migration, vital, and health statistics
TRANSCRIPT
NATIONAL CENTER Series 4For HEALTH STATISTICS Number 9
VITAL and HEALTH STATISTICSDOCUMENTS AND COMMITTEE REPORTS
Migration, Vital, andHealth Statistics
A Report of the United States NationalCommittee on Vital and Health Statistics
An assessment of the needs for migration statistics; the procedureswhereby statistics might be secured; the interrelations of vital proc-
esses and health with the movements of people; and the steps re-
quired to secure data and advance research.
U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE
Public Health Service
Health Services and Mental Health Administration
Washington, D.c. November 1968
Public Health Service Publication No. 1000-Series 4-No. 9
For sale by the Superintendent of Documents, U.S. Government Printing Office, Washirrgton, D. C’. 20402- Price W writs
NATIONAL CENTER FOR HEALTH STATISTICS
THEODORE D. WOOLSEY, Director
PHILIP S. LAWRENCE, SC.D., Associate Director
OSWALD K. SAGEN, PH.D.>, Assistant Director for Health Statistics Development
WALT R. SIMMONS, M.A., Assistant Director /or Research and Scierzti/ic Development
ALICE M. WATERHOUSE, M. D., Medical Consultant
JAMES E. KELLY, D. D. S., Dental Advisor
EDWARD E. MINTY, Executive O//ice?
MARGERY R.. CUNNINGHAM, lrz/ormation O//icer
OFFICE OF HEALTH STATISTICS ANALYSIS
IWAO M. MORIYAMA, Ph. D., Director
DEAN E. KRUEGER, Deputy Director
Public Health Service Publication Na. 1000-Series 4-No. 9
Library of Congress Catalog Card Number 68-62235
FOREWORDThe United States is a Nation built by a migrant population. The
population of the country continues to be mobile through internal aswell as international migration. The resulting migration patterns in-fluence and are in turn influenced by marriage, birth, illness, anddeath.
This report, prepared under the auspices of the U.S. National .Committee on Vital and Health Statistics, calls attention to the oppor-tunity, especially in the 1970 census period, for the study of migrationand the vital processes by official agencies-Federal, State, and local—and by research workers in universities and foundations. Recommen-dations are made for the improvement of vital records and statisticsto provide the adequate statistical base needed for the formulation ofnational policy, plans, and programs.
Robert L. Berg, M.D.ChairmanU.S. National Committee onVital and Health Statistics
...Ill
U.S. NATIONAL COMMITTEE ON VITAL AND HEALTH STATISTICS
Robert L. Berg, M.D., ChairmanProfessor and Chairman, Department of
Preventive Medicine and Community HealthThe Medical CenterThe University of RochesterRochester, New York
Iwao M. Moriyama, Ph. D., Executive SecretaryDirector, Office of Health Statistics Analysis “’ “.National Center for Health Statistics
..
Public Health Service*Washington, D.C.
Donald J. DavidsChief, Records and Statistics SectionColorado State Department of Public Health13mver, Colorado
Clyde V. Kiser, Ph.D.Senior Member, Technical StaffMilbank Memorial FundNew York, New York
Herbert E, Klarman, Ph.D.Department of Public Health AdministrationSchool of Hygiene and Public HealthThe Johns Hopkins UniversityBaltimore, Maryland
Forrest E. Linder, Ph.D.Department of BiostatisticsSchool of Public HealthUniversity of North CarolinaChapel Hill, North Carolina
Robert Parke, Jr.Program “Planning Officer
, Bureau ‘of the CensusU.S. Department of CommerceWashington, D.C.
John R. Philp, M.D.Health OfficerCounty of Orange Health DepartmentSanta’ Ana, California
Donovan J. Thompson, Ph.D.Department of Preventive MedicineSchool of MedicineUniversity of WashingtonSeattle, Washington
Theodore D. Woolsey, ex officioDirector, National Center for Health StatisticsPublic Health Service*Washington, D.C.
SUBCOMMITTEE ON:MIGRATION AND HEALTH STATISTICS
Irene B. Taeuber, Ph. D., ChairmanSenior Research DemographerOffice of Population ResearchPrinceton UniversityPrinceton, New Jersey
Mindel C. Sheps, M. D., M. P. H., SecretaryProfessor of BiostatisticsSchool of Public Health and Administrative
Medicine of Columbia UniversityNew York, New York
William R. Gaffey, Ph.D.Statistical ConsultantDivision of ResearchState Department of Public Health13erkeley, California
Robert D. Grove, Ph.D.Director, Division of Vital StatisticsNational Center for Health StatisticsPublic Health Service*Washington, D.C.
William HaenszelChief, Biometry BranchNational Cancer InstituteNational Institutes of HealthPublic Health Service*Bethesda, Maryland
Everett S. Lee, Ph.D.Head of the DepartmentDepartment of Sociology and AnthropologyUniversity of Massachusetts .Amherst, Massachusetts
Henry S. Shryock, Jr., Ph.D.Assistant Chief, Population DivisionBureau of the CensusDepartment of CommerceWashington, D.C.
Karl E. Taeuber, Ph.D.Professo2 of SociologyDepartment of SociologyThe University of WisconsinMadison, Wisconsin
‘Department of Health, Education, rind Welfare.
iv
CONTENTSPage
Foreword ------------------------------------------------------------
Introduction ---------------------------- --------------------------- ----
Summary ofRecommendatibns ------------------ ------------------- ------1.
2.
3.
4.
5,
6.
7.
Definitions, Procedures, and Tabulations-------------’--------------
Rates, Risks, and Models ------------------- --------- --------- -----
Sources for Healti, Vital, and Migation Statistics ------------------
Marriage, Natali~, and Mi~ation SWtistics ------------------------
Special Populations ----------------------------------------------
Essential Bases for Research 'md Development ---------------------
Plans and Programs for the1970 Census Period --------------------
Findingsand Recommendations -----------------------------------------1.
2.
3.
4.
5*
6.
7.
Definitions ofWgation ------------------------------------------
Rates, Risks, and Models --------------------------- --------------
Sources of Data -------------------------------------------------
Marriage, NataUty, mdM&ation Statistics ------------------------
Special Populations ----------------------------------------------
Essential Bases for Research md Development ---------------------
Plans and Programs for the1970 Census Period --------------------
. . .111
1
22
2
3
3
3
4
4
44
5
7
9
10
13
13
IN THIS REPORT a Subcommittee of the U.S. National Committee onVital and Health Statistics presents its findings on the needs for mi-gration statistics as velated to health and recommends the developmentof data fov the study of migration and health. These recommendationsrelate to definitions, procedures, and tabulations; measures of risks;sources of vital and health statistics and migration statistics; mar-m“age, birth, and migration statistics; and to studies of spectil popu-kztions, including the disadvantaged and migratory labor and migvantfamilies. The Subcommittee also proposes an analytical and researchprogram for the 1970 censws period, when migration olu!awill becomeavailable.
vi
MIGRATION, VITAL, ANDHEALTH STATISTICS
INTRODUCTION
The National Committee on Vital and HealthStatistics noted the diverse but little exploredrelations between vital processes, the movementsof people, and health and appointed a Subcom-mittee on Migration and Health Statistics. Thetasks of the subcommittee involved the assess-ment of the needs for migration statistics; theprocedures on how statistics might be secured;the interrelations of vital processes and healthwith the movements of people; and the steps re-quired to secure data and advance research.
