Credit health human services union

Among the millions of documents spewed forth each year by the federal government is a glossy, 692-page tome from the Department of Health and Human Services (HHS) called Healthy People 2000: National Health Promotion and Disease Prevention Objectives. The document lists hundreds of laudable health care goals for the coming millennium, such as reducing deaths from work-related injuries to 4 per 100,000 workers, or limiting HIV infections to no more than 800 per 100,000 people. Trouble is, the department doesn't say how it intends to get there from here. And even if the department's officials did have a plan, they couldn't possibly put it into effect--since by their own admission, they can't even guess at the size of one quarter of the problems they have nevertheless promised to address, and for a full two thirds lack the data to figure out if they are helping matters or making them worse.

For instance, the department wants to reduce drug-abuse-related emergency room visits by 20 percent over the next time years. Great idea. But how many such visits are there now? The department doesn't know. Nor does it know the number of adolescent suicide attempts (which the deparment wants to reduce by 15 percent) or the percentage of pediatricians who screen children for developmental problems (the goal: 80 percent) or the number of people with "inappropriately stored" weapons (Healthy People 2000 will cut that number, whatever it is, by 20 percent).

If it all sounds to you a bit like another episode of "Yes, Minister," bear in mind that the numbers those bureaucrats are merrily tossing about represent real people: teenagers shutting themselves in a New Jersey garage to drink in carbon monoxide, or a four-year-old Bronx boy shooting himself dead with his daddy's pistol. You'd think these are the sorts of problems Uncle Sam would be keeping his eye on. But then again, if he were, we'd all be able to tell when he wasn't doing anything to address them. Of course, statistics can't tell you everything about tragedies like these. But without numbers to give them some sense of direction and accountability, as the empty promises of Healthy People 2000 amply demonstrate, the government programs that might prevent such tragedies simply won't get anywhere.

In fact, it's a telling demonstration of the power of statistics that when they do exist, they can be more dangerous than when they don't. It's like the difference between having no bridge and having a bridge that drivers don't realize is about to collapse. If you pick apart any federal number, you'll probably find that it's derived from faulty assumptions or incomplete data, which means we are basing all sorts of decisions on lies. For instance, according to a recent story in The New York Times Magazine, the Food and Drug Administration (FDA) reports that it rejects 27 percent of all inspected seafood as spoiled or contaminated--a measure that suggests it's doing a thorough job of protecting consumers. So, feeling safe and sound, we cheerfully indulge in kippers for breakfast, tuna for lunch, sushi for supper ... until we read the fine print and learn that the FDA inspects no more than 2 to 4 percent of the total catch, presumably allowing large quantities of rotten fish to slip through.

Counted out

But maybe you never expected much from HHS in the first place, and maybe you don't like seafood. Missing or misleading statistics are hurting you anyway. The figures generated by the federal government's $1.9 billion statistics-collecting enterprise make their way into every nook and cranny of the government, from entitlement programs to law enforcement to trade policy--not to mention private businesses, local and regional economic planning, private health care administration, and magazine pieces like this one. Name an organized activity at random, and chances are good that it depends in some fashion or another on federal numbers. So wouldn't it make sense to keep the system in sharp working order?

Sure it would. Unfortunately, no one's been at the switch for at least a decade--and in some cases, far longer. If someone had been, perhaps we wouldn't have witnessed missteps like these:

* Consider a single mother of two in Washington who scrubs floors and empties wastebaskets in gleaming office towers for $5.10 an hour. Guess what? She's not officially considered poor, despite the fact that she has to raise two kids on barely $10,600 a year in one of the most expensive cities in the nation. Now, that alone doesn't keep her from receiving all federal assistance, since the poverty line is so badly calculated that Congress has instructed most federal welfare programs to set their eligibility levels a third above it. But there are glaring exceptions to this policy, such as Medicaid, which is typically available only to those whose incomes fall far below the poverty line.

Why does such a widely cited figure bear so little relation to reality? Because no one is paying attention to how it's calculated. Back in the sixties, Molly Orshansky--an obscure Social Security Administration statistician who has probably had a greater impact on federal welfare policy than most U.S. congressmen--looked up a decade-old study that said poor families generally spent one third of their income on food, multiplied the cost of minimum annual food supply by three, and--presto!--created the poverty line. Since 1969, the Census Bureau hasn't even calculated Orshansky's figure anew, instead simply adjusting the previous year's figure for inflation. Of course, such crude assumptions aren't even close anymore; these days a poor family typically spends ony one sixth of its income on food, as other expenses like rent and utilities have taken a larger and larger bite. Patricia Ruggles, an Urban Institute economist, estimates that a more realistic measure might raise the current poverty line by 50 percent--a change that, with the stroke of a pen, would boost the national poverty rate from 13 to 25 percent. Of course, those poor people exist no matter what the numbers say. But the numbers help determine whether and how the federal government tries to help them, and, at a more profound level, how Americans feel about the state of their society: Wouldn't it shock you to learn that one in four Americans is poor?

* The Centers for Disease Control (CDC) determine how many people have died of AIDS by examining mortality data and adding up the number of patients for whom HIV or AIDS was the "underlying cause" of death. But as a team of CDC researchers reported in the Journal of the American Medical Association last year, this conservative definition probably understates the true size of the epidemic. The problem is that, although the CDC maintains what is known as a "surveillance definition" of AIDS--a list that includes a number of opportunistic infections almost always associated with HIV infection, such as Pneumocystic carinii pneumonia or Kaposi's sacroma--it does not use that information in calculating its aggregate AIDS death figures. When the researchers conducting the JAMA study counted deaths due to these infections in their sample, HIV-related mortality jumped by 28 percent. If that figure held up within the population as a whole, the number of deaths due to AIDS--23,300 in 1990--would be about 6,500 people higher.

* Until recently, Republicans enjoyed boasting about how their economic policies brought about 92 months of uninterrupted growth--what George Bush used to call "the longest peacetime expansion in history." There's just one problem: It never happened. A little-noticed 1988 revision in the GNP figures for the second quarter of 1986 turned a quarter of healthy growth into one in which the GNP actually fell. A less dramatic, but still serious, revision affected the last quarter of 1984, when an initial estimate of a 4.3 percent growth rate dove to an anemic 0.6 percent. The hidden weakness of the economy did more than bolster Republican political fortunes: Data collected by the National Association of Business Economists (NABE) suggests that before the Bureau of Economic Analysis (BEA) lowered its initial 1989 GNP growth figures by an average of 1.2 percent, or roughly $600 billion, the Federal Reserve was misled into holding down the growth of the money supply, thus choking off an expansion of credit that might have produced higher growth and possibly even helped avert the recent recession.