prising 8.8 percent of employed civilians (National Center for Health Statistics, 1999).

The growth of the health care industry in the United States has been accompanied by significant achievements in public health, including advances in prevention and significant declines since 1950 in death rates for diseases of the heart (56 percent), and stroke (70 percent) (Morbidity and Mortality Weekly Report, 1999). We have been successful in monitoring these and other morbidity and mortality trends through the growth and development of our health data systems.

Health care is a pressing social, political, and economic issue in the United States. The American pluralistic health care economy presents special problems for data collection, analysis, and dissemination. Health statistics systems have grown rapidly with the growth of the industry and the expansion of private health insurance coverage and public health care programs.

There is general agreement that data are needed to monitor the health of the nation; to plan and develop better health services; to deliver those services in an effective, efficient, and equitable manner; to measure their effectiveness; to make decisions on resource allocation; and to conduct research. Data also are needed to facilitate effective policy making, planning, management, and evaluation. Private organizations of health professionals, health service providers, health insurance, and many others have important interests in the collection and use of health data. The federal government needs a variety of data to support its major role in improving health and medical care delivery systems throughout the nation. State and local government agencies also have key roles in disease prevention, delivery of health services, and health planning and evaluation that require timely and reliable health statistics.

This paper presents a brief historical review of how the health statistics system has evolved to its present configuration and the lessons to be learned that might guide the future evolution of the system. This review will focus on the changes during the past 35 years in the types and uses of health statistics, the constituencies, and changes in technologies supporting the health statistics system. Gaps in health statistics, as well as several cross-cutting issues, will be discussed. Special focus will be on the federal health statistical system, especially as it relates to the production, use, and need for health data at the federal, state, and local levels. The paper concludes with challenges for the future in producing a health statistics system for the twenty-first century.