including more tables of race and ethnicity and socioeconomic status.
To assist in fully understanding the causes of racial and ethnic disparities in health status and
health care access and use, PHS agencies should include additional questions on social and
economic factors as well as race and ethnicity in major surveys, and expand their analyses of
existing data relating to the role of socioeconomic factors. Among the factors to be included
are education, occupation, income, health insurance and related economic and program
participation information.
Ongoing and continuous need
In addition to social and economic factors, behavioral factors are essential to a fuller
understanding of the causes of racial disparities in health. Accordingly, PHS agencies should
expand the collection and analysis of data on individual risk factor behavior, e.g., cigarette
smoking, in major surveys.
Ongoing and continuous effort
To better assess health status and health care access issues in diverse minority populations,
PHS agencies should include selected questions on acculturation, nativity and recency of
immigration in appropriate surveys and studies and include such factors in analyses. In
addition, PHS agencies should support further research into the relationship between those
issues and minority health.
Ongoing and continuous effort
In developing future plans for the family of provider-based surveys which comprise the
National Health Care Survey, NCHS should examine the potential for improved and
expanded data collection, analysis and dissemination of information on minority populations.
Ongoing and continuing effort
NCHS, in collaboration with OMH and ODPHP, should develop a plan to address minority
data needs associated with Healthy People 2000. Data gaps relating to monitoring progress
toward the minority health objectives included in Healthy People 2000, as well as data gaps
which impeded the development of minority health objectives should be addressed.
Input needed from each agency
All agencies of the Public Health Service should examine the potential for expanded data
collection, analysis and dissemination of minority health data from existing data systems,
whether surveys, surveillance activities, epidemiological studies, registries, or other
activities. Specifically:
-- ADAMHA should build and expand upon existing profiles of minority populations based
on its alcohol, drug abuse and mental health surveys and epidemiological studies relating
to the prevalence, correlates and consequences of ADM disorders, the treatment system,
the use of services and associated expenditures.
-- In collaboration with OMH, NCHS, AHCPR and IHS should intensify efforts to analyze
and disseminate the unique minority data obtained in the Hispanic Health and Nutrition
Examination Survey and the Survey of American Indians and Alaska Natives.
-- CDC should promote improved information on minority populations in all of its existing
and planned public surveillance systems and applied research activities.
-- FDA should develop improved information on minority populations in its consumer
surveys.
-- AHCPR should improve information on minority populations available from its survey,
research and analytical activities, especially the next cycle of the National Medical
Expenditure Survey.
-- NIH should improve the information on minority populations available from its
epidemiological research and statistical activities.
Input needed from HRSA
HRSA should develop a strategy to improve data on the numbers, geographic distribution and
practice characteristics of minority health personnel. The first step would involve the
determination of which occupations to focus on, followed by the development of occupation-specific plans.
Input needed from HRSA
HRSA and AHCPR should support the development of data on health care access and
delivery issues for specific racial and ethnic minority groups, including where they receive
care, the types of personnel providing care and the effect of the health care provided.
Input needed from HRSA
HRSA should examine the potential for improved information on minority status in its
service recipient populations, its health professions training support programs, health
resource development programs, and health personnel data activities.
Ongoing and continuous need
All PHS agencies should examine existing and planned program management data systems,
whether for research, training or services program administration, for their potential to
provide improved data on minority groups. For data systems which do not include
information on race and ethnicity, the standard racial and ethnic reporting categories should
be incorporated into the next planned revision of the respective system. This Initiative should
be monitored through the OMB clearance process.
Ongoing and continuous need
OMH should work with the Health Care Financing Administration and the Social Security
Administration to promote the development of data on minorities in its enrollee and
beneficiary populations.
1993: Surgeon General's National Hispanic/Latino Health Initiative
Ongoing and continuous need
Ensure that sociocultural data be collected, so that analysis and interpretation of
Hispanic/Latino health data can be placed in the context of larger social issues.
Ongoing and continuous need
Ensure that sociocultural data are collected and that appropriate statistical methodologies and
interpretation of these data are used. Analysis and interpretation of Hispanic/Latino health
data should be placed in the context of larger social issues to ensure that "blaming the victim"
is avoided and to allow identification of social factors that contribute directly and indirectly
to the production and treatment of disease.
Completed
Starting immediately, review existing Healthy People 2000 objectives and establish
subobjectives to target Hispanics/Latinos. Provide baseline data for Hispanics/Latinos for
these subobjectives at the Federal, State and local levels.
