Notes from Editor's Note: Submlsions to Notes from the Field (SOO-1000 words) should be sent to Hugh H. Tilson, MD, Medical Division, Burroughs Wellcome Company, 3030 Cornwallis Road, Research Triangle Park, NC 27709. This column presents information regarding newsworthy public health programs and project experience at the community level. Further information should be sought from the person(s) listed in the footnote to each article.
Diapering Decisions: A Community Education Project At its 117th annual meeting October 22-26, 1989, in Chicago, the American Public Health Association's Governing Council adopted a policy statement on the "Health and Environmental Hazards of Disposable Diapers."' One of the recommendations in the policy statement was to support consumer education on the alternatives to disposable diapers. Earlier in 1989, the Seattle-King County (Washington) Nurses Association (KCNA) in conjunction with the Seattle Solid Waste Utility had developed a community education project about the potential health and environmental issues related to the use of disposable diapers. Disposable diapers, one of the many single-use products purported to make our lives simpler, are being scrutinized today because of the threat they pose to the environment. The sheer volume of solid waste created by singleuse items such as disposable diapers is of considerable concern since landfill space is decreasing. Over the past 30 years, the disposable diaper industry has grown to well over a $3 billion industry. Today, over 16 billion disposable diapers are sold in this country annually. Disposable diapers are used in approximately 85 percent of the diaper changes made in the United States despite the fact that they are the most expensive diapering alternative. Furthermore, sales of adult incontinent products are rising to meet the needs of the elderly in the community and in
institutions. AJPH June 1990, Vol. 80, No. 6
the Field Single-use diapers comprise 2 to 3 percent of the municipal waste system nationally, well over three million tons per year. It is estimated that the hidden cost of disposal is $.08 cents for every dollar spent on disposable diapersalmost $300 million annually. Experts agree the hierarchy of techniques to manage solid waste in order of the most to least desirable is waste reduction at the source, reuse, recycling, waste-to-energy incineration, and landfill. Up to this point, landfilling, the least desirable option of disposal, has been used for most solid waste, including disposable diapers. Furthermore, most of the innovative solutions to solid waste management have focused on recycling or incineration to the exclusion of source reduction and reuse. This is especially unfortunate when considering disposable diapers. An alternative to disposable diapers that reduces solid waste at the source is readily available in reusable cloth diapers. In addition to the solid waste problems created by disposable diapers, there are potentially serious health effects related to the disposal of diapers in the municipal waste stream. Used disposable diapers often contain human excrement. Over 100 enteric viruses are excreted in human feces including hepatitis and polio if live vaccine is used in immunizations. This creates a potential risk of disease transmission for sanitation workers through the feces left on a disposable diaper. In addition, many localities have regulations that make it unlawful to dispose of human excrement in residential trash. In early 1988, members of KCNA formed a Task Force and wrote a position paper. It was disseminated to local officials as well as interested community members. When a request for proposals was publicized by the Seattle Solid Waste Utility, KCNA applied for and received a grant of $35,000 to fund a one-year education project to carry out some of the recommendations made in the position paper. An advisory board of community representatives was selected for their special expertise and included: a nurse epidemiologist
and environmental health specialist from the Seattle-King County Department of Public Health, a pediatrician, an occupational health physician, a virologist, and representatives from diaper services and the disposable diaper industry. The overall goals of the project were to educate consumers about the alternative methods of diapering babies and to instruct users of disposable diapers to dump the solid fecal material into the toilet before disposing of the diaper in the trash. To achieve these goals, a multifaceted educational approach was chosen. A colorful brochure was designed for new parents; it was produced in Spanish and Vietnamese as well as English in order to reach a variety of ethnic groups. The brochure was distributed through newborn nurseries, the health department, childbirth education classes, clinic sites, and physicians' offices. The brochure includes information about the variety of alternatives for diapering baby and a table comparing the convenience, cost, and health and environmental effects of the diapering methods. The importance of hand