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For the past twelve years, the annual release of the Index of Social H ealth has been a major event, cited in The New York Times, The Washing ton Post, and other national media as our most reliable barometer of p rogress in addressing America's social ills. Now, in The Social Health of the Nation, the Index for 1999—an invaluable fount of information —is available for the first time in book form.
How Are We Doing?
The Dominance of the "Economy." Is the GDP rising? Is the stock market strong? Are businesses prospering? Is inflation low? Is the deficit shrinking? Are exports increasing? These are the types of questions we ask when we wish to know "how we are doing" as a nation.
What we do well in the United States, perhaps better than any other country in the world, is monitor our economy. We ask hundreds of precise questions to assess its strength. To answer these questions, we have an array of well-recognized and frequently reported business-economic indicators and indexes.
The Gross Domestic Product, for example, tracks the size and growth of the economic sector. The monthly Index of Leading Economic Indicators combines critical indicators to forecast the coming business cycle. The Index of Consumer Confidence gives a broad picture of public sentiment and people's willingness to purchase costly goods and services. The Dow Jones Industrial Average assesses the strength of bluechip stocks and is reported to the nation on a minute-by-minute basis. The nation's economy is closely observed by such measures. They provide a timely and widely accessible portrait of our economic life. Each aspect has a gauge or meter to tell us precisely where we stand.
Movement in these many measures is assumed to affect us all. If exports are strong, dividends high, interest rates low, inflation stable, the stock market bullish, and the GDP rising, we have come to believe we are doing well. If these indicators worsen, we quickly become concerned.The various parts of the economy that we monitor are viewed as interdependent, affecting each other and affecting the whole. The economy is about "us," and its precise measurement provides vital information. A "2.5 percent gain over the last quarter" implies vigilance and rationality. When the Federal Reserve Board increases the interest rate by a "quarter of one percent" there is a sense of surgery about it.
To interpret the continuous flow of information, economists, politicians, and business leaders convene on a regular basis to assess the economic life of the nation. The annual publication of the Economic Report of the President, prepared by the Council of Economic Advisors, provides a routine point of departure to gauge the overall state of the economy. In-depth analyses of the dynamics of the various sectors are presented. The previous year's events are documented in great detail, as are trends over time, some dating back as far as 1929.
Every six weeks, the nation focuses on another important set of economic indicators when the Federal Reserve Board issues its Beige Book, a systematic survey of economic activity. Network and other national news programs report economic data every night. Most newspapers have a daily section devoted to business and economic news which includes regular updates of stocks, business activity, consumption patterns, and other related activity. A range of newspapers and magazines are devoted exclusively to the economy, including the Wall Street Journal, Business Week, and Fortune.
In contrast to the tools, structures, and mechanisms of the economic sphere, the richness and variety of its indicators, and the regularity with which they are reported, our vision of the social sphere is far more obscure. Social data are collected once a year at best, rather than daily, weekly, monthly, or quarterly, as in economics. Moreover, they are often two to three years out of date by the time they are released, making the information they convey far less compelling and our ability to deliberate or to respond far less likely. Even the occasional front-page story on a social problem, such as teenage suicide, may present data that are more than two years old, and the common caveat, "the last year for which data are available," is an all too familiar aside. In fact, there may be as many as twelve or more regular monthly reports to the nation about the availability of durable goods or the size of factory inventories for each single, out-of-date, accounting of how many teenagers were sufficiently depressed to take their own lives (see Chart 1.1).
Most significantly, social data are not generally thought of, collected, or released as indicators that chart the performance of a larger condition like the "social state of the nation," nor are they combined into accessible indexes or barometers designed to keep track on a regular basis of what is considered important. Furthermore, there are no official bodies to review the processes of data conception, collection, and release, to issue statements of interpretation and analysis, to relate the various results to each other, or to provide a perspective on their implications for the condition of society as a whole.
The child abuse rate, for example, may be issued once a year, but not in the context of other related data such as poverty, suicide, drugs, or crime, that would give it context and enlarge our understanding of the total picture. Health insurance coverage is another critical issue, but it is typically released apart from related issues such as infant mortality or life expectancy. Some important issues have no reliable data at all. Problems such as hunger, homelessness, and illiteracy are still not reliably measured or tracked.
