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World Health Organization (WHO) Classification Activities

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The World Health Organization (WHO) constitution mandates the production of international classifications on health so that there is a consensual, meaningful, and useful framework that governments, providers, and consumers can use as a common language. The WHO Family of International Classifications (WHO-FIC) promotes the appropriate development and maintenance of classifications in the range of settings in the health field across the world. The reference classifications, which are the main classifications on basic parameters of health, include:

WHO has designated a number of collaborating centers to participate in the development, dissemination, maintenance, and use of WHO-FIC to support national and international health information systems, statistics, and evidence. These centers represent an international network of expert centers in health classifications, coding, and terminology development. They meet on an annual basis to discuss matters of mutual interest and to advise WHO. The North American WHO-FIC Collaborating Centre (NACC) is housed at NCHS and works collaboratively with Statistics Canada and Canadian Institute for Health Information. NACC was renamed the WHO Collaborating Centre for the Family of International Classifications for North America ( in 2003 and was redesignated for 4 years in March 2012. For more information about the NACC, including its mission, activities, meetings, and participants, click here. ISP participates in and liaises with the various WHO-FIC activities administered by NCHS, which focus on the ICD and ICF. These activities are described in more detail below.

International Statistical Classification of Diseases and Related Health Problems, Tenth Revision

ICD–10 is the global health information standard for mortality and morbidity statistics. ICD–10 was endorsed by the 43rd World Health Assembly in May 1990 and came into use in WHO member states in 1994. More than 100 countries use the ICD system to report mortality data, a primary indicator of health status. Increasingly, the ICD system also is used in clinical care and research to define diseases and study disease patterns, as well as manage health care, monitor outcomes, and allocate resources. Both the United States and Canada have developed clinical modifications of ICD for morbidity applications. NACC participates in the ICD–10 activities listed below.

WHO-FIC Education and Implementation Committee

The NACC Head is Co-Chair Emeritus of the WHO-FIC Network Education Committee, which was established in 1999. Now called the Education and Implementation Committee (EIC), the organization is cochaired by the Portuguese Language and Australian Collaborating Centres. EIC is one of the four working committees of the WHO-FIC Network and meets twice a year. This committee assists and advises WHO and the WHO-FIC Network in implementing the WHO-FIC and improving the level and quality of their use in member states. The EIC tracks implementation of the classifications and develops implementation, education, training, and certification strategies for the WHO-FIC, prioritizing the ICD and ICF reference classifications. More information on the EIC can be found here.

WHO-FIC Network Mortality Reference Group

Cochaired by NCHS and Statistics Canada through NACC, the Mortality Reference Group (MRG) is an integral part of the updating mechanism for ICD, and works with the WHO-FIC Update and Revision Committee (URC) on updating ICD. Established in 1998, the MRG is one of two Network Reference Groups and aims to improve the international comparability of mortality data by establishing standardized application of the ICD to cause-of-death coding. (Terms of Reference[PDF - 115.5KB]). Meeting twice a year, MRG uses a democratic process that attempts to achieve consensus on recommendations that are then submitted to URC, including clarifications and correction of errors in the ICD.

The Mortality Forum

The Mortality Forum is an international discussion network of about 150 members representing more than 40 countries and organizations. Many MRG proposals to update ICD originate in Mortality Forum discussions.

  • MRG reports from various WHO-FIC Network meetings can be found here.
  • A list of official ICD–10 updates can be found here.

International Statistical Classification of Diseases and Related Health Problems, 11th Revision

Development of ICD–11 is currently underway through an innovative, collaborative process. For the first time, WHO is calling on experts and users to participate in the revision process through a web-based platform. The outcome will be a classification that is based on user input and needs.

Revision Steering Group (RSG)

The NACC participates in the ICD–11 Revision Steering Group (RSG). The ICD RSG serves as the planning and steering authority in the ICD–11 update and revision process. RSG is composed of various Topic Advisory Groups (TAGs) that serve as the planning and coordinating advisory body for specific issues that are key topics in the update and revisions process. The RSG includes four cross-sectional TAGs—the Morbidity TAG, the Mortality TAG, the Quality and Patient Safety TAG, and the Functioning TAG. The Morbidity TAG (responsible for clinical modifications for morbidity coding) and the Mortality TAG (responsible for mortality linearization of ICD–11) are cochaired by NCHS and ISP staff, respectively. Together with the NACC Head, these staff serves as members of RSG. The Functioning TAG is cochaired by staff from the Office of the Secretary of Department of Health and Human Services.

International Classification of Functioning, Disability and Health (ICF)

After 10 years of international revision efforts coordinated by WHO, the World Health Assembly on May 22, 2001, approved the International Classification of Functioning, Disability and Health, and its abbreviation of ICF. This classification was first created in 1980 (and then called the International Classification of Impairments, Disabilities, and Handicaps (ICIDH)) by WHO to provide a unifying framework for classifying the consequences of disease. Revision activities for ICIDH and promotion of the use of ICF in the United States and Canada have been under the umbrella of NACC since 1993. More information about ICIDH and ICF can be found here.