Alonzo Plough

The data come from an analysis system that for the first time gives officials access to health behavior information on a local level that can be compared to data from neighboring communities, the state and the nation. The system is called SMART BRFSS (Selected Metropolitan/Micropolitan Area Risk Trends from the Behavioral Risk Factor Surveillance System).

The system was announced at a news conference at the APHA meeting on November 18 and can be accessed at www.cdc.gov/brfss.

Information in health categories such as diabetes, obesity, smoking and health status is available for 98 regions, including the Boston-Quincy and Cambridge-Newton-Framingham areas. The regions are in 49 states and Washington, D.C. The regions are based on those designated as "Metropolitan/Micropolitan Areas" by the U.S. Census Bureau.

Health officials have long had access to information on infectious diseases in their local areas because health care providers and hospitals are required to report cases of specified diseases based on a pre-determined list, explained Alonzo Plough, director of the Seattle-King County Public Health Department in the state of Washington and former HSPH visiting lecturer. With SMART BRFSS, health officials can now be better aware of trends in chronic diseases in their areas, he said. That information becomes particularly important because health departments, using local funding, set their program and research priorities with an eye to community concerns, he said.

Chronic diseases make up three-quarters of health care costs in the U.S., pointed out James Marks, director of the CDC’s National Center for Chronic Disease Prevention and Health Promotion. The SMART system allows local officials to measure the health status of their communities and see how they compare to neighboring areas, he said.

"The Healthy People 2010 Initiative emphasizes that the health of the individual is inextricably linked to the health of the community," observed Howard Koh, director of the Division of Public Health Practice and former Massachusetts Commissioner of Public Health. He was not directly involved in planning the new system but notes the value of it. "SMART BRFSS can guide the work of all public health practitioners committed to eliminating health disparities in our nation."

The SMART system statistics reveal a nation where behavioral risk factors range widely from region to region. For example, there was an overall four-fold difference, ranging from 6.7 percent in one area to 26.2 percent in another area, among people reporting their general health as fair or poor.

The system pulls information from the Behavioral Risk Factor Surveillance System (BRFSS), consisting of annual telephone surveys conducted by each state on health risk behaviors, preventive health practices and health care access related to chronic disease and injury. The surveys involve more than 200,000 adults, who self-report their behaviors.

From the BRFSS data collected in 2002, organizers of the new SMART system culled local-level information. Statistics were drawn for counties that had enough respondents, more than 500 participants in BRFSS, to make a statistically competent sample size.