Although much social data exists on many important aspects of daily life, it is usually not made available in a form that is accessible to the public, to the makers of policy, or to the media. Studies with numerous tables of raw statistics are often distributed with little interpretation or text. The results of whole surveys are sometimes published with few references to past trends or larger meanings. Some data are published under several auspices, each using a different definition of the same problem, each released at a different time of year. Reports are often technical documents meant for experts, and contribute little to the public dialogue unless a special effort is made by a journalist or scholar to make them accessible.
In effect, the data available from the literally thousands of studies and surveys conducted by the government are not narrated, as are traditional business and economic indicators. This lack of coherence frames the way in which social conditions are covered in the national news media and shapes the public's view. Social data, when they are covered, are presented as unrelated pieces of information rather than as part of a larger system that tracks and updates important on-going conditions. A subject may be presented once, but there is often little or no follow-up.
More typically, social data appear in the media as incidental information in the context of sensational events. If a particularly brutal case of child abuse occurs, coverage may include the latest data. The O. J. Simpson trial, for example, produced a smattering of statistics on domestic violence. The Los Angeles riots of 1992 evoked some discussion of poverty and inter-racial conflict. The high school killings of 1998 and 1999 brought a brief reflection on the nature of juvenile crime. In each case, news coverage was intense for a short period, but as such crises petered out and as the nation moved on, the sense of the seriousness and pervasiveness of these problems quickly faded from public view.
This approach applies even to our major print media. In the New York Times, for example, there were 52 stories in 1996 on the problem of infant mortality. Of these, 74 percent dealt with the death of individual infants. Two particularly sensational cases accounted for more than half the stories. Seven stories dealt with new medical interventions. None dealt with infant mortality as a social indicator. An analysis of the same year found similar results for issues of child abuse, drunk driving, and suicide.
Episodic reporting of this kind obscures the daily impact of conditions such as child and domestic abuse, poverty, low wages, the lack of health insurance, inadequate housing, and substance abuse. Instead of being acknowledged as being a part of everyday society, these problems often appear as if they were random occurrences that defy understanding or solution. Yet, as Part Two of this book clearly shows, these conditions are not idiosyncratic as the coverage often conveys; they are a pervasive part of our national life.
Other aspects of our society are far better narrated. The nation's politics are measured nearly as precisely as is the economy, and probably receive even more on-going coverage. Highly sophisticated polls keep track of the ups and downs of our responses to major politicians. Countless commentaries and reports in the print and electronic media keep us well informed of the moves and countermoves of politicians; many are devoted exclusively to the most recent poll data. Our political life is monitored, regularly and precisely.
But few newspapers have a daily or weekly section devoted exclusively to social issues or conditions. It is rare for a reporter to be assigned to cover social issues as a whole. There is no accepted social "beat" similar to those for politics or economics. Even major newspapers, such as The New York Times, The Washington Post, or The Los Angeles Times, have no section devoted solely to social issues and conditions, that routinely combines the statistical and the human to provide a continuous flow of information on what is happening to the nation in this area. There are sections which are regularly devoted to art, style, science, dining, home, and, most recently, computers; there are weather reports, business and economic reports, sports reports, and movie reports, but nowhere are there established social reports.
The lack of context and regularity in the reporting of social issues, and the absence of the kind of familiarity that an on-going narrative, grounded in fact and interpretation, could provide, have made public deliberation about social issues more vulnerable to the politics of the moment. The recent national debate about health insurance illustrates the point. It has been widely acknowledged that the fate of national health care reform turned on the effectiveness of partisan political advertising, which easily filled a void in public knowledge. The welfare reform debate was similarly intertwined with the struggle for political advantage in a presidential election year. Even the current discussion about changing the Social Security system has focused almost exclusively on fiscal and political matters, while generally ignoring the impact that the various proposals might have on the future well-being of the elderly population.
There are many problems that need to be overcome if we are to develop a fuller answer to the question, "How are we doing?" As we have argued, our ability to understand and to accurately monitor the health of our society is limited by the absence of a well-conceived and organized system of social reporting and by the lack of coherent and consistent vehicles in the print and electronic media to bring a social health perspective to the public with context, consistency, and meaning. We are limited, as well, by the sheer magnitude and impact of economic and business reporting, which provides so consistent an assessment of our progress that there may seem to be no need to look any further.