National Asian Pacific American Families Against Substance Abuse, Inc.
(12/17/93 memo to Peter Edelman)
Need input from appropriate program(s)
There is an unacceptable lack of basic health statistics regarding substance abuse, mental
health and primary health care for Asian and Pacific Islander populations. The absence of this
crucial public health information creates enormous problems in developing health promotion
and treatment programs at the local, State and national levels. Further, the lack of incidence
and prevalence data place Asian and Pacific Islanders at a tremendous disadvantage in
pursuing grants and other resources from the public and private sectors. HHS (should) take
immediate corrective action by implementing a systematic action plan to gather the necessary
data. Short-term data gathering projects should be implemented in each of the major Asian
and Pacific Islander population centers in at least six States.
Need input from appropriate program(s)
The pertinent HHS studies that collect health data, including the Center for Substance Abuse
Prevention's National Household Survey and National High School Seniors Survey [should]
be modified to include data on specific Asian and Pacific Islander groups.
Need input from appropriate program(s)
HHS (should) take immediate corrective action to revise the Healthy People 2000 strategy in
order to effectively address the needs of Asian and Pacific Islanders.
Need input from appropriate program(s)
HHS should collect detailed surveillance data on the incidence and prevalence of HIV/AIDS
and STDs among Asian and Pacific Islanders in the continental U.S., Alaska, Hawaii, and the
Pacific Islands.
Need input from appropriate program(s)
HHS (should) add the Pacific Islands to the Healthy People 2000 strategy document
including a full description of the needs (with baseline data) and corresponding objectives.
9. Analysis/Publication/Dissemination
1985: Task Force on Black and Minority Health
Short term
HHS should undertake activities which would improve existing sources of health data, such
as: enhancing cooperative efforts with the States in recording vital statistics, incorporating
specific racial/ethnic identifiers in databases, and oversampling selected minorities in
national surveys. Furthermore, HHS should support innovative uses of currently available
data consistent with the Privacy Act and confidentiality constraints. Analyses such as cross-comparisons from different data sets and specialized studies should be encouraged because
they can contribute to understanding the health status and needs of minority populations.
Completed 1990
Feasibility for 2000 questionable (See section 4, Cooperative efforts)
Work with the Bureau of the Census to improve health-related, minority-specific data
collection for the 1990 census.
Ongoing and continuous need
Investigate, in the absence of legislation permitting data linkage across HHS agencies,
mechanisms whereby the minority-specific, health-related data collected by each agency can
be analyzed and published.
1992: PHS Task Force on Minority Health Data
Short term
(See section 6, Methodology)
PHS should support methodological studies on issues associated with the collection, analysis
and dissemination of data on minority populations. In addition to general methodological
issues, attention should be directed to language and cultural factors, as well as health status
and health care issues unique to certain minority subpopulations.
Ongoing
Analyze and highlight minority health issues, especially in the six health priority areas, that
result from improved minority identifiers in data collection.
Short term
CDC/NCHS should combine several years of data from the National Health Interview
Survey, the National Hospital Discharge Survey, the National Ambulatory Medical Care
survey, the National Vital Statistics System and other data sources to develop and publish
periodic comprehensive profiles of the health status and health care use of minority
populations in the U.S.
Ongoing and continuous effort
To promote wider analysis of minority health data, PHS agencies should develop aggressive
public use data tape release programs, including grant and contract support for data analysis
as well as periodic data users conferences.
Short term
OMH should develop approaches to promoting wider analysis and availability of existing
minority data within PHS. Approaches might include the establishment of an internal
statistical capability, a statistical resource contractor, a task order contract or other
alternatives.
Ongoing and continuous need
ASPE and AHCPR updated and expanded the directory to include other agencies within the
Department. The Directory is now on the Department's Internet homepage.
OMH should publicize and update the Directory of PHS Minority Health Data Resources on
a periodic basis. The Directory was developed by the Task Force as a central reference guide
to existing and planned data sources in minority health.
Short term
Feasible for vital statistics
NCHS should compile and disseminate State and community level health data with special
attention to minority data and Healthy People 2000.
Short term
(See section 6, Methodology)
NCHS should develop a monograph focusing on guidelines and approaches to small area
analysis using national data sets as well as more localized approaches. This monograph
should include methodological research on health status measures and indicators for minority
populations.