washing to prevent the spread of infection and the technique for proper hand washing are reviewed. A brief discussion on the prevention and treatment of diaper rash is included, along with some hints for baby's health and safety. A 15-minute videotape featuring a parent education group also was produced. The videotape can be used for either professional or lay audiences and includes the same information as the brochure. In-service training classes were conducted for staff in newborn nurseries, clinics, and childbirth education classes to assist them in educating new parents. Newspaper publicity and public service announcements were planned to coincide with the distribution of the brochure and in-service training. The final phase of the project was evaluation, although in reality, evaluation was an ongoing source of feedback. For example, comments from the Advisory Board were used throughout our planning phase. Drafts of the brochure 743
NOTES FROM THE FIELD
were field tested among parents and professional groups and their recommendations were incorporated into the final version of the brochure. Our educational efforts, evaluated through direct feedback from parents and health care professionals about the brochure and the educational programs, received a positive response from both professionals and the general public. Results from a preliminary marketing study of the diapering preferences of 157 Seattle families were completed in late 1989. Almost 30 percent of Seattle families diapered their babies in cloth diapers exclusively as compared to about 15 percent nationally. There was a correlation between the type of diapers used in the hospital and the type of diapers used by parents at home. Another indicator about the effectiveness of the project is the number of institutions using cloth diapers. In early 1987, none of the hospitals that delivered babies used cloth diapers. Five of six institutions that deliver babies in the Seattle area now use cloth diapers. One of the reasons for the increase in cloth diaper services had to do with the increased concern about disposal of medical waste and incineration. The volume of diaper services in Seattle is another indicator of program effectiveness. All diaper services in Seattle estimate their service to have increased from 22 to 35 percent over the one-year period of the project. Indirect indicators such as a waste stream analysis are being used to further evaluate our efforts. Because of the time required to compile an annual rate for the waste stream analysis, we do not expect to have this portion of the analysis completed until mid-1990. We did not anticipate that our project would fuel research and development by the disposable diaper industry. However, the disposable diaper industry has subsequently developed recycling programs for disposable diapers in the Seattle area. To conclude, disposable diapers are symbolic of a single-use product that costs more than a readily available reusable one and burdens the nation's already overflowing landfills. Seattle's Diaper Education Project targeted new parents who make diapering choices and the health care providers who work with them. As a result, more parents have accurate, unbiased information about the environmental effects of various diapering methods so that they can make an informed choice. Whatever diapering method is chosen, products are now used in a more responsible 744
manner to minimize the risk of disease transmission and maximize a healthy environment. Furthermore, the project has stimulated scientific inquiry about the potential health consequences of disposing of human waste in the solid waste stream. The diaper decision task force of KCNA is expanding its focus to include a larger geographic area of the county and the state. The task force is studying the problem of adult incontinent products as well and continues to work with community groups on diapering issues. ACKNOWLEDGMENTS Funding for the project was provided by Seattle Solid Waste Utility of the Department of Engineering. An earlier version of this paper was presented at the 117th annual meeting of the American Public Health Association, Chicago, IL, October 22-26, 1989. The author acknowledges the assistance of King County Nurses Association and the Diaper Decision Task Force: Annie Bruck, Patricia Greenstreet, Linda Leaders, Laurian Pennylegion, Mary Salazar, and Alma Miller Ware, Executive Director. Mozeli Brown of the Seattle Engineering Department is also gratefully acknowledged.
REFERENCE 1. American Public Health Association: APHA Policy Statement No. 8910: The Health and Environment Hazards of Disposable Diapers. Am J Public Health 1990: 80:230. Prepared by: Janet Primomo, PhD, RN, School of Nursing, SM-24, University of Washington, Seattle, WA 91895. Tel. 2061685-855. NOTE: For information about multiple brochure orders or the videotape, contact KCNA (206/523-0997). Single copies of the brochure are available for $1.00 (enclose a self-addressed stamped envelope) from: King County Nurses Association, 8511 15th Street NE, Seattle, WA 98115.