But the power of economic and business indicators suggests a framework for developing and advancing the social health perspective. The traditional economic barometers, instruments, and indicators do not furnish a complete picture of the performance of the nation. Nevertheless, their form, method, and impact provide guideposts by which to proceed.
Changing the Picture. The effort to create and communicate the social side of American life requires innovation on many fronts. The foundation for these advances rests on the ideas and tools of the field itself.
Fields of analysis advance at different rates. Sometimes they leap ahead when a new vision is discerned. At other times, disciplines move forward in increments, creating building blocks which serve as "tools in readiness" for the time when that larger vision emerges. The building blocks for social health are social indicators. They are the basis upon which a broader vision can be built; they represent a different approach to thinking about the issues. The concept of indicators is a key to viewing social conditions in a new way—in terms of performance.
An indicator is a metaphor, a sounding, a hint of something greater. A good indicator is not "a thing in itself," to be examined and understood in isolation, but a glimpse of a broader context. It "indicates." Economic indicators clearly function in this manner. Business starts, business failures, interest rates, durable goods, or the money supply are aspects of that greater entity we call the "economy." Each tells us something about the larger picture.
As we have noted, social data are generally neither conceived nor recognized as indicators. To become true indicators and to have significant value to the national discourse, they cannot continue to stand alone as isolated and unrelated statistics. There must be a series of related indicators, recognized as representing key aspects of society, that are frequently and consistently monitored, indicators that can be easily charted, communicated, and discussed by policy makers and the public. Furthermore, we need to develop agreed-upon benchmarks and standards by which the performance of these indicators can be assessed. Rational judgments can then be made as to whether or not the nation has attained a desirable state. Most importantly, each indicator must be viewed as part of a system that monitors something larger that is of importance to the society and its population. At present, that "something larger" in the social sphere has a much more diffuse identity than the "economy" and no precise name other than "society," a term whose meaning is far less grounded. Because of the current vagueness of this larger frame, its significance for "us" is far less evident.
Yet if housing starts and factory inventories can be viewed as parts of a larger picture that affects us all, if the personal approval ratings of our governors, senators, and presidents are deemed vital information, then the proportion of students who drop out of school, the suicide rates of our youth, the percentage of children who are abused, the availability of low-cost housing, or the quality of our civic engagement must also be considered crucial aspects or indicators of our nation's condition, a part of the official social portrait of the nation's progress.
Such issues have great consequences for the social fabric because they go far beyond the specific population or group that is initially affected. Those who drop out of school, for example, shape not only their own lives, but the lives of many others as well, through their lower earning power, their constrained civic participation, and the effects of these on the next generation. Youth suicides are tragedies not only for the immediate families involved, but often for the children's schools, their communities, and sometimes the nation. Such events ripple outward, affecting the future. Children who are abused may never recover, suffering lifetimes of anxiety and pain, affecting those with whom they build relationships. Alternatively, a significant increase in the number of meaningful and satisfying jobs that provide means for advancement and that pay good wages has lasting significance, as well, both for those directly involved and for the society as a whole.
To gauge such effects, to connect them to one another and to a broader picture, sharper and more focused tools must be developed. One important concept that is rarely applied to the social sphere is the idea of thresholds of performance. Most economic assessments are based on such concepts. Economists routinely assess whether the economy is performing well or performing poorly. When the economy is performing particularly poorly, we have a name for the phenomenon: we declare a recession. Recessions have a working definition—two or more quarters of declining GDP—and there is an official oversight body, the National Bureau of Economic Research, which assesses the depth and longevity of each episode. Recessions usually embody many problems at once: employment drops, housing sales decline, consumer spending falls, businesses fail, profits decline. The engines of the economy begin to sputter and a critical period is identified.