Short term
(See section 4, Cooperative Efforts)
CDC/NCHS, in collaboration with OMH, should develop and disseminate a periodic report
on the health of minorities similar in concept to Health U.S. and Mental Health: U.S.
Ongoing and continuous need
OMH should promote the improved dissemination of minority data to appropriate audiences
through such existing PHS dissemination mechanisms as Public Health Reports, MMWR,
clearinghouses and related approaches.
1993: Surgeon General's National Hispanic/Latino Health Initiative
Ongoing
(included in other recommendations)
Facilitate public access to Hispanic/Latino health data reports and systems. Federal, State,
and local health departments should identify existing data sets that can be used to assess the
health status of Hispanics/Latinos and should determine the accessibility of these data sets to
researchers.
Short term
Provide regular Hispanic/Latino health data updates in publicly funded electronic newsletters,
bulletin boards and other communication activities.
Short term
Increase the use of Hispanic/Latino newsletters, radio and other effective media mechanisms
as tools for disseminating data information.
Short term
Encourage researchers to report back to Hispanic/Latino communities regarding their
research findings before public dissemination of results, including publication and
presentation at scientific meetings.
Ongoing
Establish local, State, regional and national Hispanic/Latino health data clearinghouses.
Short term
Develop publicly accessible computerized systems for retrieval of Hispanic/Latino health
data.
Short term
(See section 2, Infrastructure)
Establish cooperative agreement mechanisms to develop easily accessible Hispanic/Latino
health data retrieval computer programs.
Prepare user-friendly summary reports regarding Hispanic/Latino health on a regular basis
and distribute them to local elected officials and community leaders.
Short term
Develop summary reports on Hispanic/Latino health for dissemination for policy analysts,
program planners, elected officials, and community and political leaders.
10. Training/Technical Assistance
1993: Surgeon General's National Hispanic/Latino Health Initiative
Ongoing and continuous need
Increase quantitative skills of Hispanic/Latino undergraduates to expand the pool of Latino
researchers with the skills necessary to conduct research on Hispanic/Latino health issues.
Ongoing and continuous need
Require statistical agencies of the Federal Government to provide technical assistance to
State and local agencies for the development of data collection instruments and the
completion of instruments according to high standards of quality. Additionally, software to
assist in this process should be developed and provided.
Short term
Develop programs for Hispanic/Latino community-based organizations to enhance their skills
in Hispanic/Latino health data collection, analysis and interpretation.
Short term
(See Section 5, OMB/Identifiers/Subgroups)
Enforce OMB Directive 15 and Public Law 94-311 among Federal agencies. Educate Federal
agencies about the use of OMB Directive 15 for the inclusion of Hispanics/Latinos (and
Hispanic/Latino subgroups) in data systems, and in federally funded intramural and
extramural research programs.
11. Representation
1993: Surgeon General's National Hispanic/Latino Health Initiative
Ongoing and continuous need
Increase Hispanic/Latino representation in the design, implementation, analysis and
dissemination of health assessment and health monitoring data systems, and in funding
decisions affecting these systems, including the identification of health indicators specific to
Hispanics/Latinos.
Ongoing and continuous need
Feasibility beyond National level questionable
Increase Hispanic/Latino representation in the design, implementation, analysis, and
dissemination of health assessment and health monitoring data systems and in funding
decisions affecting these systems. This increased representation is needed in Federal, State
and local departments and agencies, community-based organizations, colleges and
universities, and other private research entities.
Authority questionable
Increase Hispanic/Latino membership in committees, councils and commissions appointed by
county, State, and Federal health departments; agency administrators; State and Federal
legislators; and Governors to monitor data collection, analysis, interpretation and
dissemination.
Long term
(See section 2, Infrastructure)
Tie the release of Federal funds to States to the collection and reporting of Hispanic/Latino
ethnicity. Data collection and reporting should include both documented and undocumented
Hispanics/Latinos.
Ongoing and continuous need
Allocate funds in Federal, State and local health programs to pay for data collection, analysis
and dissemination of Hispanic/Latino health data so that progress in improving
Hispanic/Latino health status, and ultimately the health status of the Nation, can be tracked.
Government agencies that use these data, but do not produce data, should share in the
expenses of data collection, analysis and dissemination.
