The Power of Data, the Price of Exclusion

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LAST JUNE, a special issue of Morbidity and Mortality Weekly Report (MMWR) focused on suicide with the stated goal “to provide insights that might lead to successful prevention programs.” The issue included articles on trends in suicide by young people, suicide attempts and physical fighting among high school students, school-associated suicides, suicide among Hispanics, and suicidal behavior in China. MMWR is a publication of the Centers for Disease Control and Prevention, and its purpose is to alert public health officials about emerging trends, issues, and outbreaks of disease. On occasion it dedicates an issue to a single theme in order to draw attention to important topics.

Suicide is the eleventh highest cause of death in the United States, third among ten-to-24-year olds, and in 2002 was the cause of over 124,000 visits to emergency rooms in the U.S. The prevention of suicide is a national priority, and objectives to track and ultimately reduce suicide are included in Healthy People 2010, the nation’s health promotion plan. Countless studies over the past ten years document the fact that gay youth are at increased risk for attempting suicide. Studies have appeared in publications such as the Archives of General Psychiatry, International Journal of Eating Disorders, Pediatrics, Archives of Pediatrics and Adolescent Medicine, Journal of Gay and Lesbian Social Services, Journal of Pediatrics, Social Work, American Journal of Public Health, and Journal of Adolescent Research, and in reports published by the states of Massachusetts, Oregon, Vermont, and Washington. Of all the issues that affect gay youth, there is no other issue on which there’s so much consensus as on gay youths’ risk of suicide.

And yet, despite this robust finding, no mention of sexuality appears in the 28-page Morbidity and Mortality Weekly Report for June 2004. In July 2004, a similarly glaring omission appeared in an MMWR report on violence among high school students. A product of the federal government, the MMWR is subject to the same political pressures as other parts of the Department of Health and Human Services. So it should come as no surprise that the editors of the MMWR would shy away from open communication about sexuality. The omissions, however, raise questions about the ability of the federal government to succeed in securing the health and well-being of its citizens.

Unlike most other countries, the United States takes a disease-specific rather than a population-specific approach to health. That means

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