HEALTH CARE/Joan Retsinas

Grade Inflation at the CDC

Wow! The headlines extol "a new high," a stellar performance on the vaccination front. Consider this from the Wall Street Journal (7/27/05): "On-Time Vaccinations Hit Record Levels."

The Centers for Disease Control and Prevention, which tracks statistical progress on an assortment of health measures, has given the nation an A. But in government, like much of academia, an A is whatever you want to call A.

Last year 80.4% of the nation's toddlers were fully vaccinated for 9 diseases. That is the highest percentage ever -- up from last year's high of 79.4% (another "record-breaker," according to last year's headlines). Ask any high school teacher: Does 80% merit an A? This sounds like Lake Wobegon, where all the children are above-average. Only in this Lake Wobegon, average merits an A.

Outside Lake Wobegon, and outside the CDC, 80% would merit a B-minus. B-minus is of course a respectable grade, and parents generally accept it as such. But parents know that B-minus won't get their child into Yale. Neither children nor parents boast.

B-minus, moreover, is the nation's average. In pockets of the country, vaccination rates dip lower. The rate in Nevada was 68.4%; in Houston, 65%. Such concentrations of un-immunized children can be dangerous: A disease outbreak can easily emerge from such a pocket.

The analysts of the 80% "success" blame the usual suspects for the shortfall. Parents overburdened with taking care of their children's illnesses may have difficulty scheduling "well-baby" visits expressly for vaccinations. The number and variety of shots are daunting; a conscientious parent may forget one or two.

Some parents don't recognize the importance of vaccinations, especially when their child is healthy and the disease not imminent. Some parents are neglectful; some, ignorant. After all, no contemporary parent remembers when polio, or measles, or rubella, were endemic, and no contemporary parent has seen the consequences of those diseases. Physicians too garner some blame: Their recording/reporting/reminder systems are not sufficiently up to date, and pint-sized patients fall through the administrative cracks.

Ironically, even while the government pats itself on the collective national back for the 2004 performance, in discussing the pockets of low vaccination, the government does not accept much of the blame. Yet surely the government's inattention to health has contributed to those rates.

Day care, for instance, is regulated by states. Yet even though states require that all children in day care be vaccinated, the states are not enforcing this requirement. Otherwise, the statistics would show that virtually all children in day care are vaccinated. Yet the statistics show no major difference in vaccination rates of day care versus at-home children. (In contrast, vaccination rates for school-age children reach 95%, because schools are insistent.)

As for inadequate/neglectful/ignorant parents, look to poverty as a contributing factor. Parents who move often, who live in chaotic situations, who have no support, may understandably put vaccinations on the back burner of troubles. To have her child vaccinated, the single parent who works full time risks losing her job or at least a few hours' pay. With a sick child, she may take the time off; with a healthy child, she may choose not to.

The government does not "make" people poor. Our economy is bifurcating into a two-tiered sector. On the top tier, people earn megabucks and are insured. On the lower tier, people earn less than $15 an hour in the service sector, often without benefits. Our government's stingy welfare policies -- from food stamps to Medicaid to housing subsidies -- exacerbate the distress of these people.

Finally, even while spotlighting physician record-keeping, the CDC shines the spotlight away from the fact that lots of the nation's children, particularly immigrant children, have no health insurance; and, with the erosion of "safety net" hospitals and clinics, these children have no regular source of care. The Robert Wood Johnson Foundation recently reported that 33% of the nation's uninsured children had not seen a physician in a year.

Citizens should give the government's "success" the same skeptical response as parents give their children's grades. The CDC set 80% as its vaccination goal for 2010, so that today, five years early, the CDC can proclaim, to cite the Wall Street Journal, "a record level that comes five years ahead of government expectations." But 80% -- after 5 years -- is not an ambitious agenda. A country as wealthy as ours could have set a more ambitious and more compassionate goal: 100%.

Joan Retsinas is a sociologist who writes about healthcare in Providence, R.I. Email

From The Progressive Populist, Sept. 15, 2005

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