As will be shown in Part Two, the nation has experienced comparable conditions in the social sphere, and we need comparable concepts to define and communicate these developments when they occur. Rising inequality, the poverty of children, the lack of health insurance, the increase in youth suicide, the escalation of child abuse and drug use, the erosion of our schools, the weakening of our infrastructure, all suggest something akin to a recession—a social recession. Yet, even where problems have worsened consistently for a decade or more, we have no concept—and no words—to declare the episode special. When problems improve, we have little sense of their significance. We have no widely recognized indexes or indicators that "lead" or "lag" critical periods, telling us if upheavals are imminent or past. Are we in recession or recovery? The inner workings of the social sphere have yet to be defined.
When the economy as a whole is not in recession but instead has specific weaknesses—perhaps in housing sales or the bond market—these "soft spots" often can be clearly identified. The social sphere, too, has its soft spots. But there is no Alan Greenspan for the social health of the nation, no one in an official capacity to "sound the alarm," take stock, and recommend action. If we had a true system of social indicators, with agreed-upon benchmarks of performance which were easily communicated, we could begin to establish a firm basis on which to determine whether or not to be concerned.
The medical field, too, offers insights. In medicine, the careful monitoring of soundings, samples, or indicators is done on a routine basis. The indicators here are symptoms, and like economic indicators, they are connected to a whole. A rising temperature is usually not so much a problem in itself, but is considered a cause for concern because it may reveal an infection or a deeper underlying condition; the same is true for cell counts, antibody counts, heart rates, or other similar measures. We need the same broad framework or context in the social sphere so that we can read an indicator, like a symptom, as a reflection of something larger, which needs to be diagnosed, interpreted, and rationally discussed in order for it to be corrected.
In medicine, certain symptoms have relative urgency or priority. Some are more critical than others; they affect vital organs or the fundamental well- being or integrity of the body. In the social sphere, we need indicators that, like medical symptoms, carry similar priority. Clearly, some problems are more crucial than others. Which? A precise answer may be a while in coming, but it is a vital question to consider.
In both the medical sphere and the economic sphere, there are thresholds beyond which a critical point is reached: temperatures above or below a certain point, economic growth above or below a certain level. These lines, obviously arbitrary to some degree, are nevertheless instructive, in that they alert us to potential crises and conditions. As in physics, they point to a "critical mass."
In the social sphere, there are more than forty million people in this nation without health insurance. Is there an agreed-upon line which, when crossed, tells us that we have reached the point of urgency? How do we know when we have passed it? The child poverty rate has remained at or around twenty percent for more than a decade. When does this become significant?
By the same token, how do we know we are doing well? How many years of improvement are required to declare an issue a "non-problem" because agreed-upon and significant progress has been achieved? Violent crime has improved for six consecutive years. Is it no longer a matter of serious import? The rate of teenage births has returned to the downward trend it demonstrated in the 1970s. Should we cease to be concerned? Alcohol-related traffic fatalities have declined sharply in recent years. Is that significant? Is it likely to hold?
In summary, the creation and communication of the social side of the nation's official portrait will require new ideas and new resources. There need to be vast improvements in the way current information about our social health is conceived, analyzed, interpreted, made accessible, and presented to the media and to the public. These advances will help us to envision the nation's most pressing concerns more clearly, defining the limits of our tolerance for adverse conditions, and identifying national successes when they are achieved. They will help to move into the arena of public concern issues that too often are seen solely as examples of private misfortune.
Economic indicators took time to achieve their current power and significance, and the same will hold true for social indicators. But their advancement represents an opportunity to improve democracy by helping to stimulate a more informed involvement on the part of the public. This is particularly important at a time when there is a general concern over the ebbing quality of our public deliberations. As the next chapter will show, there is a context for this work, drawn from our own history and from current efforts both here and in other nations.
|The Working Group on Social Indicators|
|Pt. 1||Seeking the Social Side of the Portrait|
|1||How Are We Doing?||11|
|2||Part of a Tradition||21|
|Pt. 2||Framing a Social Health Perspective For the Nation|
|3||There's Something Else Out There||39|
|4||Indicators of Improving Performance||47|
|5||Indicators of Worsening Performance||73|
|6||Indicators of Shifting Performance||117|
|7||Judging the Nation's Social Performance||149|
|Pt. 3||Pursuing a Practical Vision|
|8||Advancing the Field||159|
|9||The Tasks of Visibility: A New Direction for Social Reporting||169|
|List of Charts and Indicators||181|