The South Florida Perinatal Network The South Florida Perinatal Network, Inc., in Miami, Florida was organized in December 1981 as a multidisciplinary alliance of Dade and Monroe County agencies and institutions which share the responsibility for assuring the availability of quality perinatal services to all women in the community. With an estimated total population of 1.9 million in 1988, 421,436 were women of childbearing age. More than 100 agencies have forged this alliance with health professionals, hospitals, educators, parents, and community leaders whose mission is to: * provide a public forum for discussion of perinatal issues and
improve communication among Network components; * advise community and governmental agencies concerning plans for improving perinatal services; * respond to community imperatives in perinatal health; * serve as a perinatal services data bank; and * provide community education in perinatal care. The Network is recognized as a valuable resource for information by the media, local agencies and institutions, and grant applicants. Since the Network does not provide any direct service, it is able to remain impartial to any special interest groups. Numerous problems exist in the South Florida area with regard to perinatal care. A 1981 health planning study pointed to high infant mortality as a major problem, with non-White deaths being nearly twice those of White infants. The study further identified problems in access to family planning, prenatal care, and hospital services for low income women and children, as well as a shortage of neonatal intensive care beds. Planning, professional education and advocacy were directed by separate health disciplines without opportunity for a system-wide understanding. Since its inception, the South Florida Perinatal Network has made a measurable difference in improving the perinatal services system. A Maternal and Infant Care Plan for South Florida, completed in 1984, spelled out community goals and priorities. The first priority, ". . . education for healthy living and responsible childbearing," led the agency to provide the Dade County school system with in-service teacher training, to work for improved health curriculum and to take a leadership role in convincing the School Board to approve a school-based health clinic in a local area high school. With a $200,000 grant from the Robert Wood Johnson Foundation of Princeton, New Jersey and subsidies from the Public Health Trust of Dade County, the clinic is now open. The clinic offers a wide array of medical sciences; each student receives only those services that the parents approve. The second priority, ". . . promoting prevention efforts on assuring access to prenatal care and family planning," led to legislative initiatives and statewide coalition building in Florida with a resultant steady increase in general state revenue allocation for ImAJPH June 1990, Vol. 80, No. 6
NOTES FROM THE FIELD
proved Pregnancy Outcome Programs amounting to $20.6 million in additional funds over a five-year period. The Network recently established a planning committee to examine health systems issues with regard to access and availability of quality perinatal services. Access to care remains a critical issue in South Florida, and strategies are needed to stimulate community initiatives to respond to these problems as well as to develop further assistance from state, local, and national institutions. Coordination is enhanced by regular monthly Board meetings which provide a public forum to discuss issues ranging from prenatal outreach, to legislative initiatives, issues relating to acquired immunodeficiency syndrome (AIDS), cocaine-addicted babies, and battering of pregnant women. In 1986, with the problem of adolescent pregnancy on the increase, the South Florida Perinatal Network formed the Adolescent Pregnancy Prevention Advisory Council to study the problems of adolescent pregnancy in
I
the county. This advisory group has chosen to focus attention on preventing repeat teenage pregnancies, as well as prevention of the initial pregnancy. A recently completed study has revealed some disturbing facts about the complexities of this problem. The Network has been involved in providing high-quality training and workshops each year for both health professionals and the community atlarge. These sessions have dealt with such topics as: rationing of perinatal health, adolescent pregnancy, risks of pregnancy to very young and older women. The Perinatal Network is governed by a 33-member Board of Directors which includes five appointed representatives of the two regional perinatal intensive care centers, the two county health departments, and one member of the Metropolitan Dade County Commission. All remaining directors are elected by the membership, with at least five directors representing consumers. The Perinatal Network receives its
Health, United States, 1989