The frequencies of migration, the places oforigin and destination of migrants, the types ofmovements, the characteristics of migrants, andthe stabilities and nobilities within areas ofresidence influence and are influenced by mar-riage, birth, and death. Health is related in vary-ing ways to natural movements and to migrations.Technically, migration is a component of and adisturbing factor in the definitions of numeratorsand denominators in vital and health statistics.Analytically, migration can be viewed as an in-dependent or a dependent variable in populationdynamics,
The needs for data and analysis of populationdynamics influence the National Center for HealthStatistics (NCHS), the U.S. Bureau of the Census,other governmental agencies, and universities andresearch institutions.
The field of migration, vital, and health sta-tistics is broad. Perhaps the goal of the Sub-committee on Migration and Health Statisticsshould have been a survey of activities and studiesrelating vital and health statistics and migration
variables. This would have yielded an assess-ment of needs, feasibilities, and priorities, withreference both to special or recurrent surveysand to the inclusion of migration or mobility vari-ables in the continuing registrations of a vitalstatistics system. There was neither time norresources for this substantive and methodologicalsurvey. Therefore, the subcommittee assessedthe state of the data and the needs for analysisin three time perspectives.
In the short run, advances must be keyed tothe vital records as now secured in the States,the decennial census as now planned, and thepossibilities of integrated analysis with partiallinkages of vital and census statistics. In theintermediate period, there may be -supplementsto the basic data through the National HealthSurvey and the Current Population Survey. In thelong run, there may be special studies of proc-esses and populations, improved and expandeddata collection, and incisive analyses.
The crises in the cities, the movements to-ward equal opportunities for all, and the unequaldistributions of population, economic resources,and social facilities create urgent needs for socialas well as economic statistics and analyses. Themost neglected resource as a statistical base inthe national search for policy, plan, and programis the vital records system, with major statisticalneeds in improving the collection, tabulation,and analysis of its records. The most neglectedareas are those of most immediate relevance tothe national needs: marriage and natality.
The time is appropriate for advance in thefields of migration, vital, and health statistics.There is a developing background in analysis and
theory. Current surveys, queries ofsamplesfromvital records, and other sources supplementcensus and. vital statistics. There are regionaland local differences in problems and in re-sources for analysis. There are technical fa-cilities that permit the coordinated and multipleuses of basic data.
Comprehensive activities in the years 1969through 1971 would provide information andanalysis significant in science and relevant topolicies and plans. Concerted drives ‘inpreviouslyneglected fields of vital and health statisticswould yield evaluations of current data and imp-rovements in vital rates while contribut~g toongoing and projected programs and the cooper-ative efforts of the National Center for HealthStatistics, State and city statistical organizations,and research itistitutions.
SUMMARY OFRECOMMENDATIONS
1. Definitions, Procedures, and Tabulations
1.1
1.2
Definitions, procedures, and tabulationsof variables and for areas should kcomparable with those of the Bureau ofthe Census so that vital and health sta-tistics can k related to census basepopulations and data from both sourcescan be available for integrated analysis.This requties a mechanism for continu-ing consultation and coordination betweenthe agencies lxxh in general plaming andin specific operational details of rele-vant programs.
The National Center for Health Statis-tics and the State organizations shouldadopt the following procedures to insurethe availability of the data now needed:
1.2.1
1.2.2
Identification and tabulation of dataspecifically for Negroes, insteadof grouping them under the head-ing of “nonwhite” as previouslydone.
Coding and tabulating data on Stateand country of birth on vital rec-
1.2.3
1.2.4
1.2.5
1.2.6”
1.2.7
orals, and distinguishing PuertoRicans and identifying the coun-tries of birth of the foreign-born.
Coding educational data whenavailable and taking all possiblesteps to insure the inclusion ofeducational queries on standardforms in “all States.
Coding of legitimacy status whendata are included in birth records.
Devising procedures for the con-tinuing integration of reports ofinfant deaths and births.
Urging the States and cities to usethe 1970 geographic codes of theBureau of the Census for alloca--.—. .—tions of areas within standard met-ropolitan statistical areas or cit-ies, as feasible.
Exploring the use of supplementarystatistical forms in selectedstandard metropolitan statisticalareas, cities, or other specialareas in 1970 or 1969 through1971, with queries on health, mi-gration, mobility, and stabilityalong with the regular informationon marriage, natality, or mor-tality.
2. Rates, Risks, and Models
2.1
2.2
2.3
Nobilities associated with vital andhealth processes should be defined inrelation to the specific process and theresearch or analytical need.
The National Center for Health Statis-tics should work with the Bureau of theCensus on problems of allocations ofresidence for the Armed Forces, stu-dents, institutional inmates, and otherproblem groups and on allocations ofmigrant status to those not reporting it.
The National Center for Health Statisticsin cooperation with the Bureau of theCensus should provide for a technical
2.4
study of definitions of migrants, mi-gration and other movements, prob-lems of denominators for migration andvital rates, and appropriate bases forrates. Such a study should also assessmigration as a longitudinal process, thetemporal relations of movements withvital events, and the development ofneeded techniques for nieasurement andanalysis.
There is need for a comprehensive andcritical review of migration models andof general demographic models that in-clude migration, with specifications ofconcepts, events, and probability distri-butions to be considered in future models.
3. Sources for Health, Vital, and
Migration Statistics
3.1
3.2
The definition, testing, and validation ofprocedures to secure information onhealth through census and survey pro-cedures are essential. Health questionsshould be included in population sur-veys, mobility questions in health sur-veys,
Pilot studies on the uses and limitationsof hospital records are indicated. Thereshould also be explorations of the tech-niques, feasibilities, and difficulties incombining such records for local areasand regions.
4. Marriage, Natality, and
Migration Statistics
4.1
4.2
The national needs for marriage andnatality statistics and analysis requireexpansions in geographic detail and ana-lytic depth.
The steps that can be taken in the nearfuture require the utilization of infor-mation now on registration forms. Thisinvolves emphasizing the importance ofcompleting all items on the forms, check-
4.3
4.4
4.5
ing the coverage of the data, and testingthe precision and validity of entries.
The upgrading of marriage and natalitydata, tabulations, and analyses to levelscoordinate with those of mortality re-quires an expansion of the national datasystem, not a reallocation of effortswithin it.
The measurement of the health dimen-sions in marriage, fertility, family sta-bilit y, and individual and family nobili-ties should be subjected to intensiveresearch and field experimentation.
The extent and nature of the current a+longitudinal relations of migration andmobility with marriage and reproductionshould be explored in field studies andin special queries of samples of thosereporting events.
5. Special Populations
5.1 Economic deprivation, social retarda-tion, marital instabilities, high rates ofchildbearing, and high morbidity andmortality are concentrated in certainsegments of the population in limitedareas. The greatest numerical concen-trations of the problem groups and theproblem environments are in the centersof the great cities. There are also seri-ous difficulties in Appalachia and inparts of the Deep South and the Southwest.The largest of the disadvantaged groupsis the Negro, but there are also majorproblems among other ethnic and culturalminorities such as the Puerto Ricans inin the Northeast and the Spanish Ameri-cans in the Southwest. Modern facilitiesfor the storage of data on tapes and theirprocessing permit the development ofthese regular and special tabulationsthat are needed. Planning for these de-velopments should be initiated even priorto the provision of additional staff andfinances.
5.2 The responsibilities for vital, health,and migration statistics extend to specialgroups where new procedures are es-sential to the procurement of the dataneeded in plans and programs.
5.2.1 In the study of migratory laborandmigrant families, the continu-ing focus is on agricultural labor,but similar problem groups maybe involved in current difficultieswith vital records and “census enu-merations in urban settings.
5.2.2 Indians, particularly those on res-ervations, and the Aleuts, Eski-mos, and Indians of Alaska remainthe most economically retarded inthe American population. The as-sociations” of migration with thedeclining mortality and the veryhigh fertility should be measuredin vital and health statistics.
