Health Monitoring and Life on the Mississippi

Suggested citation for this article: Wilcox LS. Health monitoring and Life on the Mississippi. Prev Chronic Dis [seri-al online] 2004 Apr [date cited]. D esigning health monitoring systems is a complex task. This issue of Preventing Chronic Disease includes a report and commentary on measuring the burden of diabetes at the individual level in minority populations (1,2) and a report on measuring heart disease and stroke indicators at the policy level (3). To inspire stalwart professionals to design such systems, I turn to an individual recognized for his insightful commentary — Mark Twain, also known as Samuel Clemens. Twain had a keen eye for the idiosyncrasies of human behavior, and his nonfiction works suggest he was adept at amateur qualitative research. Though he was a man of letters rather than a scientist, he clearly appreciated the issues involved in gathering quality information: There is something fascinating about science. One gets such wholesome returns of conjecture out of such a trifling investment of fact (4). The balance of conjecture and fact is a source of ongoing tension in public health: collecting data is time-consuming and costly, but operating health programs based on conjecture is risky. Although Healthy People 2010 (5) emphasizes the elimination of health disparities, the nation lacks an accurate way of measuring the burden of diabetes in minority populations. Surveillance systems, for example, may treat Spanish-speaking populations as a homogeneous Hispanic group while individuals within the group may have originated from different Spanish-speaking countries (1). Without an understanding of the diversity of these cultures , health programs may lack the context to serve these populations effectively. A report in this issue of Preventing Chronic Disease, prepared by an expert panel at the Centers for Disease Control and Prevention (CDC), recommends extending the capacity of existing surveys to obtain better measurements of minority populations instead of developing new surveys, in light of the high costs of taking the latter route (1). Community-level policy and environmental indicators related to stroke and heart disease prevention present a different problem. Researchers in 2 states, Alabama and South Carolina, examined data sources for 31 pilot indicators and found that, while data sources for most indicators are available in the school setting and are available for indicators of tobacco policies across all settings examined, data sources are least available in the health care and work site settings (3). This report calls for combining current data …