major funding from Metro-Dade County ($53,000) and the United Way of Dade County ($48,500). Annual membership dues provide the balance of approximately $10,000. Start-up funds were provided initially through a grant of $24,000 from the March of Dimes. In addition to all the specific accomplishments of the Network, there is yet a further clear benefit. Since its inception, the Network has provided health professionals, educators, and consumers with an opportunity to form linkages which in turn have contributed to our ability to provide more effective solutions to community perinatal and related health issues. NOTE: Materials developed by the Network for use in its programs are available on request from the authors. Prepared by: Marilyn Lesser, PhD, President, and Patricia McGovern, Executive Director, South Florida Perinatal Network, 3050 Biscayne Boulevard, Suite 206, Miami, FL 33137. Telephone: (305) 573-8313. C 1990 American Journal of Public Health
1
Overall life expectancy in the United States rose to 75 years of age and mortality from heart disease and stroke have declined dramatically during the past two decades. These facts, and other data on the health of Americans, are provided in Health, United States, 1989, the 14th annual report from the Secretary of Health and Human Services to the President and Congress. While health is improving for Americans as a whole, this improvement is not shared equally by all segments of the population. Blacks and other minorities are affected disproportionately by the impact of AIDS, homicide, smoking, and lack of access to medical care. The infant mortality rate for 1987 was 10.1 deaths per 1,000 live births. Between 1986 and 1987, the rate declined by 3 percent for white infants to 8.6 deaths per 1,000 live births, while declining by less than 1 percent for black infants to 17.9 deaths per 1,000 live births. The United States ranks 22nd in the world for infant mortality. In comparison, Japan had the lowest infant mortality rate (5.2 deaths per 1,000 live births) for 1986. Health, United States, 1989 was prepared by the National Center for Health Statistics of the Centers for Disease Control, US Public Health Service. This volume contains the fourth triennial Prevention Profile, which charts progress toward meeting the nation's 1990 health objectives. Its 131 detailed tables cover health status and determinants, utilization of health resources, health care resources, and health care expenditures. Copies are available for sale for $19.00 from the US Government Printing Office, Washington, DC 20402.
AJPH June 1990, Vol. 80, No. 6
745
Diapering Decisions: A Community Education Project At its 117th annual meeting October 22-26, 1989, in Chicago, the American Public Health Association's Governing Council adopted a policy statement on the "Health and Environmental Hazards of Disposable Diapers."' One of the recommendations in the policy statement was to support consumer education on the alternatives to disposable diapers. Earlier in 1989, the Seattle-King County (Washington) Nurses Association (KCNA) in conjunction with the Seattle Solid Waste Utility had developed a community education project about the potential health and environmental issues related to the use of disposable diapers. Disposable diapers, one of the many single-use products purported to make our lives simpler, are being scrutinized today because of the threat they pose to the environment. The sheer volume of solid waste created by singleuse items such as disposable diapers is of considerable concern since landfill space is decreasing. Over the past 30 years, the disposable diaper industry has grown to well over a $3 billion industry. Today, over 16 billion disposable diapers are sold in this country annually. Disposable diapers are used in approximately 85 percent of the diaper changes made in the United States despite the fact that they are the most expensive diapering alternative. Furthermore, sales of adult incontinent products are rising to meet the needs of the elderly in the community and in
institutions. AJPH June 1990, Vol. 80, No. 6
the Field Single-use diapers comprise 2 to 3 percent of the municipal waste system nationally, well over three million tons per year. It is estimated that the hidden cost of disposal is $.08 cents for every dollar spent on disposable diapersalmost $300 million annually. Experts agree the hierarchy of techniques to manage solid waste in order of the most to least desirable is waste reduction at the source, reuse, recycling, waste-to-energy incineration, and landfill. Up to this point, landfilling, the least desirable option of disposal, has been used for most solid waste, including disposable diapers. Furthermore, most of the innovative solutions to solid waste management have focused on recycling or incineration to the exclusion of source reduction and reuse. This is especially unfortunate when considering disposable diapers. An alternative to disposable diapers that reduces solid