6. Essential Bases for Research and
Development
7.
The bases essential for research, develop-ment, and experimentation require not onlythe direct involvement of the National Centerfor Health Statistics but also its stimulationof work in universities and research institu-tions through grants and contracts.
Plans and Programs for the 1970
Census period
7.1 Concentration of activities.
- 7.1.1
7.1.2
7.1.3
7.1.4
7.1.5
Coordination of vital records andcensus tabulations.
Detailed tabulations in selectedareas and for special groups.
Special tabulations of vital recordsas needed.
Collation of infant death recordswith birth records.
Special topical, area, and groupstudies.
7.2 Guidelines to types of approach andstudies.
7.2.1
7.2.2
7.2.3
7.2.4
7.2.5
7.3
Relevance and significance notonly to research but to publicpolicy and program.
Additions to rather than replace-ments of activities or analysesregularly carried out by the gov-ernment.
Contributions to knowledge,whether evaluations of data, ex-ploration of relations, or advancesof concepts and methods.
Incisive studies in depth, oftendirected to State, city, regional,or special groups rather than thenational population.
Cooperation with State and localheaith departments, as with uni-versities and research institu-tions.
Contributions.
7.3.1 A forward thrust in data, recordutilization, and research.
7.3.2 A movement for comparability inand cumulative contributions fromthe many special tabulations, sur-veys, and analyses that will bemade on the basis of or in re-lation to the 1970 census.
7.3.3 Major contributions to knowledgeof the interrelations of vital proc-esses, health, and migration.
FINDINGS ANDRECOMMENDATIONS
1. Definitions of Migration.
Migration is a change of residence from onearea to another. A migrant is a person residentin an area who moved in from another area. If achange of residence involved crossing nationalboundaries, the person is an international mi-grant. If a change of residence involved cross-
.4
ing a boundary withinan internal migrant.
The definitions of
the country, the person is
migrant status prevalentin official statistics and in most studies are thosedeveloped by the U.S. Bureau of the Census.Movements from one residence to another areclassified according to whether a county boundarywas crossed. Changes of residence within coun-ties are referred to as short-distance mobility,those from one county to another as migration.Migrants are further classified as movers with-in States or between States.
The census of 1970 will include questionson State or country of birth of the perso~ coun-try of birth of the parents; place of residence,activity, occupation, and industry 5 years priorto the census; year moved into present house;place of work; and, if foreign-born, year of im-migration.
The vital registration forms include Stateor country of birth, with place of birth of parentsincluded in the marriage forms.
Definitions of migration and of migrants inrelation to the crossing of political boundariesare generally practical and operational, Theremay be questions about the differing sizes of areasand about the length of time a person who hasentered an area must remain a migrant. Theremay also be questions about the definition ofresidence and what constitutes a change of resi-dence.
If vital and health variables are to be useddirectly in conjunction with census data on mi-grant status, the technical demographic definitionsof migrant status must be utilized. The productsof analysis pertain to the characteristics of areapopulations and the associations of variables insuch populations. This is relevant in studies ofareal distribution and ecological association.There are other dimensions, however, even moresignificant in the analysis of the interrelations ofhealth, mobility, and the various vital events.These are. the associations and sequences ofevents in the lives of individuals.
The frequencies, types, and timings of move-ments cliffer according to age, economic status,and place in the family cycle. Migration is re-lated in many ways to fertility; place of birth andmovements during childhood or adolescence in-fluence marriage and reproduction. Family size
itself influences movement within the area ofresidence or between the central city and fringeareas.
The movements that influence health and dis-ease, survival and death may be current or theymay have occurred at earlier periods in the lifecycle. Analysis of lifetime residential historieshas clarified some of the relations between mi-gration, smoking, and cancer. It has also shownthe cumulative effects of residence and populationmovement on disease, health, and mortality.
The relations of seasonal or recurrent move-ments to vital and health variables may be major.The journey to work may alter the ecologicalmilieu and influence home and community re-lations.
The difficulties in analysis are greater formorbidity and other health hazards than for vitalstatistics. Since morbidity is not included in thevital records system, there are limitations to thedata. Information of this type may be collectedin special studies. There may be inquiries withinor outside the National Center for Health Statis-tics and the State health departments. Migrationquestions may be included in the Health Surveyand health questions in the Population Survey. Ifindicators of health status, needs, and servicescan be validated, data can be procured in census,survey, and general questions.
2. Ratesr Risks, and Models
If migration is a variable used jointly withmarriage, natalit y, and health analysis, the spe-cific questions of area populations and types ofrates assume central interest in planning for dataacquisition and tabulations. ‘Rates in which mi-grants are related to the population of theirareas of origin have probability connotations. Ifmigrants are related to populations in the areasof destination, the statements are limited to thoseof relative frequencies. If the primary orientationof the analysis is the vital or health questionrather than migration, decisions as to bases be-come aspects of the research.
The problems of the bases of rates for typesof places within geographic areas present specialdifficulties. Census delineations of urbanizedareas provide meaningful data for descriptionand analysis within census contexts, but the allo-
5
cation of vital events for the fringes of urbanizedareas presents major if not insuperable diffi-culties. Definitions of the rural population aredependent on definitions of the urban populations.If the fringes of urbanized areas cannot be de-lineated in vital records, the fringe populationsmust be part of the rural nonfarm rather thanthe urban population. This compounds the prob-lems of a type of area that includes militaryinstallations, college dormitories, homes for theaged, and labor camps. The rural farm popula-tion itself presents complexities in vital andhealth statistics contexts, particularly those as-sociated with the aging population, the erosion ofthe younger productive ages, the prevalence ofmarginal groups, and the inclusion of seasonalworkers wherever they are at the date of enumera -t ion.
The 1970 census will include questions onplace of residence and type of activity at a date5 years before the census. This will permit theconstruction of alternate populations for areasthrough differing allocations of the Armed Forcesand college populations. Tabulations of detailedcharacteristics for alternate populations of thegeographic areas may be a major problem.
Alternate total populations would provideonly limited solutions for the problems of healthand vital rates, The base populations that arerequired from the decennial census include notonly numbers by sex but by such characteristics asage, marital status, race, nativity, place ofbirth, and highest grade of high school completed,with cross-tabulations for specified areas. It isessential that the definitions of these character-istics in numerators be identical with those indenominators. It is also essential that tabulationsof numerators and denominators be available foridentical areas. Differences in definitions and informs of reporting as between the vital recordsand the census systems are particularly seriousin the areas of marriage and natality, Censusqueries on marital status are de facto, the vitalrecords de ju$’e, Census questions about the num-ber of children ever born are asked only ofwomen who state that they are or have beenmarrie~ vital records concern all births. Thequestions on the reporting of marital status ofmothers who have illegitimate births and the
childbearing of the legally single pose seriousproblems in the computation of vital rates, asin marriage and fertility analysis.
The problems of migration as a demographicprocess or of migrant status in a census enu-meration are significant to the National Centerfor Health Statistics, but they are not its respon-sibility. Nevertheless, rates for groups classifiedby migrant status are essential in vital andhealth statistics. Thus the Center is concernedwith definitions of residence, types of nobilities,and the planning of tabulations that yield con-sistency in numerators and denominators. If theentry on State of birth in vital records is codedand utilized “indescriptive and analytical tabula-tions and studies, cooperative planning with theBureau of the Census is imperative.
