Making the Case for Supporting NCHS

 By Mary Jo Hoeksema, the Director of Government and Public Affairs for the Population Association of America and a former member of the CHF Board of Directors.

“The way we work in public health is, we make the best recommendations and decisions based on the best available data,” Dr. Tom Frieden, CDC Director, 2009-2017. 

Public health stakeholders understand the critical role accurate, objective data play in determining the allocation of funding, delivery of services, and development of evidence-based policies. To that end, members of the Coalition for Health Funding have historically been vocal proponents of the National Center for Health Statistics (NCHS), the nation’s principal health statistics agency. Despite the best efforts of its supporters, NCHS remains underfunded and seemingly underappreciated. What do public health advocates need to know and how can they help? 

Since the agency’s inception in 1960, NCHS data have been the gold standard for measuring the nation’s health status, monitoring changes in individual and population-level health outcomes and identifying emerging health trends. Within its mission, NCHS is responsible for disseminating the nation’s vital statistics as well as managing two definitive surveys, the National Health Interview Survey and National Health and Nutrition Examination Survey, which, together, have been monitoring and assessing the health and nutritional status of adults and children in the United States for over 50 years. With an annual budget below $200 million, NCHS sustains its ambitious mission, while also pursuing necessary innovations to modernize its data collection, production, and dissemination systems. 

For almost a dozen years, NCHS has been relatively flat funded, leading to a 13% loss of the agency’s purchasing power since Fiscal Year 2010. As a result, NCHS has been unable to fully implement technological and methodological improvements in existing programs and surveys at the precise times when data about issues such as maternal mortality, health disparities, opioids, COVID-19, and changes in health insurance coverage have been sorely needed. These improvements include data collection methods and new technologies to address declining survey response rates and to expedite the release of mortality data,. Additional funding is needed to support research in a variety of areas to improve data quality, granularity, and timeliness. These improvements would allow scientists, public health officials, providers, and patient advocates alike to better understand changes in the health and well-being of America’s increasingly diverse population. 

In an April 2022 editorial published in The Hill, former NCHS Directors Jennifer Madans and Charlie Rothwell reinforced the significance of the agency’s mission dubbing its data “the backbone of our public health data infrastructure.” Further, they postulated that, “had investments been made in maintaining and modernizing the health data infrastructure we would have had information on COVID-related deaths, hospitalizations, ambulatory care visits and symptoms along with information on the impacts of the pandemic on wellbeing.” This example illustrates the tremendous payoff a relatively small investment in the agency’s bottom line could have had during a national public health crisis. 

With more funding, NCHS could move beyond sustaining its mission and modernizing at the margins to forging new frontiers in areas such as use of electronic health records and administrative data linkage. Progress in both of these areas would enhance understanding of the nation’s health care delivery system and improve estimates of health differences at smaller geographic areas, thereby helping CDC and HHS to target resources more effectively and efficiently. 

NCHS stakeholders appreciate the Biden Administration requesting a minor funding increase for the agency in FY 2023. They are also pleased that Congress recognized the value of NCHS by likewise proposing small funding increases in FY 2022 and including report language praising the agency and directing the CDC to include NCHS in its multi-million Data Modernization Initiative. However, bolder action is needed to empower the agency and ensure all public health advocates have the data that they need to inform their work. I encourage CHF members to consider the challenges and opportunities facing NCHS and help promote greater awareness about the benefits all of us will reap when the most reliable, timely, and accessible public health data are widely available.