In 1996, 647 people died in Cape Girardeau County.

Cardiovascular disease claimed most of those lives -- 334 of the total deaths.

Cancer -- classified as malignant neoplasm -- was the second leading cause of death, claiming 127 deaths. Of those 127 people, 49 died of cancer of the lungs and respiratory organs.

Other leading causes of death included pneumonia and influenza (27), chronic pulmonary disease (42) and "all other" diseases (57).

Accidents claimed 15 lives in Cape Girardeau County in 1996.

Cape Girardeau County's numbers didn't differ much from the leading causes of death recorded statewide.

In 1996 in Missouri, 53,766 people died. Heart disease led the causes of death, killing 18,174 people. Next on the list were cancer (12,014), stroke (3,687), chronic pulmonary disease (2,516) and accidents (2,253).

On the other side of the coin, 803 resident live births were recorded in Cape Girardeau County last year, compared to 73,733 statewide.

Cape Girardeau County's live birth rate works out to 12.2 births per 1,000 population, while its death rate was 9.8 per 1,000.

Statewide, there were 13.8 live births for every 1,000 population, and 10 deaths per 1,000.

All of these numbers -- officially, the state's vital statistics -- do more than ensure job security for number-crunchers and bean counters.

By studying the grim statistics, health experts can determine what's killing us, and devise strategies to reduce those mortality rates.

The leading causes of death in Missouri are what health experts call chronic diseases -- heart disease, cancer, etc., -- rather than communicable, or contagious diseases -- AIDS, influenza, etc.

Finding trends in those statistics means looking at numbers stretching back five, 10 or 20 years or longer, said Dr. Eduardo Simoes, an epidemiologist for the Missouri Department of Health's Division of Chronic Disease Prevention and Health Promotion.

"With infectious disease, there's an outbreak that happens. There's a threshold number," Simoes said. "What we do with chronic diseases is look at the trends. If the trend is coming differently than what you expected, then you plan your strategy."

When there is an outbreak of an infectious disease, health experts can take an immediate action -- vaccinations for at-risk populations, quarantining the infected, improve sanitation to contain the source of the infection.

"This is so critical that you track it on a weekly basis," he said. "If in a week or two, cases start showing a very fast rise, it's an indication that maybe an epidemic or outbreak is coming."

There are no outbreaks of heart disease or lung cancer. But over the years, mortality rates from those diseases may creep up or down.

"You look at things year by year, sometimes every 10 years or every five years," Simoes said.

Health officials study mortality rates, and if the death rate from a particular condition -- whether it's lung cancer, heart disease or automobile accidents -- is high enough, they determine how much they think they can reduce those rates within a particular time frame.

By identifying risk factors that contribute to the health problem, health officials can begin working toward achieving those objectives.

For lung cancer, for example, the biggest risk factor is smoking.

Once those risk factors are identified, public health officials look for ways to prevent the public from engaging in those risk factors.

In the case of lung cancer, the emphasis has been on persuading people to either give up their cigarettes, or to not start smoking at all.

"So we know if we can get rid of smoking, 90 percent of the population will never have lung cancer," Simoes said.

In order for those objectives to be met, the public has to cooperate with public health initiatives.

Sometimes that doesn't happen, Simoes said.

Cigarette use in Missouri "has gone nowhere for the last 10 years. It's still one of the highest in the nation," he said. "I know the smoking is a risk factor. I don't know how to change people. I don't know how to make youth not smoke."

Infant mortality is closely monitored at the state and local levels, said Jane Wernsman, the assistant director of the Cape Girardeau County Health Department.

Programs like WIC, a federal initiative in which pregnant women and young children can receive nutrition assistance, are aimed at reducing infant mortality. Improving the mother's nutrition decreases the odds of her having a low-birth weight baby, and increases the odds of the baby's survival.

It's also important to know what the numbers being studied mean, especially for chronic diseases, Simoes said.

Missouri's population -- like the rest of the nation's -- is aging. And older people are more vulnerable to heart disease, cancer and stroke, the three leading causes of death in Missouri.

Other factors also come into play. Obesity is on the increase nationally, and obesity is a risk factor for many chronic diseases, including heart disease, some types of cancer, stroke and diabetes.

Breaking down health statistics by age, race, gender, location, etc., helps public health officials identify at-risk populations.

For example, older black people are at greater risk of developing diseases like diabetes and hypertension.

If statistics show that a particular group is at greater risk for a particular condition, prevention efforts can be targeted at that population, Simoes said.

"It's just a way to justify how to spend limited resources," he said.