The Making of Public Health Data: Paradigms, Politics, and Policy

F you don't ask, you don't know, and if you don't r-7 I 3know, you can't act. These basic precepts lie at the core of current and long-standing controversies about the nature and politics of public health data within the United States (1-5). At issue is the routine iL~+.wuJomission of social class data from most data sources, such as national vital statistics, disease registries, hospital records, and even individual studies, along with the persistent treatment of "race " and "sex " as essentially biological variables, their consistent conflation with ethnicity and gender, and the pervasive silence about the social realities of class inequalities, racism, and sexism. Although concerns about measures used in public health data may seem removed from the tumult of everyday life and everyday struggles for dignity and health, the ways these data are collected and reported can profoundly affect how public health professionals and the public at large perceive health problems and their support for or opposition to diverse public health programs ( 5).Label infant mortality a prob-lem of "minorities " and present data only on raciallethnic differences in rates (6), and the White poor disappear from view; label it a "poverty " issue and proffer data stratified only by income, and the impact of racism on people of color at each income level is hidden from sight (7);define the "race " or socioeconomic position of the in-fant solely in terms of the mother's characteristics (8), and the con-tribution of the father's traits and household class position ( 9) to patterns of infant mortality likewise will be obscured. Any particular approach necessarily affects our ability to understand and alter social inequalities in health. Despite being fraught with political considerations, the making of public health data-that is, the processes whereby health profession-als and institutions decide whether to obtain and present data in par