The technology and labour behind electronic death registration
a day ago
- #public health history
- #death registration
- #data infrastructure
- Theodore D. Woolsey emphasized in 1968 that data systems are crucial for public health, highlighting the need to transform anecdotes into data and policy recommendations amidst increasing demands for evidence and budget constraints.
- U.S. public health officials attempted to modernize death registration from the late 1960s, but faced decades of challenges, including issues with computerization and the reliance on human labor for data gathering, which persisted even with electronic death registration systems (EDRS) into the 2000s.
- Historiography on U.S. civil registration systems is limited, but recent works by Susan J. Pearson and Stephen Berry explore birth and death registration, though Berry's focus is on early 20th-century origins, leaving gaps in later decades.
- This article expands the chronology of U.S. death registration history, examining how infrastructure responded to technological changes, and argues that officials fell into an 'innovation delusion,' prioritizing technology over maintenance and human labor.
- Key problems identified in the 1960s included inadequate funding, staffing, and training for vital records offices, with computers seen as a potential solution despite warnings about their limitations in creating data.
- Early computerization efforts focused on automating cause-of-death classification (nosology) rather than improving data collection at the source, leaving issues of incomplete or inaccurate data unresolved.
- By the 1990s, officials pushed for electronic death registration, inspired by successful electronic birth registration, but recognized it would be harder due to multiple data sources and the need for ideological investment from death-care workers.
- Data entry labor emerged as a major challenge, with physicians resistant to entering data and funeral directors prioritizing care over paperwork, complicating EDRS implementation.
- Techno-solutionism fueled EDRS development amid budget cuts, with officials optimistic that technology could solve data quality and efficiency issues, aiming for widespread adoption by 2000.
- Design tensions in EDRS centered on balancing data quality with user-friendliness, particularly through pick lists, which risked oversimplifying data and requiring maintenance, while also facing funding shortages and technical expertise gaps in rollout.