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Multilateral Collaborations

International Collaborative Effort (ICE) on Automating Mortality Statistics

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The International Collaborative Effort (ICE) on Automating Mortality Statistics is co-chaired by ISP and the Mortality Statistics Branch at NCHS’ Division of Vital Statistics. ICE is one of several international activities sponsored by NCHS . The purpose of this ICE is to:

  • Share knowledge and experience of automated systems for coding mortality information.
  • Develop and improve existing automated systems through collaboration.
  • Facilitate the transition to ICD–10 for mortality.
  • Establish mechanisms for technical support for automated systems.

Washington Group on Disability Statistics

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The Washington Group on Disability Statistics was formed as a result of the UN’s International Seminar on Measurement of Disability that took place in New York in June 2001. An outcome of that meeting was the recognition that statistical and methodological work was needed at an international level in order to facilitate the comparison of data on disability cross-nationally. Consequently, the UN’s Statistical Commission authorized the formation of a City Group to address some of the issues identified in the international seminar and invited NCHS, the official health statistics agency of the United States, to host the first meeting of the group. The City Group format is one that has been used by the UN often to address various problems in survey measurement and methodology, such as the Rio Group, which focuses on poverty statistics. The City Group is an informal, temporary organizational format that allows representatives from national statistical agencies to collaborate to address selected problems in statistical methods. A City Group usually develops a series of three to four working meetings and is named after the location of the first meeting.


International Group for Indigenous Health Measurement

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Important health disparities exist between the indigenous and nonindigenous populations of the United States, but similar or even greater differences exist in other countries. Measurement of these health differences has been hindered by deficiencies in available health data for indigenous groups. The United States, Australia, Canada and New Zealand all have significant indigenous populations with important health disparities, similar health problems, and shared deficiencies in indigenous health data. All four countries have identified indigenous health disparities as an important problem to address and are seeking to improve the measurement of indigenous health status. The four nations are at a similar level of socioeconomic development and all have well-developed statistical systems. These issues, along with a common language and colonial experience, led health researchers, representatives of national statistical agencies, and representatives of indigenous groups from the four countries to agree to form an international interest group to promote improvement in the measurement of indigenous health status. This group is known as the International Group for Indigenous Health Measurement (IGIHM) (terms of reference [PDF - 125KB]).

The magnitude of health disparities in indigenous populations in the four countries is striking, but perhaps equally important is the absence of reductions in these disparities in recent years. In Australia, indigenous life expectancy is estimated to be at least 12 years lower than for nonindigenous persons, and the difference may be as much as 17 years (The health and welfare of Australia's Aboriginal and Torres Strait Islander peoples, 2005). Major disparities in death rates exist for treatable and preventable conditions including diabetes, respiratory diseases, circulatory conditions, and injury (Australian Institute of Health and Welfare (AIHW ) 2005). In New Zealand, the gap in male life expectancy was nearly 10 years in the late 1990s, largely due to stagnating or increasing death rates due to chronic conditions (Ajwani, 2003). The U.S. Indian Health Service reports major indigenous disparities for diabetes, accidents, suicide, pneumonia and influenza, and homicide (Paisano, 2002). In Canada, higher levels of chronic diseases, injuries, and suicides have led to an indigenous life expectancy gap of 6 years or more (Health Canada, 2009 —A Statistical Profile on the Health of First Nations in Canada: Determinants of Health 1999 to 2003).

Measurement of these health disparities faces similar challenges in the four countries. Most important of the data deficiencies is incomplete identification of indigenous individuals on administrative records, such as hospital registries and death registration forms. Added to this is incomplete access to care for Indigenous individuals in some of the countries. In addition, the small relative size of the indigenous population in Australia, Canada, and the United States makes it particularly difficult to gather health information for their indigenous populations via sample surveys.

National health research bodies in all four countries promote the development of research and knowledge on indigenous health issues. In 2002, the Canadian Institutes of Health Research (CIHR), the National Health and Medical Research Council of Australia (NHMRC ), and the Health Research Council of New Zealand (HRC) established a trilateral collaboration to support research in the area of indigenous peoples’ health (International Collaborative Indigenous Health Research Partnership (ICIHRP) on resilience, 2005 ). A 2007 memorandum of understanding (MOU) between the Department of Health and Human Services in the United States and Health Canada focuses on improving health-care delivery and access to the indigenous populations of the two countries (HHS and Health Canada MOU 2007). A 2010 letter of intent (LOI) between NCHS and the Australian Institute for Health and Welfare committed the two organizations to share improvements in methodologies and data collection for indigenous health measurement (U.S. and Australia LOI 2010). The 2010 agreement and the other collaborations include efforts to improve the measurement of indigenous health status and a commitment to share improved measurement techniques.

For an interest group such as IGIHM, it was essential to ensure that a variety of organizations were represented. Because one of the central aims of the group is to convince national statistical agencies to improve the quality and depth of health data collection for indigenous populations, it was important to include representatives of these agencies within the group. However, a crucial part of any activity involving indigenous peoples is participation by representatives of indigenous groups. This participation was ensured by actively soliciting indigenous participants from key indigenous groups in all four countries, including indigenous experts from statistical agencies, universities, and interest groups.

IGIHM Meetings

Several meetings have brought together IGIHM members and other experts to present new findings regarding indigenous health status, to propose improvements in measurement methodology, and consider related issues such as social determinants of indigenous health. These conferences, workshops, and other meetings include the following:

  • The founding meeting of IGIHM in Vancouver, British Columbia, Canada, October 2005 (AIHW 2006). Fifty-one experts attended, representing national indigenous organizations ; national statistical agencies ; universities; and other interest groups from Australia, Canada, New Zealand, and the United States. Presentations covered indigenous health information, health workforce information, health workforce development, health information and health research, data measurement, data utility, and indigenous community capacity building. The final day of the meeting was devoted to IGIHM organizational issues. The meeting was held in conjunction with the 2005 meeting of the International Network for Indigenous Health Knowledge and Development (INIHKD).

  • The second IGIHM meeting in Australia November 2006, hosted by the Australian Institute for Health and Welfare (AIHW) and cosponsored by the Office for Aboriginal and Torres Strait Islander Health (OATSIH) (AIHW 2009). The meeting included six sessions on the following topics: demand for data by researchers and policy makers , supply of data , innovative approaches to indigenous health information , methods used to count indigenous populations, and linking statistical agencies and indigenous organizations in the four countries. A final session focused on the way forward in improving indigenous health measurement.

  • A planning workshop for the third IGIHM meeting in Rotorua, New Zealand, in October 2008 in conjunction with the third INIHKD conference.
  • The third IGIHM meeting in Kona, Hawaii, in March 2009, hosted by NCHS and cosponsored by Papa Ola Lokahi/Native Hawaiian Health Organization. The meeting included sessions on Native Hawaiian health issues, improvements in indigenous health data collection, mapping health data systems, development of the indigenous health workforce, Australia’s indigenous health performance framework, indigenous child health, measurement and use of chronic disease data, estimating indigenous health expenditures, measurement and use of social determinant data, U.S. indigenous epidemiology centers, racism and resilience, and mechanisms for linking indigenous groups and national statistics organizations (NCHS, under construction).