The problems of comparabilities in data,rationality in the type of population base, and theimpact of migration on size and structure ofpopulation are all involved ~ the determinationsof numerators and denominators for vital andhealth rates. Given the most appropriate andfeasible decisions with reference to these prob-lems, there remains the specific question of thetime reference of the denominator. The usualprocedure of estimating a midyear populationassumes implicitly an even distribution of changethroughout the year or period of time, Migrationthat is episodic or otherwise changing oftenmakes this assumption invalid,
The difficulties in defining the proper basesfor vital and migration rates are major. There isoften a time lag between migration and the riskof a vital event or between a vital or healthevent and migration. The probabilities of movingseem to be related to previous movements andlength of residence in particular places. Multipledecrement life tables and other analytic methodsmay be appropriate.
There are no simple answers to the properdenominators for vital and health rates, Rather,there are different measures and different de-nominators appropriate for special purposes. Atechnical study is needed on definitions of mi-grants, migration, and other movements and onproblems of denominators to be used for mi-gration and vital rates. Such a study shouldassess migration as a longitudinal process,
6
temporal relations with vital events and health,and developing needed techniques for measure-ment and analysis.
The constraints imposed by the complexitiesof the phenomena and the data are barriers to thedevelopment of concepts, hypotheses, and experi-mental designs for relating migration, vital proc-esses, and health, The development of integratedstochastic approaches to marriage, births, deaths,and migration should be investigated. A reviewof the assumption, methods, uses, and limitationsof models should emphasize the difficulties in,and the possibilities for, the inclusion of migra-tion in general demographic models.
3. Sources of Data
Tlte vikzl recovds fo~m. --The major re-source for analysis of migration in relation tovital processes is the vital records system.Curiously, many of the data on the vital recordforms are largely, if not wholly, unexploited. Allthe vital record forms include place of birth andcurrent residence. All forms, except mortalitynow include highest grade of school completed.Marriage forms include marital history; birthcertificates include details of the present andprevious deliveries along with reproductive his-tory and present status of each live birth (whetherliving or dead), It is the possibilities inherent inthese and related data that underlie our latersuggestions for concentrated studies in populationdynamics at the time of the 1970 census.
Followback query. –The technique of the fol-lowback query for small samples of vital eventspermits probing analyses beyond the scope of thenational record system as a whole, In 1958 theNational Vital Statistics Division collected resi-dence histories for a sample of lung cancerdeaths; the Bureau of the Census collected resi-dence histories for a sample of the population atrisk of this event. Residence histories have beenincluded in some later followback studies of vitalrecords conducted by the National Center forHealth Statistics.
Queries of samples of marriage and birthreports during a census period using the mi-gration and mobility questions of the census wouldpermit significant analysis. It would also provideexperimental testings of responses to migration
and mobility questions in followback queries andin census enumerations.
The National Health Survey and the CurrentPopulation Survey are major potential sourcesfor the probing needed to extend knowledge ofmovements and their relations to specific sectorsof population dynamics. Health questions can beadded to the Current Population Survey or usedas supplements to it, along with specific mobilityquestions as needed. Questions on migration ormobility can be included in the National HealthSurvey,
E@ansionand experimentation, State and cit-ies.–The standard vital record forms of theStates yield minimum comparable data for theUnited States, At periodic intervals when formsare revised, individual States and cities or othercivil divisions could ask additional questions.The responsibility for analysis would then liewith the State or local departments of healthalong with universities or other institutionscollaborating with them.
The advances in regions, States, and cities,if they occur, will be in response to local needsand will not reduce the potential for advances indata collection and analysis. The statistical andprocedural problems of measuring migration,the adjustment of migrants, and the impacts ofmigration on vital processes, health, and healthneeds are major in California, The death cer-tificates of California include length of residencein the State. If this were to be included on mar-riage and birth certificates, forceful argumentscould be advanced to include questions on lengthof residence in sample surveys of the populationof California. Analysis of data for this populousState would contribute to the knowledge of method,technique, and interrelations of vital processeswhose values are not limited to California, Theadvances in a State where specific relations areprevalent and specific needs recognized couldserve as pretests for national assessments,modifications, and advances.
The analytical exploitation of the almost ex-perimental diversities that characterize theUnited States must proceed through the concen-trated efforts and the intensive studies of local,State, and regional institutions. The national data,tabulations, and analyses can only be a leastcommon denominator insofar as geographic, eco-
7
nomic, social, and cultural diversities are con-cerned.
The needs, functions, and contributions ofstatistical and research organizations in local-ities, States, and regions are complementaryrather than competitive with the national organi-zat ions. The pattern of governmental and uni-versity or research institute ‘cooperation is ap-propriate at all administrative and geographiclevels.
Special surveys and studies. - In principle,the hlational Center for Health Statistics or Stateand local health departments could undertakestudies with migration as a primary focus. Inpractice, migration is likely to be included instudies of marriage, natality, morbidity, or mor-tality. Similarly, analyses of migration or mobil-ity are usually framed in demographic, economic,and social rather than in health and vital statis-tics contexts. These diversities in approach couldbecome major channels for the advance of re-search in migration, vital processes, and health,and the associations among these and other vari-ables.
Perhaps the simplest way to discuss the roleand contribution of special surveys and studiesis by illustration. Longitudinal studies and con-tinuing registers of heart disease or cancer, oftwins, and of persons with radioactive exposurecould include changes of residence and other in-dications of mobility. In recurrent surveys suchas the 10-city study of trends and changes inmorbidity and mortality from cancer, therecould be probes of the type and extent of as-sociations with migration, local mobility, andsuch special movements as commuting. Con-versely, given technical and methodological ad-vances, health variables or indicators of healthcould be included not alone in studies of mi-gration but in other studies in which some or allof the migration and vital statistics variablesare included.
There are possibilities for innovation indirection and technique. In special studies andsurveys, whether governmental or private, thevital events registered for a sample or panelof informants could be secured through coopera-t ion with local registration offices. Followback orquery procedures would then add new dimensions
to data and analysis. Or, to pursue potentialitiesfurther, special questions on migration or othermovements could be attached as supplementalschedules to vital record forms.
Hospizlzl and health service records andquevies. —Hospital and health service recordshave practical but limited potential as data re-sources. Hospital records are administrativerather than statistical. There is no routine pro-cedure for the collation of records on the sameperson from different hospitals or health agencies.The Regional Medical Program and the intro-duction of regional medical centers may lead tointerhospital linkages of records among institu-t ions in the same region. With the requirementsof Medicare and increasing computerization, theuse of Social Security numbers may becomeroutine. If so, intraregional and eventually inter-regional linkages of hospital records may provideunparalleled sources of data on the movements ofpatients. Since most births occur in hospit:ls,analyses of mobility, morbidity, and reproductivehistory would be possible. Interregional linkageto a national system is so speculative a prospectas to merit only the comment that pilot tests ofthe feasibilities of such linkages and methodolog-ical analyses of form, feasibility, and relevanceshould be supported when possible.
Clinic, hospital, and health service recordsare sources for many types of special studies,prior to or quite apart from overall record sys-tems. Relations between migrant status and thedemands, receipt, and results of medical care orhealth services may be studied in individualinstitutions or areas. Hospital records may pro-vide bases for intensive followup studies. Themental health and cancer registers representanother type of research activity associated withmedical and hospital records.
The population labo~atwy. — The use of des-ignated area populations as human study centersor laboratories in vital and medical researchhas been productive. A continuing series of stud-ies was inaugurated in Hagerstown, Maryland,in 1921; health, vital events, and migrations of theEastern Health District in Baltimore were sub-jects of studies by or associated with the Schoolof Hygiene and Public Health of The Johns HopkinsUniversity. More recently, population lalxma-
tories as omnibus resources have been estab-lished in Tecumseh County, Michigan, and Ala-meda County, California.
