Many of the social problems affecting the health of Americans do not have known technical solutions. As a society, we continue to struggle with questions about how to convince people to stop smoking or to be less violent, how to improve the way health care services are coordinated for people with Alzheimer's or how to finance such services equitably. But in the area of early childhood diseases—such as measles and whooping cough—we have well-known technical solutions for reducing the incidence of these diseases. Available vaccines can dramatically reduce the onset of a wide range of childhood diseases and the vaccines are not particularly expensive or difficult to administer.
So the goal of immunizing all or most children should be attainable. As a nation, however, we have not succeeded at getting some children from low-income families—and particularly younger children—vaccinated. Barriers to medical care generally facing these families lead to low vaccination rates.
This chapter reviews a national program supported by the Foundation and other funders to use computer technology to design vaccination registries that facilitate the monitoring of childhood immunizations and allow outreach workers to get in touch with the families of children needing vaccinations. The program supported a range of efforts in 24 geographic areas to improve immunization rates for very young children.
As this chapter makes clear, even when technical solutions to a social problem exist, there are incredibly complex issues of implementation that need to be addressed. It explains in detail the barriers faced and some of the creative solutions devised by many of the grantees to make these registry systems work. The chapter also sets the work of the grantees into a context of the problems associated with immunization in this country.
- 1. Editors' Introduction
- 2. Reach Out
- 3. A Review of the National Access-to-Care Surveys
- 4. Improving the Health Care Workforce
- 5. Expertise Meets Politics
- 6. The Media and Change in Health Systems
- 7. Addressing the Problem of Medical Malpractice
- 8. Unexpected Returns
- 9. Developing Child Immunizations Registries
- 10. The Homeless Families Program
- 11. The National Health and Social Life Survey