Creating a community report card: The San Diego experience

San Diego County population is the second largest in California and the fourth largest in the United States. The 2.7 million people of this large and heterogeneous area represent diverse racial and ethnic backgrounds and present many challenges to those providing public health and social services. Recent changes - welfare reform, the movement of Medicard to managed care, and restructuring of the county's Health and Human Services Agency - further challenge the ability to improve outcomes for children and families. The Country Board of Supervisors and the members of the community wanted to know what impact these changes might be having on the health and well-being of children and families. The board ordered the development of a monitoring system, and in response, the San Diego County Child and Family Health and Well-Being Report Card was created to monitor community-level outcomes. Community report cards provide a snapshot of the overall health and well- being of a community through the use of indicators or measurements of local trends. Such reports are used increasingly across the United States to bring critical information to community members, service groups, and policymakers. A national directory of such report cards has recently been released and is described elsewhere.