Epidemiological studies in the human popu-lation laboratory context often require residencehistories or information on types (other than mi-gration) and frequencies of movement. Therefore,studies of the relations of migrant status ormobility to the disease or vital process underinvestigation yield byproduct information onmovements in community settings.
The utilization of materials collected inhuman population laboratories for studies of themovements of people should continue to receiveemphasis. Residence histories can be collectedretrospectively; information on changes in resi-dence can be secured prospectively when thepopulations are under surveillance. Probabilitiesof subsequent moves can be investigated in re-lation to a range of demographic characteristics,including previous residential histories.
Perhaps the most significant feature of thepopulation laboratory is the continued accessibil-ity of the study group. Marriage, reproduction,health, and mortality can be studied intensivelyfor in-migrants, out-migrants, the locally mobile,and the stable within a circumscribed and gen-erally known area.
The associations of sources. —The difficul-ties in the concepts and definitions of rates, thelack of comparability in data from different sys-tems, and the approaches to theoretical and em-pirical studies of interrelations can be simpli-fied by efficient use of data from various sources.If vital and health records and census and surveyschedules were collated, direct analysis couldreplace much of what is now achieved by indirector aggregate techniques.
Given modern data processing and storagefacilities, many plans once envisioned as idealare operationally feasible. The development ofnational registers of deaths has been explored inthe past. The development of interpenetratingregisters of marriages, divorces, births, anddeaths would permit analyses of population dy-namics at specific times. Once such a systemwas operative, longitudinal studies that encom-passed the vital events from birth to deathwould be possible. Place of birth would be ineach record; the places of residence at succes-
sive events would yield new measures of mobility..For instance, place of birth, place of marriage,and place of birth of each child would be avail-able for each woman who had ever been married.Any information on place of birth and on birth-place of each child would be available for eachwoman, whether single or married, Informationfrom a variety of registration certificates wouldbe available for the subject of any vital eventreport, whether birth, marriage, divorce, mater-nity, fetal death, or mortality.
The technique of matching infant death andbirth records was developed in the 19th century.Use of this technique has increased in recentdecades, with a corresponding increase in theutility of integrated data. Perhaps a total inte-grated system of vital records. is visionary, butsome further progress in integration should befeasible in the coming years.
4. Marriage, Natality, and
Migration Statistics
The registration of vital events is the re-sponsibility of the States, but responsibility forcoordination and national tabulation is dischargedby the National Center for Health Statistics. Theallocation of responsibilities to health services isobviously appropriate for morbidity and mortalitystatistics. It is equally appropriate for natalitystatistics because of the associations of doctorsand hospitals with delivery. In most States, theState health departments are the custodians of themarriage and divorce records.
The national needs for marriage and natalitystatistics require expansions in geographic de-tail and analytic depth. The initial step is theimprovement and utilization of the informationnow included on the registration forms. Thisinvolves emphasizing the significance of the in-formation and the importance of completenessin filling out the certificates. There should bechecks of the coverage and tests of precision andvalidity of entries.
The advances of marriage and natality data,tabulations, and analyses to levels coordinatewith those of mortality statistics should be aforward movement of the vital statistics system,not a reduction of the levels and details of themortality statistics.
9
There are special difficulties in the de-velopment of marriage and divorce statistics be-cause of their peripheral interest to many medicaland health personnel. The Public Health Servicehas the responsibilities for the collection, proc-essing, and tabulation of statistics that are neededprimarily in other sectors of the Department ofHealth, Education, and Welfare, in other depart-ments of government, and in the academic andresearch community. The measurement of thehealth dimensions in marriage, fertility, familystability, and individual and family nobilitiesshould be subjected to intensive research andfield experimentation. Similarly, the measure-ment of the mobility dimensions in marriage,fertility, mortality, and health should proceedthrough intensive research and field experimen-tation.
The nature and extent of the current andlongitudinal relations of migration and mobilitywith marriage and reproduction should be ex-plored in field studies and special queries ofsamples of those reporting events.
5. Special Populations
The metropolitan [email protected] critical
problems in or associated with population dy-namics and health are those of the metropolitanareas. The critical population is the Negro. Thelong stability, lethargy, and social and economicretardation in the South resulted in an extra-ordinary exodus in the last half century. Thatexodus, still in process, was not the conventionalmigrant interchange. It began, rather, as move-ment of an ill-prepared people to the centralcities of large metropolitan areas. It occurredin a period when mechanization and automationwere reducing the needs for unskilled labor tolow levels. A subculture, with unstable familyrelations, female dominance, and limited maleresponsibility, had persisted since the periodof slavery. Transferred to the cities, high fertil-ity and illegitimacy became major problems,intensified by the failure of urban society toovercome racial discriminations.
In recent decades there were major move-ments of Negroes to central cities and of whitepersons to outer areas. Migrations betweenmetropolitan areas are now replacing movements
from rural to urban areas as a central process.The metropolitan populations are composedlargely of migrants and the children of migrants.
The major questions for research concernmarriage, marital status, and family instability;childbearing within and outside marriage; theirvariations by education and duration of residence;and the trends of the generations born in metro-politan areas. The basic variables in maritaland reproductive history are includes in the vitalregistration forms. These forms also includeplace of birth and highest grade of school com-pleted.
Thus the priority problems in research canbe probed if data now on the registration recordsare given with completeness and accuracy, It isunlikely that items long unused are filled in care-fully in all or even in most metropolitan areas.Moreover, the marriage-registration area is notnationwide and many of the States do not notelegitimacy on the birth certificate. Questions oneducation have been added to the standard formsas of 1968. Thus some analyses can he nation-wide, while others may involve studies of particu-lar metropolitan areas or clusters of such areas.The concentration of effort to secure completerecords combined with the demonstration of thescientific values and policy relevance of the datashould yield improvements in the records.
Analysis of the population dynamics of ametropolitan population is deficient if it involvesonly a dichotomy of central city and outer ring.There are major differentiations within the metro-politan area itself and, particularly, with thecentral city. Insofar as possible, vital recordsshould k coded for the geographic areas of the1970 census, and tabulations should be made in asmuch geographic detail as possible. The essentialrequirement is consistency of vital statisticsand census tabulations for standard metropolitanstatistical areas (SMSA’S).
Basic requirements and recommendationsare as follows:
1. Identification and tabulation of data spe-cifically for Negroes, instead of groupingthem under the heading of “nonwhite” aspreviously done.
2. Coding and tabulating data on State andcountry of birth on vital records, and
10
3.
4.
5.
distinguishing Puerto Ricans and identify-ing the countries of birth of the foreign-born.
Coding of highest grade of school com-pleted.
Integration of infant death reports withbirth records.
Use of the 1970 geographic codes orother procedures for allocation to areaswithin SMSA’s, insofar as possible.
There should be explorations of the use ofsupplementary statistical forms in selectedSMSA’S for 1970 or for 1969 through 1971, withquestions on health and on migration, mobility,and stability.
Special areas and groups. -Types of nobili-ties and the associations among them differ byage and place of residence. Moreover, the re-lations of vital or health variables to migrationsometimes differ significantly for males and fe-males. Furthermore, measurable divergencesin subcultural and social psychological factorsdictate that all analyses be’made specifically forwhite and Negro persons.
The counterpart of metropolitan growth isrural depopulation. The population dynamics ofthe rural areas with aging and eroded age struc-tures present special problems Jri definition andmeasurement as well as topical approaches. Forinstance, the selectivities in past out-migrationsleave aging groups whose vitality and longevitymust have been affected along with their educa-tional and economic characteristics. Questions ofthe residual populations in rural areas assumea new significance as government policy turns’toward investment in the rural areas and smallerplaces with a view toward arresting, if not re-versing, the urbanward movement.