waste at the source is readily available in reusable cloth diapers. In addition to the solid waste problems created by disposable diapers, there are potentially serious health effects related to the disposal of diapers in the municipal waste stream. Used disposable diapers often contain human excrement. Over 100 enteric viruses are excreted in human feces including hepatitis and polio if live vaccine is used in immunizations. This creates a potential risk of disease transmission for sanitation workers through the feces left on a disposable diaper. In addition, many localities have regulations that make it unlawful to dispose of human excrement in residential trash. In early 1988, members of KCNA formed a Task Force and wrote a position paper. It was disseminated to local officials as well as interested community members. When a request for proposals was publicized by the Seattle Solid Waste Utility, KCNA applied for and received a grant of $35,000 to fund a one-year education project to carry out some of the recommendations made in the position paper. An advisory board of community representatives was selected for their special expertise and included: a nurse epidemiologist
and environmental health specialist from the Seattle-King County Department of Public Health, a pediatrician, an occupational health physician, a virologist, and representatives from diaper services and the disposable diaper industry. The overall goals of the project were to educate consumers about the alternative methods of diapering babies and to instruct users of disposable diapers to dump the solid fecal material into the toilet before disposing of the diaper in the trash. To achieve these goals, a multifaceted educational approach was chosen. A colorful brochure was designed for new parents; it was produced in Spanish and Vietnamese as well as English in order to reach a variety of ethnic groups. The brochure was distributed through newborn nurseries, the health department, childbirth education classes, clinic sites, and physicians' offices. The brochure includes information about the variety of alternatives for diapering baby and a table comparing the convenience, cost, and health and environmental effects of the diapering methods. The importance of hand washing to prevent the spread of infection and the technique for proper hand washing are reviewed. A brief discussion on the prevention and treatment of diaper rash is included, along with some hints for baby's health and safety. A 15-minute videotape featuring a parent education group also was produced. The videotape can be used for either professional or lay audiences and includes the same information as the brochure. In-service training classes were conducted for staff in newborn nurseries, clinics, and childbirth education classes to assist them in educating new parents. Newspaper publicity and public service announcements were planned to coincide with the distribution of the brochure and in-service training. The final phase of the project was evaluation, although in reality, evaluation was an ongoing source of feedback. For example, comments from the Advisory Board were used throughout our planning phase. Drafts of the brochure 743
NOTES FROM THE FIELD
were field tested among parents and professional groups and their recommendations were incorporated into the final version of the brochure. Our educational efforts, evaluated through direct feedback from parents and health care professionals about the brochure and the educational programs, received a positive response from both professionals and the general public. Results from a preliminary marketing study of the diapering preferences of 157 Seattle families were completed in late 1989. Almost 30 percent of Seattle families diapered their babies in cloth diapers exclusively as compared to about 15 percent nationally. There was a correlation between the type of diapers used in the hospital and the type of diapers used by parents at home. Another indicator about the effectiveness of the project is the number of institutions using cloth diapers. In early 1987, none of the hospitals that delivered babies used cloth diapers. Five of six institutions that deliver babies in the Seattle area now use cloth diapers. One of the reasons for the increase in cloth diaper services had to do with the increased concern about disposal of medical waste and incineration. The volume of diaper services in Seattle is another indicator of program effectiveness. All diaper services in Seattle estimate their service to have increased from 22 to 35 percent over the one-year period of the project. Indirect indicators such as a waste stream analysis are being used to further evaluate our efforts. Because of the time required to compile an annual rate for the waste stream analysis, we do not expect to have this portion of the analysis completed until mid-1990. We did not anticipate that our project would fuel research and development by the disposable diaper industry. However, the disposable diaper industry has subsequently developed recycling programs for disposable diapers in the Seattle area. To conclude, disposable diapers are symbolic of a single-use product that costs more than a readily available reusable one and burdens the nation's already overflowing landfills. Seattle's Diaper Education Project targeted new parents who make diapering choices and the health care providers who work with them. As a result, more parents have accurate, unbiased information about the environmental effects of various diapering methods so that they can make an informed choice. Whatever diapering method is chosen, products are now used in a more responsible 744
