CENTERS FOR DISEASE CONTROL AND PREVENTION
Volume 16 • Number 2/3 • Winter/Spring/Summer 2004

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Reporting the Social Health of the Nation

“In our increasingly secular society, what seems to matter most are economic indicators.”
—Bill McKibben, http://www.newdream.org/Chat/mckibben.html*

We know how America’s gross national product compares with Japan’s, but what about the social health of the nation? How does America compare with other industrial countries in such areas as poverty among older adults, access to health care, and youth suicide? That’s what Marc L. Miringoff, PhD, has been asking. Dr. Miringoff, co-author with Marque-Luisa Miringoff and Sandra Opdycke of Social Health of the Nation: How America Is Really Doing, founded and directs the Fordham Institute for Innovation in Social Policy and is associate professor of Social Policy at Fordham University Graduate School of Social Service in Tarrytown, New York.

Noting the lack of a U.S. social index, the Miringoffs developed the Fordham Index of Social Health in 1987, using 16 indicators of social health. They needed a threshold for measuring social progress, so they picked the best performances from the past 30 years of data (for example, in 1973, child poverty was at its lowest level). The index is modeled on economic indicators’ thresholds, and the national media are beginning to recognize it as an analogue to economic indicators.

Dr. Miringoff’s work also interests CDC researchers who are measuring health-related quality of life (HRQOL) because it is important to know what is going on in the community that affects physical and mental health. These factors, called social determinants of health, include the rates of poverty, employment, literacy, and education in a community. One of the purposes of CDC’s Healthy Days measures is to look at the relation between social factors like those included in the Miringoffs’ index and perceptions of health.

Marilyn Metzler, RN, is a co-chair of the CDC/ATSDR working group on social determinants of health, which is composed of interested employees with expertise in this area. “The ultimate goal,” she said, “is to develop methods and measures that we can use to assess the conditions that support health. With such measures, we will be able to describe communities that are sick or healthy in order to expand our understanding of what causes individuals to be sick or healthy.”

CDC research shows that social determinants of health in a community are related to individuals’ perceptions of their health. For example, CDC data show that people in areas of high poverty and unemployment report more unhealthy days than people in areas where fewer are poor and jobs are more abundant. According to Dr. Miringoff’s findings, the three variables with the greatest effect on his index are child poverty, high school completion, and access to health care.

Americans have a long history of monitoring the “health” of the economy. As a result, most of us are familiar with terms like gross domestic product and recession, which are defined by business and economic indicators and indexes. We are also accustomed to the idea that the nation’s well-being is somehow measured by such indicators. We expect that certain conditions will bring specific consequences; when the economy stalls, for instance, the Federal Reserve may lower interest rates.

“Economic indexes are institutionalized; they trigger action,”noted Dr. Miringoff.

But despite their strengths, economic indicators are not the only valid measures of how the nation is doing. They do not describe the nation’s quality of life. Many people do not find them relevant to their daily life.

Why We Need a National Social Report
Dr. Miringoff envisioned a different type of national index—one based on social data. Such an index “would provide a very different picture from what is conveyed by traditional business and economic barometers,” he wrote in Social Health of the Nation. Social data are not collected as frequently as economic data, nor are they commonly treated as indicators of how the nation is doing. The findings of a particular study or survey may create public interest briefly, but they seldom attract the kind of media analysis that economic reports receive. Social data may be less accessible to the public and media because they are issued discretely, without common definitions.

Social determinants of health are rarely discussed in terms of their interrelationships. Dr. Miringoff argues that analyzing social issues in relation to each other, rather than in isolation, will promote public understanding of our strengths and weaknesses. “The lack of context and regularity in the reporting of social issues, and the absence of the kind of familiarity that an ongoing narrative, grounded in fact and interpretation, could provide, have made public deliberation about social issues more vulnerable to the politics of the moment,” he wrote.

In contrast, the last 12 years of index data clearly show areas in which the nation’s performance is improving (infant mortality, high school completion, poverty among older adults, and life expectancy); areas of worsening performance (child abuse, child poverty, youth suicide, and others), and areas for which trends are shifting (adolescent drug use and adolescent birth rates).

Social reporting can benefit every level of government. Under Dr. Miringoff’s direction, The Fordham Institute for Innovation in Social Policy produces The Social State of Connecticut, a report used by the governor’s office and the state legislature to assess the social well-being of the citizens of Connecticut. The goals of the project are to focus public attention on the issue of social health in the state, inform public policy, and create an accessible information source. The document brings together diverse information regarding a number of critical social problems over an extended period of time. It has made a difference in Connecticut. After noting an increase in child abuse one year, Dr. Miringoff met with legislators, who redirected funds to address the problem. Connecticut has shown overall improvement in all categories 6 years in a row.

The indicators included in the Index of Social Health offer warning signs that significant sectors of our national life are in decline or crisis. The data indicate that the nation’s social health was stronger in the 1970s than it is today. Dr. Miringoff is particularly concerned about rising youth suicide rates.

Dr. Miringoff would like to see a government organization that would function as a Council of Social Advisors to the President (like the Council of Economic Advisors). Among other duties, this group would produce an annual social report that would combine state data with national survey data to offer a comprehensive picture of the social health of the nation. It will address the nation’s need for a yearly benchmark of social performance—something that is already available in every other industrial country, but is lacking in the United States.

Current Status of Social Reporting in the United States
You might call health-related quality of life the place where social health intersects with physical and mental health. This intersection is becoming obvious in the many surveys and report cards being used across the nation to measure key health and social factors at various levels (see page 30, “Measuring Quality of Life in the World, Nation, States, and Local Areas”). Some of them combine both social determinants of health and quality of life measures like CDC’s Healthy Days measures.

The CDC Perspective
Whereas Dr. Miringoff wants to stimulate public discourse and shape public policy, CDC has a different perspective. It wants to distinguish between community health outcomes and their social and environmental determinants.

If potential social determinants of health such as community poverty rates truly influence population health, the effect should be seen in surveys using well-designed HRQOL measures, which track people’s health perceptions over time. CDC researchers want to use continuously collected Healthy Days surveillance data to validate such determinants.

They also want to work with Dr. Miringoff to examine how his index might help to explain variable patterns of response to CDC’s HRQOL measures. Population HRQOL surveillance may be complementary to tracking community indicators of health. The HRQOL surveillance strategy is to track perceived physical and mental health over time in adult populations, identify potential community-level indicators of HRQOL, and analyze ties between survey-based HRQOL data and the indicators.

Although the annual release of the index is covered by national media, including The New York Times and The Washington Post, the public remains less familiar with findings on social health than with economic indexes. Will a national social index improve our quality of life? “We can only hope,” said Dr. Miringoff.

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