Analysis of the population dynamics and healthof Appalachia and other problem areas is needed.The critical questions are not so much the cross-sectional analysis of retardation as the dynamicanalysis of exodus and metropolitan influence.The focus should be the developments in theyounger ages rather than those among the agingand aged, Major analysis of Appalachia and otherareas would be possible with the coding, tabulation,and utilization of information from vital records
and the 1970 census. The basis would have to beagglomerations of counties rather than combina-tions of States. Special surveys and studies couldbe formulated efficiently on the basis of thisanalysis.
The areas for special study should not belimited to recognized problem areas. Comparativeanalyses are essentiat both the areas of originand the areas of destination of the migrantsshould be examined. For example, studies of theNegro population still in Mississippi would besignificant in research and program. For com-parative purposes, there might be similar studiesof the residual white populations in the rural areasof the Dakotas or the northern region of the Stateson the Great. Lakes.
The foveign stock. —Oneof the most neglectedof the resources for measuring the associationsof marriage and divorce, natality, morbidity andmortality, and mobility itself with the migrationsof past periods is the foreign stock, includingboth those born in foreign countries and thoseof foreign or mixed parentage. General or spe-cific analyses for populations of various nationalorigins could contribute to the measurement ofthe cultural aspects and the ‘chronological atten-uations of migrant differentiations and adapta-tions.
ongoing studies of foreign-born populationssuggest other possibilities. The cohorts of resi-dents in the United States who were born in Nor-way and the United Kingdom from whom residencehistories have been collected are representativesamples of migrants from these countries. Ma-terials for migrants in the United States can becompared with findings for living sibs of mi-grants and for probability samples of the generalpopulations in Norway and the United Kingdom.
Populations of Spanish or Mem”canorip”n.—The problem minorities moving to the centralcities of metropolitan areas include the Negroes(classified in vital and census statistics as non-white). They also include the Puerto Ricans inthe East and the populations in the West withMexican or Spanish surnames, the majority ofwhom are classified in vital and census statisticsas white.
Vital records include State or country ofbirth and thus permit identification of thoseborn in Puerto Rico and in Mexico. Marriage
11
forms include an item on place of birth of parentsof bride and groom, but the birth and death formsdo not include this item. Thus if vital recordsare used without linkage to each other or to thecensus, analysis would include persons born in theUnited States of Puerto Rican or Mexican parent-age and would be limited largely to those born inPuerto Rico or Mexico. The nobilities and ad-justments of the second generation would be lost.
The dynamics of the Puerto Rican populationare particularly significant, for the entire popu-lation of Puerto Ricans is included in the Ameri-can statistical system. Analysis can cover thepopulation in Puerto Rico, persons born in PuertoRico and now living in the United States, andpersons born in the United States of Puerto Ricanparentage. If vital records for centers of con-centration such as San Juan and New York couldbe linked to census schedules, the resultantanalysis would be highly significant to the UnitedStates and to the Commonwealth of Puerto Rico,It would also contribute to the knowledge of ademographic transition in process. Comparableanalyses for Puerto Ricans, Negroes, and southernwhite immigrants in New York could probe thedistinctive aspects of race, culture, origin, andsocioeconomic status in metropolitan adjustment.
The problem of identifying populations ofSpanish or of Mexican origin is difficult. Mexicanimmigrants can be identified by country of birth,but this is not possible with persons of Mexicanparentage or descendants in later generations.Then there are the descendants of the Spanishinhabitants who were once subjects of Spain orMexico. Movements of these populations of Spanishorigin from Texas to California is major; so isthe dispersion’ from the Southwest to the metro-politan regions of the Great Lakesf.
To identify persons of Spanish origin, theBureau of the Census coded from a list ofSpanish surnames in 1950 and 1960 for the fiveSouthwestern States. Such coding may be under-taken again in 1970; the needs of the NationalCenter for Health Statistics would be a factor inthe decision, Experimentation and analysis of thelist of names and the tasks of coding in Californiaprovide a basis for assessment and decision as toprocedures for the 1970 census period.
Indiuns and othwother subcommittee of
12
indigawua groups, --An-the U.S. National Com-
mittee on Vital and Health Statistics is consider-ing the Indian population, It should be noted,however, that the Indian population and the AlaskaNatives are among the most economically re-tarded of the American mim)rit y groups. Char-acteristic of the population are the high birthrates and the almost modern death rates thatyield high rates of natural increase. This inter-national problem with which the U.S. Governmentis concerned also exists within the United States,
The question for analysis and the feasibilityof analysis break logically and practically intotwo studies. The first would be that of the Indianin the conterminous United States. The secondwould be that of the Alaska Native population.If the Department of Health of Alaska requiredracial designation such as Aleut, Eskimo, orIndian on the vital records and the Bureau of theCensus required similar designations in the cen-sus of Alaska, studies of these population groupswould be possible. If census schedules and vitalrecords w&e linked, evaluation of the ethnicdesignations and measurement of coverage wouldbe possible. The linked records and scheduleswould permit incisive analysis of this smallbut significant subgroup in the population.
Hawaiians, Chinese, and Japanese. — Theanalysis of the population dynamics of the AlaskaNatives concerns indigenous groups remote fromthe larger population. The analysis of the dy-namics of the population of Hawaii and of theChinese and the Japanese in California concernsthe assimilation and integration of peoples ofdiverse Asian backgrounds. In comparative de-mography the nobilities, the ages at marriage,the limited fertility, and the very low mortalityof the Chinese and the Japanese in Hawaii andCalifornia permit analyses both of the potentiali-ties of the. peoples of China and Japan and of theconditions associated with the realization of thosepotentialities, Again the requirement for analy-sis is a comparable racial designation on vitalrecords and census forms. The designations arenow included in the registration forms of Hawaii;Chinese and Japanese are noted in the forms ofCalifornia. The use of racial designations on cen-sus schedules and the collation of vital records andcensus schedules would permit direct analysisof this blending population in the Pacific. Suchcollation would also permit the evaluation of the
comparability of the ethnic classifications in theseparate sources,
Migrant labor.– The problems of migrantlabor merit and receive special attention frommany agencies and committees. The neglectedsector is the relation of marriage and fertilityto the origin and persistence of the patterns ofmigration, poverty, and deprivation. Explorationof the direction of relations and the crucial pointsin breaking the cycles of the generations shouldreceive priority in future analyses. Rather, mar-riage, natality, reproductive wastage, and familydynamics should be major components in studiesof the economic and health status of the migrantgroups.
6, Essential Bases for Research and
Development
Resources for research may be defined aspresent and potential sources of data. Thisapproach dominated the preceding discussion. Ina more basic sense, resources for research maybe defined as the professional personnel and fa-cilities that constitute the research staffs of uni-versities and research institutions. Pioneer stud-ies on the interrelations of migration, vitalprocesses, and health are undertaken by theseresearchers. Further advances that are outwardthrusts of inquiry, method, and knowledge arelikely to be based in universities or researchinstitutes or to involve their cooperation.
Today there is a growing need for increas-ingly intricate and intensive research. There areincreasing numbers of research specialists andresearch facilities. There are new technologiesthat permit analyses that have been impracticalin the past. There are professional statisticalorganizations and research staffs in government.These coincidences made feasible approaches toresearch that would have been visionary a fewyears ago.