manner to minimize the risk of disease transmission and maximize a healthy environment. Furthermore, the project has stimulated scientific inquiry about the potential health consequences of disposing of human waste in the solid waste stream. The diaper decision task force of KCNA is expanding its focus to include a larger geographic area of the county and the state. The task force is studying the problem of adult incontinent products as well and continues to work with community groups on diapering issues. ACKNOWLEDGMENTS Funding for the project was provided by Seattle Solid Waste Utility of the Department of Engineering. An earlier version of this paper was presented at the 117th annual meeting of the American Public Health Association, Chicago, IL, October 22-26, 1989. The author acknowledges the assistance of King County Nurses Association and the Diaper Decision Task Force: Annie Bruck, Patricia Greenstreet, Linda Leaders, Laurian Pennylegion, Mary Salazar, and Alma Miller Ware, Executive Director. Mozeli Brown of the Seattle Engineering Department is also gratefully acknowledged.
REFERENCE 1. American Public Health Association: APHA Policy Statement No. 8910: The Health and Environment Hazards of Disposable Diapers. Am J Public Health 1990: 80:230. Prepared by: Janet Primomo, PhD, RN, School of Nursing, SM-24, University of Washington, Seattle, WA 91895. Tel. 2061685-855. NOTE: For information about multiple brochure orders or the videotape, contact KCNA (206/523-0997). Single copies of the brochure are available for $1.00 (enclose a self-addressed stamped envelope) from: King County Nurses Association, 8511 15th Street NE, Seattle, WA 98115.
The South Florida Perinatal Network The South Florida Perinatal Network, Inc., in Miami, Florida was organized in December 1981 as a multidisciplinary alliance of Dade and Monroe County agencies and institutions which share the responsibility for assuring the availability of quality perinatal services to all women in the community. With an estimated total population of 1.9 million in 1988, 421,436 were women of childbearing age. More than 100 agencies have forged this alliance with health professionals, hospitals, educators, parents, and community leaders whose mission is to: * provide a public forum for discussion of perinatal issues and
improve communication among Network components; * advise community and governmental agencies concerning plans for improving perinatal services; * respond to community imperatives in perinatal health; * serve as a perinatal services data bank; and * provide community education in perinatal care. The Network is recognized as a valuable resource for information by the media, local agencies and institutions, and grant applicants. Since the Network does not provide any direct service, it is able to remain impartial to any special interest groups. Numerous problems exist in the South Florida area with regard to perinatal care. A 1981 health planning study pointed to high infant mortality as a major problem, with non-White deaths being nearly twice those of White infants. The study further identified problems in access to family planning, prenatal care, and hospital services for low income women and children, as well as a shortage of neonatal intensive care beds. Planning, professional education and advocacy were directed by separate health disciplines without opportunity for a system-wide understanding. Since its inception, the South Florida Perinatal Network has made a measurable difference in improving the perinatal services system. A Maternal and Infant Care Plan for South Florida, completed in 1984, spelled out community goals and priorities. The first priority, ". . . education for healthy living and responsible childbearing," led the agency to provide the Dade County school system with in-service teacher training, to work for improved health curriculum and to take a leadership role in convincing the School Board to approve a school-based health clinic in a local area high school. With a $200,000 grant from the Robert Wood Johnson Foundation of Princeton, New Jersey and subsidies from the Public Health Trust of Dade County, the clinic is now open. The clinic offers a wide array of medical sciences; each student receives only those services that the parents approve. The second priority, ". . . promoting prevention efforts on assuring access to prenatal care and family planning," led to legislative initiatives and statewide coalition building in Florida with a resultant steady increase in general state revenue allocation for ImAJPH June 1990, Vol. 80, No. 6
