Measurement of death needs to be improved to save lives in future

In a world dealing with the worst public health crisis in a century, the current U.S. system for tracking deaths suffers from organizational, political and procedural flaws that actually put public health and safety at risk, and requires significant updates and reform to solve the problems laid bare by the COVID-19 pandemic.

"Inaccuracies in mortality data have real consequences for the public health mission," said Dr. Vickie Mays, UCLA Fielding School of Public Health professor of health policy and management, who said these weaknesses have played out in how the U.S. measures mortality, creating data gaps critical to accurate classification of deaths, from COVID-19 to suicides to legal use of deadly force.

"The extensiveness of missing race/ethnicity data or inaccurate classifications in testing data, registries for vaccinations, health survey data, and hospital and administrative data impairs the work of public health and puts everyone at risk," Mays said. "And if public health is not guided by a social justice approach, we may end up viewing the racial and ethnic health disparities of the COVID-19 pandemic as 'normal.'

Mays, director of the UCLA BRITE Center for Science, Research & Policy, served as guest editor of a special issue of the American Journal of Public Health, published today, that examines the lessons learned from COVID-19 and a wide array of potential solutions, actionable at the federal, state, and local levels.

"A major lesson from COVID-19 was that we don't have the surveillance tools to track the progression of the pandemic as it unequally ravaged communities across the U.S.," said Dr. Alfredo Morabia, editor-in-chief of the Journal, a monthly peer-reviewed academic publication established in 1911 by the American Public Health Association. "This supplement is a topical and timely contribution about the instruments that are urgently needed to accurately count the deaths."

In the lead editorial, Mays and her co-editor, Dr. Susan Cochran, UCLA Fielding School of Public Health professor of epidemiology, make the point the problems are widespread, and that there are potential solutions at hand – including some already proven at the pilot project level.

"There is a need to improve the quality of mortality data and routine surveillance in general; this is especially true for disasters – including when the world is experiencing a global pandemic - and when we are trying to learn from mortality incidents to delay or reduce their occurrence," said Cochran, who is both a both a psychologist and an epidemiologist. "But there are solutions to these mortality and measurement concerns that have been allowed to fester."

In the lead piece which provides a roadmap to the overall supplemental issue, Mays and Cochran make the point there are at least three underlying issues:

• First, the need to internationally and domestically to improve the quality of mortality data and routine surveillance in general. It is important to the living to understand how deaths occur in order to prevent them
• Second, inaccuracies in mortality data have real consequences for the public health mission. Delays in reporting race/ethnicity and updating death collection systems means that the most vulnerable may be the last in line for life-saving interventions
• Third, the public health professionals who register deaths, aid the bereaved, and conduct mortality research, are often forgotten voices as first responders also impacted by deaths in large numbers

The edition include some 26 peer-reviewed pieces and commentaries; these include seven by Fielding School-affiliated authors. The faculty authors include Mays, Cochran, and Dr. Jody Heymann, Dr. David E. Hayes-Bautista, Dr. Paul Hsu, and Dr. Ninez Ponce.

"Contributions by (these) outstanding scholars add great weight and depth to this supplement," Morabia said. "(They) run the gamut of issues that will have an impact on how we evaluate mortality data and also its importance in addressing social justice and disparities in this country."

Specific articles include:

• A Look at When Dying Really Counts: An AJPH Supplement on Mortality Data in Public Health Surveillance
• To Save Lives, We Need to Improve the Measurement of Death
• Social Justice Is Not the COVID-19 Vaccine Alone: It Is Addressing Structural Racism Through Social Policies That Shape Health
• Aggression, Escalation, and Other Latent Themes in Legal Intervention Deaths of Non-Hispanic Black and White Men: Results From the 2003‒2017 National Violent Death Reporting System
• Deaths of Non-Hispanic Black and White Men: Results From the 2003‒2017 National Violent Death Reporting System
• Office of Management and Budget Racial/Ethnic Categories in Mortality Research: A Framework for Including the Voices of Racialized Communities
• Disparities in Native Hawaiian and Pacific Islander COVID-19 Mortality: A Community-Driven Data Response