Any dichotomy of governmental and academicapproaches and responsibilities has increasingcomponents of artifact. The National Center forHealth Statistics is considering increasing in-volvements with universities and research in-stitutions,
This Committee’s sketch of areas of researchand the suggestions for priorities in research con-
cerned a field of activities rather than a directiveto specific organizations within or outside Federalor State Governments. The es sent ial bases fordevelopment, research, and experimentation re-quire not only the direct involvement of the Na-tional Center for Health Statistics but also itsstimulation of work in universities and researchinstitutions through grants and contracts.
,7, Plans and Programs for the 1970
Census Period
The responsibilities of the National Centerfor Health Statistics dictate major emphasis ondata collection, tabulation, and analysis for theyears around the 1970 census. The fields in whichknowledge is needed most urgently include mar-riage, natality, and infant mortality in the popula-tions formed largely of migrants and the childrenof migrants. The field of concentration in theperiod of the 1960 census was mortality; thefields of concentration in the period of the 1970census should be marriage, natality, and mi-gration.
The advances of statistics and research, thetechnological developments, and the widely rang-ing activities already in process are furtherarguments for the feasibility and productivity of aflexible program in the period when 1970 censusresults and queries recently added to vital rec-ords are both available. There is emphasis onmigration in the 1970 census. Tabulations will beoriented toward metropolitan distribution andprocess; the problems of central cities and dis-advantaged rural areas; and the relations ofracial, economic, and social variables to thesedemographic components. The records of mar-riage, divorce, natalit y, and fetal death includeinformation on place of birth, ethnic group (in-cluding the Negro specifically), and educationallevel.
For the first time in the 20th century, thecensus of 1970 will include a direct questionon the presence, nature, and duration of disability.One may also anticipate the inclusion of ques-tions on health in the current population andhealth surveys, followbacks of reported vitalevents, and other special studies.
andThe concentration on marriage, fertility,migration in the period of the 1970 census
13
has an immediate justification in todayts problemsof population, health, and welfare. In longerperspective, this is an appropriate period foradvances in the comprehensive analysis of popu-lation dynamics. Natality cannot be analyzedmeaningfully apart from marital status, familyinstability, and illegitimacy. Fetal, neonatal, andinfant losses are aspects of the reproductiveprocess, as of mortality. The changing relationsof mortality of men and women at various agesmay be described but not explained throughmortality statistics alone. Health and vitalityand disease and disability are related not onlyto rates of dying but to reproduction and mobility.Migrations and changing distributions ‘alter thelocus if not the levels of births and deaths andcomplicate problems of vital rates.
The involvement of the National Center forHealth Statistics can be summarized in fourcategorical statements:
1.
2.
3.
4.
Major advances in vital, health, and mi-gration statistics are essential to theanalysis of the population dynamics ofpresent and future, overall and for areasand groups within the population.
The analysis of levels and changes inmarriage, natality, mortality, and mi-gration involve the interrelations of thespecific variables in population growthand distribution with the demographic,economic$ and social characteristics ofthe population.
Measures of health and vitality should beincluded within or related closely to thevital statistics system.
Migration statistics should be componentsin a system of population dynamics.
There are major problems in the evaluation,tabulation, and utilization of information on thevital record forms that is not now used or thatis used only sparsely. The problem of procedureis the joint planning of tabulations from vital rec-ords and census enumeration. There is thenfurther exploration and decision as to whatcurrent surveys or special procedures supple-ment the resources of the vital records systemand the census.
Outline of Resources
1. Vital Records
1.1
1.2
1.3
1.4
MaWage.-The certificate requiresinformation on the State of birth ofthe bride and groom and of the fatherand mother of each. Race is specified.Queries include order of marriageand, if previously married, type oftermination. Education is includedfor groom and bride. The major prob-lem is allocation by residence whenthe system covers only 38 States.
Divorce or annulment. -l%is certifi-cate includes State of birth of husbandand wife but not of parents. Place anddate of marriage are included, as isdate of separation by total numberof living children and by number ofchildren under 18. Number of themarriage and type of dissolution ofprevious marriage or marriages aresecured separately for husband andwife.
Live bivth. —The certificate includesState of birth of father and mother,race of each, and whether or not thebirth was legitimate (38 States). De-tails on the birth include date, place,and attendant; pregnancy care; weightof infant; injuries; and malforma-tions. There is a reproductive his-tory, with the date of the last livebirth or fetal death together withprevious deliveries by the numbernow living, those born alive and nowdead, and those born dead.
Fetal dea~h.—l%is certificate in-cludes State of birth, race, and edu-cation of the father and the mother.Reproductive history of the mother isincluded, with date of last live birth,date of last fetal death, and previousdeliveries by whether now living,born alive but now dead, or borndead.
14
1.5 Infant mo?’tdity. —’The tiformationon infant death includes State of birthof the infant but neither the States ofbirth nor the education of the fatherand the mother. Analysis in the con-text of reproduction requires match-ing with the birth certificate.
2. The 1970 Census
Information on age, race or nativity,place of birth, and highest grade of schoolcompleted is included in the census sched-ule as in vital records. The 1970 censuswill have complete enumeration a 25-per-—..>.—cent sample, and ‘then—2<-“and 5-percentsamples; these latter will be comparableto the 25-percent sample but not to eachother. The question of marital status isincluded in the 100-percent enumerationand marital history in the 5-percent sam-ple. Marriage is defined de facto. Num-bers of children ever born to women evermarried are included in the 25-percentsample.
Migration or mobility questions on thecensus forms are as follows: State orcountry of birth (25 percent); country ofbirth of parents (20 percent); mothertongue (20 percent); year moved intopresent house (20 percent); place of resi-dence 5 years prior to census (20 percent);place of work and means of transportation(20 percent); year of immigration (5 per-cent).
New questions on labor force status 5years ago (25 percent) and occupation andindustry 5 years ago (5 percent) permitthe allocation or reallocation of collegestudents, the Armed Forces, and workgroups to secure the most appropriatedenominators for vital rates of varioustypes.
A question on the presence and durationof disability introduces direct health queryinto the census and provides an empirical
3.
4.
5.
6.
test of the quality and value of the datathus secured.
The housing questions include six itemsused by the Housing and Urban Develop-ment to delineate areas for housing pro-grams: water supply, toilet, bathtub orshower, complete kitchen facilities, heat-ing equipment, and rent or value.
National Health Survey and Current Popu-lation Survey
The inclusion of migration or mobilityquestions in the National Health Surveyand the inclusion ,of health and mobilityquestions in the Current Population Sur-vey supplement vital statistics and thecensus enumeration, The regular Employ-ment E2wnings and Monthly Report on theLabov Force, which is the core of theCurrent Population Survey, includes ill-ness or disability as reason for not work-ing.
Followback Queries
The retrospective query of vital reportsmay supplement information and evalu-ation.
State Vital Record Systems
Analyses from the vital records systemsof the States are relevant to future de-velopments of the national systems. Forinstance, California and Alaska ask aboutlength of residence in the State. Therehas been work in California on the use ofSpanish surnames in vital records.
Special Surveys, Queries, and Studies inStates
State or municipal health departments,perhaps in cooperation with universitiesand research institutes, may undertakestudies not feasible at regional or national
15
7.
8.
levels. For instance, North Carolina mightdevelop studies of the data and the dy-namics of marriage, fertility, andlegiti-macy in the native white and Negro popu-lations.
Other Government Surveys or Series
An illustration: an ADC (Aid to DependentChildren) survey was conducted in 1967.Another may be undertaken in 1970. If so,there could be supplementation with thetabulations and analyses of marriage,family formation, fertility, pregnancywastage, and illegitimacy in the generaland in this special population.
