If you did not measure it, it didn't happen

Editor's Note: Jacob Edwards is a third-year pediatric resident from Children's National Medical Center who is interning with us this month as a part of an advocacy rotation. Welcome, Dr. Edwards!

There is an old saying in public health research “if you did not measure it, then it did not happen”. Taken at face value this statement holds little merit. For instance, in the District of Columbia, vital statistics on infant mortality have not been released since 2007. At that time, the rate was reported to be 13 infant deaths per 1,000 live births and rising -- more than twice the national rate, which was improving. (Read our post from last summer about this troubling trend.) Now, no one is naïve enough to believe that because it is not recorded children are not dying in D.C. As a pediatrician I can promise you that that is far from the truth. However if we dig a little deeper, it is really not that far off the mark.

As physicians, public health officers and government officials, we are tasked with allocating resources and evaluating best practices to refine our efforts to provide the population with the best health care available.  We depend on quality research and aggregate data to guide decisions. We use the decisions to divide what is becoming a smaller and smaller financial pie. If health indicators, such as infant mortality, are not recorded then it is impossible to know 1) if there is a true problem, 2) what resources are dedicated to the problem, 3) what resources are needed and 4) if it is working.    

Without comprehensive, targeted, and quality data decision makers are blind to the needs of the population.  If decision makers are blind to the problem then effectively it is as if it did not occur. Which brings me back to my original statement, “if you did not measure it, then it did not happen.”

In 2009, during the Children’s Health Insurance Program Reauthorization Act, the Institutes of Medicine ( IOM) and National Research Council (NRC) were tasked with evaluating state health data on child and adolescent health and health services. During their evaluation they found a general lack of standardized data, large gaps in research, and an overall lack of strategy in evaluating children and adolescents in terms that characterize and define their unique determinants of health. (Read the IOM report.)

We and clinicians, researchers and policy makers must work together to standardize health indicators and to create “measurement practices that can adapt to changing conditions changing populations and opportunities for health improvement.” If we don’t, we will continue to make key decisions with limited or no vision. Hospitals will continue to expand emergency and tertiary services when primary care is needed, children will continue to be obese without safe neighborhoods to play in, mental health will continue to be ignored and infant mortality will continue to unaddressed.

As a pediatric resident in the trenches with the sick and disenfranchised children and adolescents in D.C., I can attest that decision makers are blind when it comes to addressing the health care and health needs of this vulnerable population. Until quality data exists, our vision will continue to be limited. With limited vision our decisions will be ineffective. Ineffective decisions produce minimal -- if any -- change. 

Without change our efforts are wasted. It’s as though they never happened.

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