NOTES FROM THE FIELD
proved Pregnancy Outcome Programs amounting to $20.6 million in additional funds over a five-year period. The Network recently established a planning committee to examine health systems issues with regard to access and availability of quality perinatal services. Access to care remains a critical issue in South Florida, and strategies are needed to stimulate community initiatives to respond to these problems as well as to develop further assistance from state, local, and national institutions. Coordination is enhanced by regular monthly Board meetings which provide a public forum to discuss issues ranging from prenatal outreach, to legislative initiatives, issues relating to acquired immunodeficiency syndrome (AIDS), cocaine-addicted babies, and battering of pregnant women. In 1986, with the problem of adolescent pregnancy on the increase, the South Florida Perinatal Network formed the Adolescent Pregnancy Prevention Advisory Council to study the problems of adolescent pregnancy in
I
the county. This advisory group has chosen to focus attention on preventing repeat teenage pregnancies, as well as prevention of the initial pregnancy. A recently completed study has revealed some disturbing facts about the complexities of this problem. The Network has been involved in providing high-quality training and workshops each year for both health professionals and the community atlarge. These sessions have dealt with such topics as: rationing of perinatal health, adolescent pregnancy, risks of pregnancy to very young and older women. The Perinatal Network is governed by a 33-member Board of Directors which includes five appointed representatives of the two regional perinatal intensive care centers, the two county health departments, and one member of the Metropolitan Dade County Commission. All remaining directors are elected by the membership, with at least five directors representing consumers. The Perinatal Network receives its
Health, United States, 1989
major funding from Metro-Dade County ($53,000) and the United Way of Dade County ($48,500). Annual membership dues provide the balance of approximately $10,000. Start-up funds were provided initially through a grant of $24,000 from the March of Dimes. In addition to all the specific accomplishments of the Network, there is yet a further clear benefit. Since its inception, the Network has provided health professionals, educators, and consumers with an opportunity to form linkages which in turn have contributed to our ability to provide more effective solutions to community perinatal and related health issues. NOTE: Materials developed by the Network for use in its programs are available on request from the authors. Prepared by: Marilyn Lesser, PhD, President, and Patricia McGovern, Executive Director, South Florida Perinatal Network, 3050 Biscayne Boulevard, Suite 206, Miami, FL 33137. Telephone: (305) 573-8313. C 1990 American Journal of Public Health
1
Overall life expectancy in the United States rose to 75 years of age and mortality from heart disease and stroke have declined dramatically during the past two decades. These facts, and other data on the health of Americans, are provided in Health, United States, 1989, the 14th annual report from the Secretary of Health and Human Services to the President and Congress. While health is improving for Americans as a whole, this improvement is not shared equally by all segments of the population. Blacks and other minorities are affected disproportionately by the impact of AIDS, homicide, smoking, and lack of access to medical care. The infant mortality rate for 1987 was 10.1 deaths per 1,000 live births. Between 1986 and 1987, the rate declined by 3 percent for white infants to 8.6 deaths per 1,000 live births, while declining by less than 1 percent for black infants to 17.9 deaths per 1,000 live births. The United States ranks 22nd in the world for infant mortality. In comparison, Japan had the lowest infant mortality rate (5.2 deaths per 1,000 live births) for 1986. Health, United States, 1989 was prepared by the National Center for Health Statistics of the Centers for Disease Control, US Public Health Service. This volume contains the fourth triennial Prevention Profile, which charts progress toward meeting the nation's 1990 health objectives. Its 131 detailed tables cover health status and determinants, utilization of health resources, health care resources, and health care expenditures. Copies are available for sale for $19.00 from the US Government Printing Office, Washington, DC 20402.
AJPH June 1990, Vol. 80, No. 6
745