Universities and Research Institutions
The major developments of populationresearch and training centers and the in-creases in demography in university de-partments, including public health, pro-vide sources for analysts who wouldutilize the data generated by the specialactivities of the 1969-71 census period.Representatives should be included in theplanning of the activities.
Procedures
Tabulations of the usual types of vital sta-tistics for areas within central cities and standardmetropolitan statistical areas require that thegeographic codes of the census be used in therelevant vital statistics records. Tabulations ofthe information on place of birth require assess-ment of the quality of the information on the basisof previous tabulations and uses of these data.Tabulations of the information OP educationallevels require evaluation of the completeness andaccuracy of the data. If detailed data on repro-ductive patterns and histories are to be securedfrom birth reports, special efforts should bemade to insure completeness and care in thefilling out of birth records. Similar attentionshould be given to legitimacy status in Stateswhere the information is collected.
These considerations indicate that the Na-tional Center for Health Statistics and State reg-istrars should be asked to assess the adequacy
of datations:
1.
2.
3.
4.
5.
and where feasible take the following ac-
Use geographic codes for address of resi-dence at time of vital event.
Code place of. birth.
Code educational level.
Request the completion of all items onpresent and previous deliveries and onlegitimacy in the natality reports,
Emphasize the importance of complete-ness and accuracy in all items notedabove, plus the specific designation ofrace.
Types of Products
1. Tabulation of Vital Records.
1.1
1.2
1.3
. 2. The
Tabulations of the usual types of mar-riage, divorce, and natality data, withallocations to geographic subareaswithin metropolitan areas and withsufficient detail by age and otherrelevant demographic characteris-tics to permit refined measures.
Tabulations of vital statistics vari-ables by migrant status as indicatedby State of birth, with major emphasison places of origin of the metropolitanin-migrants and places of residenceof the out-migrants from rural areas.The prime focus involves the exodusof Negroes from the South and themarriages and births of Negroes inmetropolitan areas whether born lo-cally, elsewhere in the North andWest, or in the South.
Tabulations of marriage and natalityby educational level, place of resi-dence, and place of origin.
Linka~e of Infant Death ReDorts WithBirth Records.
2.1 Tabulations of fetal deaths, neonatal,and later infant mortality by place
16
2.2
2,3
of residence and place of origin forNegro and white populations.
Tabulations of fetal and infant deathsby educational levels of the parents.
Tabulations of infant deaths by age inrelation to the reproductive history ofthe mother and various characteris-tics of the parents.
3. The Matching of Census Schedules for In-fants Born Near the Census Date WithBirth Records.
3.1
3.2
3.3
3.4
3.5
The basic goal would be the testingfor completeness of birth registra-tion, particularly in the Negro popu-lation. Careful design would permitanalytical use.
If infant deaths are linked to birthrecords, the matching of censusschedules, for infants and birth rec-ords provides census data for theinfant and the family, detailed mor-tality information, reproductive his-tories, and legitimacy status.
The comparison and evaluation of in-formation on age, race, marital sta-tus, place of birth, and educationallevel in census enumeration and vitalrecords is thus feasible.
The evaluation of data from censusqueries on children ever born towomen ever married on the basis ofbirths reported from all women giv-ing birth without reference to maritalstatus is essential.
The analytical possibilities ofmatched and fully utilized natality
reports and census enumerations areso diverse and potentially so pro-ductive that no statements are re-quired beyond the noting of the fact.
Statistical Publications and Studies
The various tabulations would permit manytypes of analyses now and in future years. Specialtabulations or access to tapes should be availableto responsible users. Thus the program would in-clude
1.
2.
3.
Statistical publications, perhaps in part asa joint series with the Bureau of the Cen-sus.
Tapes or other access to data.
Special studies or monographs.
It would not be appropriate to outline a mono-graph series in advance of the work of the com-mittee that develops the project. The Subcom-mittee on Migration and Health Statistics viewedthe analytical publications as a series of specialstudies in significant fields. In many fields,monographs on the total population of the UnitedStates- would mean reduction to least common de-nominators. Geographic coding for metropolitanareas will not be nationwide. Illegitimacy is notnoted in all States. The marriage-registrationarea is not nationwide. Moreover, there are social,cultural,’ and regional dimensions to populationdynamics. Social change is not a uniform process.
The special statistical activities in the cur-rent health and population surveys and othersources will be undertaken in light of the analyticalproblems judged most significant. They will berelated to the analyses that are projected. ;
000
%?U, S, GOVERNMENT PRINTING OFFICE: 1068-042042/2S
17
,
OUTLINE OF REPORT SERIES FOR VITAL AND HEALTH STATISTICS
Public Health Service Publication No. 1000
Series 1.
Series 2.
SeVies 3.
Sevies 4.
Series 10.
Series 11.
Series 12.
Sevies 13.
Sertes 14.
SeVies 20.
SeYies 21.
Series 22.
PrognLms and collection procedures.—Reports which describe the general programs of the NationalCenter for Health Statistics and its offices and divisions, data collection methods used, definitions,
and other material necessary for understanding the data.
Data eL~aluation and methods reseavch. —Studies of new statistical methodology including: experi-mental tests of new survey methods, studies of vital statistics collection methods. new analytical
techniques, objective evaluations of reliability of collected data, contributions to statistical theory.
Aua[ytical studies. -Reports presenting analytical or interpretive studies hased on vital and healthstatistics, carrying the analysis further than the expository types of reports in the other series.
Documents and committee reports. - Final reports of major committees concerned with vital and
health statistics, and documents such as recommended model vital registration laws and revised birthand death certificates. *
Data fvom the Health Interuiezo Suwe~. —.Statistics on illness, accidental injuries, disability, use of
hospital, medical. dental, and other services, and other health-related topics, based on data collectedin a continuing national household interview survey.
Data fvom the Health Examination Suvcey. — l)ata from direct examination. testing, and measure-nlent of national samples of the population provide the basis for two types of reports: (1) estimatesof the medically defined prevalence of specific diseases in the United States and the distributions ofthe population with respect to physical, physiological, and psychological characteristics; and (2)
.wllysis of relationships among the various measurements without reference to an explicit finiteuniverse of persons.
Data from the Institutional Population Su)-Leys. —Statistics relating to the health characteristics ofpersons in institutions, and on medical, nursing, and personal care received, based on national
samples of establishments providing these services and samples of the residents or patients.
Data from the Hospital Disclla)-ge Suwey. —Statistics relating to discharged patients in short-stayhospitals, based on a sample of patient records in a national sample of hospitals.
DUtO on health wsowces: manpowev and facilities, —Statistics on the num~rs, geowaphic distri-
bution, and characteristics of health resources including physicians, dentists, nurses, other healthmanpower occupations, hospitals, nursing homes, and outpatient and other inpatient facilities.
Data on ~no~taLity. -Various statistics on mortality other than as included in annual or monthlyreport s— special analyses by c~use of death, age, and other demographic variables, also geographicand time series analyses.
Data on natality, )narviage, a>LddiL’o?’ce.—Various statistics on natality, marriage, and divorce otherthan as included in annual or monthly reports—special ana]vses by demographic variables, alsogeographic and time series analyses, studies of fertility.
Data from the National Natality and ,Mo].ta~ity SurL:eys. — Stati sties on characteristics of births anddeaths not available from the vital records, based on sample surveys stemming from these records,includin~ such topics as mortality by socioeconomic class, medical experience in the last year oflife, characteristics of pregnancy, F’t”.
For a list of titles of reports published in these series, write to: office of Infornution
~r:Ltiotl:il [:ellt<.r for Hcdlth St.ltistics
U.S. Public’ fkalth ServiceVJ,~shington, D.C. 20201
