Recent international developments in vital and health statistics.
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Biomedical subjects
Publications and source records attributed to F F HARRIS.
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In 1948, the Canadian Federal Government launched a programme of annual grants to the provinces to expand and improve their health services. However, if there was to be a sound basis for planning and expenditure, much more had to be known about the incidence and prevalence of illness and injury; about the amount of medical, nursing, and similar care needed; and about the volume of family expenditure on health. Accordingly, an agreement was reached in 1950 to conduct a nation-wide survey to determine these matters. The Dominion Bureau of Statistics and the federal Department of National Health would be responsible for planning the survey, designing and setting up the sample, co-ordinating provincial activities, and analysing and publishing the results. The provinces would select, train, and pay enumerators; collect the data; verify diagnoses; and edit completed returns.The survey was conducted over a period of 14 months, each household in the random sample being visited monthly. The size of the sample (sampling error: 20%) was calculated to ensure that results would be within the margin of error 95 times out of 100. While certain areas of Canada had to be excluded from the survey for various reasons, 98% of the 1941 population was covered by the sample, which was composed of a random selection of households in the metropolitan areas and of primary sampling units of 2,000 people elsewhere.When the results were in, the Detailed List of the International Statistical Classification of Diseases, Injuries, and Causes of Death was tabulated for analysis, and it was found that only 19 categories occurred with the minimum frequency needed for a valid estimate. Of the family expenditure on health, 24% was for prepayment plans, 54% for direct services, and 22% for drugs, appliances, etc. The estimated total cost of the survey amounts to Can. $600,000.
Securing the co-operation of persons supplying information required for medical statistics is essentially a problem in human relations, and an understanding of the motivations, attitudes, and behaviour of the respondents is necessary.Before any new statistical survey is undertaken, it is suggested by Aubenque and Harris that a preliminary review be made so that the maximum use is made of existing information. Care should also be taken not to burden respondents with an overloaded questionnaire. Aubenque and Harris recommend simplified reporting. Complete population coverage is not necessary.Neurdenburg suggests that the co-operation and support of such organizations as medical associations and social security boards are important and that propaganda should be directed specifically to the groups whose co-operation is sought. Informal personal contacts are valuable and desirable, according to Blaikley, but may have adverse effects if the right kind of approach is not made.Financial payments as an incentive in securing co-operation are opposed by Neurdenburg, who proposes that only postage-free envelopes or similar small favours be granted. Blaikley and Harris, on the other hand, express the view that financial incentives may do much to gain the support of those required to furnish data; there are, however, other incentives, and full use should be made of the natural inclinations of respondents. Compulsion may be necessary in certain instances, but administrative rather than statutory measures should be adopted. Penalties, according to Aubenque, should be inflicted only when justified by imperative health requirements.The results of surveys should be made available as soon as possible to those who co-operated, and Aubenque and Harris point out that they should also be of practical value to the suppliers of the information.Greater co-operation can be secured from medical persons who have an understanding of the statistical principles involved; Aubenque and Neurdenburg suggest that a course in elementary statistical methodology be introduced in the curriculum of medical schools.Methods for improving co-operation, and thus the compilation of statistics, in particular countries are discussed by Lal and de Shelly Hernández, who deal with India and Venezuela respectively.
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