Valid and reliable data are a sine qua non of constructive health policy. A paper in the April 27, 2023 issue of the New England Journal of Medicine on the topic of advances in artificial intelligence for infectious-disease surveillance acknowledged when nurse and statistician Florence Nightingale developed her innovative “rose diagram” of preventable deaths in the Crimean War (April 1854 to March 1855). Despite heavy opposition from her British medical and military superiors, her efforts revolutionized data-driven disease surveillance. An excellent summary of her achievements is conveyed in an article by Lee Brasseur in the Spring 2005 issue of the journal Technical Communication Quarterly.
Her figures consisted of wedges arranged around a center with each wedge representing by its area the amount of mortality for the period to which it refers. They were called rose diagrams, so called because of their shape, which resembles that flower. The illustrations are remarkable not only in being able to communicate this kind of comparative argument, but also because of their ability to show the progression of the war as revealed both through their circular shape and their textual features. Clearly, nothing like Nightingale’s rose diagram had been seen previously. Not only was her approach unique, it compares favorably with two famous visualizations of that same period: Charles Joseph Minard’s portrayal of wartime mortality while plotting the strength of the Napoleonic Russian Campaign as it progressed through the Russian winter and John Snow’s production of a map displaying epidemiological data leading to the discovery of the source of a cholera epidemic at the famous Broad Street Pump in London, England.
Many important statistical advances have occurred since then and the U.S. leads the world in the production of important data pertaining to a broad spectrum of human and animal existence. As described in the May 2023 issue of The American Journal of Clinical Nutrition, the 1956 National Health Survey Act authorized federal agencies to collect statistics for a variety of health issues. This law created the U.S. National Health Survey Program, a component of which was the National Health Examination Survey (NHES). Nutritional assessment was added to NHES in 1971 and the survey was renamed NHANES (National Health and Nutrition Examination Survey) to assess health and nutritional status of adults and children in this nation. It operates primarily out of mobile examination centers (MECs) that travel to selected sites to obtain a representative sample of the U.S. population.
Presently, NHANES is at a key crossroads. The impact of years of inflation on the survey’s stagnant budget has undercut activities to meet the future. The potentially game-changing nature of newer challenges cannot be avoided. Supporters believe that a study by the National Academies of Sciences, Engineering, and Medicine (NASEM) to set the stage for the future of NHANES, i.e., to provide an actionable framework, is a critical and prudent step forward. Also, maintaining the status quo and failing to adapt to emerging challenges cannot be an option for a survey that is so vital to the nation’s health and wellbeing.