Feasibility in question
Create a Hispanic/Latino advisory board to the Secretary of Health and Human Services,
State departments of health, and philanthropic foundations to oversee the implementation of
the recommendations from the National Workshop and Regional Health Meetings of the
Surgeon General's Hispanic/Latino Health Initiative.
Short term
Include Hispanics/Latinos in interdisciplinary work groups, which should plan for research
and data collection, evaluate data collection instruments, ensure that collected data are
inclusive and usable, and assist in the interpretation and dissemination of these data. These
work groups should include multiethnic individuals from the community to be studied,
community-based organizations, health care professionals, advocates, and researchers.
Authority in question
Establish regional Hispanic/Latino health coalitions to monitor implementation of the
strategies developed during the national and regional workshops of the Surgeon General's
Hispanic/Latino Health Initiative.
1993: National Asian Pacific American Families Against Substance Abuse, Inc.
(12/17/93 memo to Peter Edelman)
Refer to appropriate program(s)
The Secretary (should) establish an Asian and Pacific Islander Work Group on Health Data
Needs to advise the Secretary on these issues, and assist in monitoring the progress of the
Department in this area. This Work Group will be a subset of the Secretary's Asian and
Pacific Islander Task Force on Health and Human Services.
Completed
HHS (should) take immediate corrective action to revise the "Healthy People 2000" strategy
in order to effectively address the needs of Asian and Pacific Islanders.
Refer to appropriate program(s) but may be overtaken by time
The Secretary (should) establish an Asian and Pacific Islander Work Group on the "Healthy
People 2000" objectives to work with the Secretary in revising the "Healthy People 2000"
objectives to better address the needs of Asian and Pacific Islanders. In addition to expanding
the existing provisions for Asian and Pacific Islanders to a comprehensive array of objectives
(with baseline data), the revisions must establish an action plan to implement those new
objectives. This Work Group will be a subset of the Secretary's Asian and Pacific Islander
Task Force on Health and Human Services.
Appears to not be feasible but refer to appropriate program(s)
HHS (should) add the Pacific Islands to the "Healthy People 2000" strategy document
including a full description of the needs (with baseline data) and corresponding objectives.
12. Other
1993: Surgeon General's National Hispanic/Latino Health Initiative
Conduct a national conference--cosponsored by the National Center for Health Statistics,
other parts of the Centers for Disease Control and Prevention, the Commerce Department, the
Department of Justice, the Environmental Protection Agency, and other Federal agencies--to
improve the coordination of data collection, analysis and dissemination, with the goal being
to reduce the burden of voluntary and mandatory reporting by the States, and to improve the
consistency of reporting of racial/ethnic origin. Recommendations based on the findings from
the 1993 PHS Task Force on State and Community Data should be used to help develop the
agenda for the conference. Among the products of this conference should be guidelines for
comparability and plans for providing, on a continuous basis, technical assistance and
resources to State and local agencies responsible for data collection. This conference should
take place by 1995 at the latest to ensure that tracking of Healthy People 2000 objectives can
be based on consistent and accurate data.
Encourage researchers to report back to Hispanic/Latino communities regarding their
research findings before public dissemination of results, including publication and
presentation at scientific meetings.
Promote needs assessment at the local level to empower communities to prioritize their
health needs and seek funding accordingly.
Identify and develop funding mechanisms for survey methodologies to study Hispanic/Latino
subgroups. Additional funds should be allocated to the National Center for Health Statistics'
Minority Health Statistics Grant program and census survey research programs to support
targeted research to develop appropriate, culturally competent and linguistically sensitive
survey methodology to study subgroups of Hispanics/Latinos. Consideration should be given
to the undocumented and recent immigrants.
HHS should collect detailed surveillance data on the incidence and prevalence of HIV/AIDS
and STDs among Asian and Pacific Islanders in the continental U.S., Alaska, Hawaii and the
Pacific Islands.
Establish a balance between the data needs for research and policy making and the burden on
the health care provider to collect information in addition to providing services.
Identify and develop funding mechanisms for survey methodologies to study Hispanic/Latino
subgroups. Additional funds should be allocated to the National Center for Health Statistics'
Minority Health Statistics Grant program and census survey research programs to support
targeted research to develop appropriate, culturally competent and linguistically sensitive
survey methodology to study subgroups of Hispanics/Latinos. Consideration should be given
to the undocumented and recent immigrants.
Develop methodologies and programs for educating public and private entities regarding the
need for scientifically valid Hispanic/Latino health data.
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