Using data to improve communities' well-being
The work of advancing health equity isn't new – but more seamless data sharing has unlocked more potential to use information and analytics to work toward addressing disparities in care.
Panelists at the WEDI Quest for Health Equity event on Wednesday noted that it's important to reinforce the relationship between public health and medicine as advocates move forward in this work.
"In terms of interoperability, technology [and] data, there may be a new conversation, but it's important for us to incorporate some of that work that's been going on for many decades," said Kenyetta Jackson, health equity manager, health solutions, at the American Medical Association.
"It's important for us to be partnering with some of those equity champions," Jackson added.
Melissa Kotrys, CEO at the Health Current health information exchange, agreed that examining social determinants of health has been an issue for decades.
Now that "we've got a reasonable handle on the exchange of clinical information, what other information can we bring to bear to improve the health and well-being of individuals and communities?" Kotrys wondered.
"How can we get access to the information we need to make a difference?" she continued. "I think the sky's the limit when it comes to how we can use … data to identify what barriers are, what challenges are, what gaps are and how we can fill those." Kotrys flagged the disconnect she sees in data sharing among county, state and federal governments – made particularly stark amidst the COVID-19 crisis.
"We always have to keep an eye toward: What is that outcome we are trying to achieve and what is it we are trying to advance?" she said. "And making sure policy decisions are in alignment with that."
"I think there needs to be strong private-public partnership," said Jackson. "I think it's very important that local public health organizations be a part of conversations, including at the federal level.
"In my opinion, when we've had health crises in the past, the feds have been helpful in providing coordination in response," Jackson added. "Where there are state-level governments that have great models, those models can be spotlighted and used to develop guidance at the federal level."
Dr. Deborah Duran, senior advisor for data science analytics and systems at the National Institute on Minority Health and Health Disparities, agreed that making change without adequate information will be challenging.
"I work with a lot of federal data, and what's happening is the data doesn't have key variables for us at the local level, state level, county level," said Duran. "Even today, there still aren't states that are collecting race and ethnicity data on COVID vaccines and cases."
That absence of information can make it more difficult to acknowledge – and subsequently address – gaps in care.
"There is a light in the tunnel there: There's an opportunity from COVID, all these things that have been brought to light as gaps in our system," said Kotrys. "We are trying to address it; it's just going to take a concerted effort from all stakeholders … and taking into account disadvantaged populations."
Jackson agreed that the pandemic may act as a tipping point: "We're thinking about these things," like health equity and social justice, "as systems seen nationwide."
Still, Duran warned, technology is not inherently neutral. As decision-makers rely more heavily on machine learning and analytics, she cautioned that they must be aware of both their own biases and those that might be baked into the system.
"When the machine is able to learn how to give us analytics, it also presents a whole other layer of confounding issues that makes biases more prevalent, and potentially can lead to more health disparities," Duran said.
She noted that in a capitalistic framework, "When there's an opportunity to make more money, the marginalized group challenged by health equity gets more marginalized."
"It's important to find a balance between the urgency to address social equity alongside the need to be thoughtful in how we're dealing with data," said Jackson.
Duran and Jackson emphasized the importance of including a wide range of viewpoints when it comes to decision-making and strategic planning.
"Make sure that whoever is not like you also exists in the room," said Duran.
"Bring uncommon players to your tables, especially if you're working with data and interoperability concerns," said Jackson.
Focus on Health Equity
This month we will be reporting on the challenges, opportunities and success stories as work continues to build a healthcare system that works for everyone.