Meet Charles J. Rothwell, Director, National Center for Health Statistics
Amstat News invited the director of the National Center for Health Statistics, Charles J. Rothwell, to respond to the following questions so readers could learn more about him and the agency he leads. Look for other statistical agency head interviews in past and forthcoming issues.
Rothwell has 30 years of federal government experience and 13 years of state government experience. He is a Fellow of the ASA and winner of the APHA Award in statistics. He also served as an officer in the U.S. Marine Corps.
What about this position appealed to you?
I have been involved in health statistics for more than 40 years and, to me, during those years, NCHS has been the leader in survey methods, addressing the nation’s important health questions and disseminating that information in innovative and effective ways. Who wouldn’t be interested in working with such outstanding staff on such interesting activities? NCHS is where the health statistics gold is mined and delivered!
Describe the top 2–3 priorities you have for the National Center for Health Statistics.
We must continue to produce high-quality timely data on major health topics and issues while identifying new health threats and groups at risk, as well as changes in the organization and financing of health care. In addition to describing the global picture of health in America, we need to produce more data on the health of minority populations to understand important differences in health status and access to care and more geographic detail to target those communities that lag behind. In collecting data, we need to take full advantage of new technology to analyze and disseminate data, as well as use the latest methodology to conduct our surveys and data systems. That includes expanding the use of electronic health records to gain more clinical information and link health care and outcomes. We need to continue to rejuvenate the nation’s vital statistics system so it can document “the now” and not just the past.
What do you see as the biggest challenge(s) for NCHS?
I think the biggest challenge for NCHS is making sure we are collecting the right data—the information the government and public buy ativan from mexico need to make the best decisions, plan the most effective programs, and take action to advance health. While using new technology for the collection and dissemination of data, we need to test the accuracy and quality of those new methodologies (e.g., when disease incidence and prevalence data are based on multiple modes of collection such as electronic health records in combination with data from health interviews and health examinations). An overall challenge is to continue to increase access to NCHS data available in new ways because of technological advances while ensuring we are maintaining and protecting the confidentiality of respondents, both people and providers.
What kind of support from the statistical community do you look for?
First and foremost, we look to the statistical community to advocate for statistical agencies and support their adherence to the principles that ensure the highest standards of accuracy and objectivity. We look to the statistical community for support in several other ways. We continually draw upon and adapt advances in survey and research methodology to our ongoing surveys and data systems. We count on the statistical community to train and develop the bright, young statisticians to fill our ranks and enrich our programs and look to the statistical community to promote government service. Let us not forget that advancing the statistical literacy of our citizens and their respect for and ability to use statistics is another function of the statistics community that benefits us all.
Prior to your tenure, what do you see as the biggest recent accomplishment of the agency?
I believe that modifying, expanding, and upgrading our data systems to produce information on a wide range of new topics in a much faster time frame is a significant accomplishment. In the past few years—with an infusion of new funds, some from the Prevention and Public Health Fund established by the Affordable Care Act—NCHS has expanded its surveys to produce state estimates of key findings, generated data on priority health topics on a fast track, and produced more detailed information by race and ethnicity, including an expansion of statistics on Asian Americans.
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Given the resources that the government devotes to the study of health and healthcare disparities, the development of a sound approach to measuring those disparities should be one of the highest priorities of a new NCHS director. In 2004 and 2005, confronted with the pattern by which reducing the frequency of an adverse outcome tended to increase relative differences between rates at which advantaged and disadvantaged experienced the outcome while reducing relative differences between rates at which such groups avoided the outcome, NCHS statisticians first formally recognized that determinations of whether health and healthcare disparities were increasing or decreasing would commonly turn on whether one examined relative differences in favorable outcomes (e.g., survival, receipt of appropriate care) or relative differences in the corresponding adverse outcomes (e.g., mortality, failure to receive appropriate care). The agency, however, failed to regard such pattern as calling into question the utility of either relative difference for quantifying the strength of the forces causing outcome rates to differ or provide guidance as to how one might quantify those forces in ways unaffected by the frequency of an outcome. Instead, the agency merely recommended that all health and healthcare disparities be measured in terms of relative differences in adverse outcomes. In an age of improving health and healthcare, that approach tended to result in findings of increasing disparities even when the forces causing outcome rates to differ were in fact diminishing. More important, the approach left the healthcare community without a compass for determining whether policies intended to address disparities were useful and should be expanded or were harmful and should be abandoned.
As of result of the NCHS failure to provide responsible guidance on this matter, even after recognizing the described pattern, health disparities research is in disarray, providing little of value and much that it misleading, as I discuss in references 1 and 2. See also reference 3 regarding similar issues in other areas where the federal government attempts to address demographic differences in outcome rates without recognizing the ways measure tend to be systematically affected by the frequency of an outcome.
NCHS eventually will have to address this subject in a sounder fashion that it has done to date. The longer the delays in doing so, the greater the waste of resources and misappraisal of the utility of policies intended to address health and healthcare disparities. The new director would thus be wise to turn his attention to the matter as soon as possible.
1. Measuring Health and Healthcare Disparities. Federal Committee on Statistical Methodology 2013 Research Conference, Washington, DC , Nov. 4-7: http://jpscanlan.com/images/2013_Fed_Comm_on_Stat_Meth_paper.pdf
http://jpscanlan.com/images/2013_FCSM_Presentation.ppt
2. Can we actually measure health disparities? Chance 2006:19(2):47-51: http://www.jpscanlan.com/images/Can_We_Actually_Measure_Health_Disparities.pdf
3. Misunderstanding of Statistics Leads to Misguided Law Enforcement Policies, Amstat News (Dec. 2012):
http://magazine.amstat.org/blog/2012/12/01/misguided-law-enforcement/