Data for Equity: Creating an Antiracist, Intersectional Approach to Data in a Local Health Department

Engaging Antiracist And Decolonial Praxis To Advance Equity In Oregon Public Health Surveillance Practices

Public health surveillance and data systems in the US remain an unnamed facet of structural racism. What gets measured, which data get collected and analyzed, and how and by whom are not matters of happenstance. Rather, surveillance and data systems are productions and reproductions of political priority, epistemic privilege, and racialized state power. This has consequences for how communities of color are represented or misrepresented, viewed, and valued and for what is prioritized and viewed as legitimate cause for action. Surveillance and data systems accordingly must be understood as both an instrument of structural racism and an opportunity to dismantle it. Here, we outline a critique of standard surveillance systems and practice, drawing from the social epidemiology, critical theory, and decolonial theory literatures to illuminate matters of power germane to epistemic and procedural justice in the surveillance of communities of color. We then summarize how community partners, academics, and state health department data scientists collaborated to reimagine survey practices in Oregon, engaging public health critical race praxis and decolonial theory to reorient toward antiracist surveillance systems. We close with a brief discussion of implications for practice and areas for continued consideration and reflection.

Equity Work Among Accredited Health Departments in the United States, 2015-2021

OBJECTIVES

Minimal research has examined the number of health departments conducting work related to equity and/or the kind of work, if any, they are conducting. We examined the relationship between public health accreditation and work related to health equity by analyzing accredited health departments' responses to a prompt in the Public Health Accreditation Board's (PHAB's) annual report.

METHODS

We analyzed self-reported responses from accredited health departments to questions about emerging public health issues and innovations in PHAB's annual report. We identified themes using a priori and inductive coding.

RESULTS

A total of 316 health departments submitted an annual report from January 2015 through December 2021. Of those health departments, 283 (89.6%) stated in their annual report that they engaged in work related to health equity, 50 (17.7%) of which provided a narrative about this work. Of those 50 health departments, the most common theme reported was community partnership, described by 23 (46.0%) health departments. The next most reported themes were COVID-19 vaccine access for racially or socioeconomically marginalized communities (n = 17, 34.0%) and programs related to health equity (n = 16, 32.0%).

CONCLUSIONS

We found that most accredited health departments conduct work related to health equity. Further research is needed to examine characteristics that influence a health department's likelihood of conducting equity work. Models and resources on how health departments, particularly small health departments, can begin equity work would be valuable.

Centering Communities of Color in the Modernization of a Public Health Survey System: Lessons from Oregon

Context

Public health survey systems are tools for informing public health programming and policy at the national, state, and local levels. Among the challenges states face with these kinds of surveys include concerns about the representativeness of communities of color and lack of community engagement in survey design, analysis, and interpretation of results or dissemination, which raises questions about their integrity and relevance.

Approach

Using a data equity framework (rooted in antiracism and intersectionality), the purpose of this project was to describe a formative participatory assessment approach to address challenges in Oregon Behavioral Risk Factor Surveillance System (BRFSS) and Student Health Survey (SHS) data system by centering community partnership and leadership in (1) understanding and interpreting data; (2) identifying strengths, gaps, and limitations of data and methodologies; (3) facilitating community-led data collection on community-identified gaps in the data; and (4) developing recommendations.

Results

Project team members' concerns, observations, and critiques are organized into six themes. Throughout this engagement process, community partners, including members of the project teams, shared a common concern: that these surveys reproduced the assumptions, norms, and methodologies of the dominant (White, individual centered) scientific approach and, in so doing, created further harm by excluding community knowledges and misrepresenting communities of color.

Conclusions

Meaningful community leadership is needed for public health survey systems to provide more actionable pathways toward improving population health outcomes. A data equity approach means centering communities of color throughout survey cycles, which can strengthen the scientific integrity and relevance of these data to inform community health efforts.

Racial Health Equity Plans in the 30 Largest US Cities

BACKGROUND

Racial inequities in life expectancy vary significantly across US cities, with city-level gaps ranging from zero to more than 10 years. Given that these inequities are rooted in racism and maintained through social structures and policies, population-level solutions are needed. Local health departments (LHD) are well-situated to lead these types of changes.

METHODS

We conducted an environmental scan and document review of formal health plans of the LHDs with jurisdictions covering the 30 most populous US cities. We assessed the inclusion of equity priorities and specific and measurable equity goals. Secondary outcomes related to organizational structures, data, formal declarations, and other practices were also assessed. Data were collected between January and August 2022.

RESULTS

The extent of focus on racial equity in the identified strategic health plans varied. Less than half of the cities with a formal public health plan (13 of 29) listed racial health equity as an area of focus. Only seven cities (all of which had a health plan focusing on racial health equity) had specific goals related to racial health equity. Twenty-five LHDs provided local data on racial health inequities. All but seven cities had declared racism a public health crisis. About half of the LHDs had positions or divisions focused on racial equity, or specified equity as an area of focus for Covid-19 efforts.

CONCLUSIONS

These findings reveal that few large cities translate growing support for anti-racism into their formal planning. While most LHDs acknowledge (and provide data pointing to) gaps in racial health equity in their jurisdictions, more attention is needed to incorporate specific and measurable racial health equity goals into strategic plans, and provide adequate structure and resources to attain those goals.

Designing and developing a digital equity dashboard for the emergency department

Disparities in diagnosis, treatment, and health outcomes of racial minorities are well documented in the emergency department (ED). Although EDs may provide broad departmental feedback on clinical metrics, lack of up-to-date monitoring and data availability present significant challenges to identifying and addressing patterns of inequitable care. To address this issue, we developed an online "Equity Dashboard," incorporating data that is updated daily from our electronic medical record to highlight demographic, clinical, and operational variables, stratified by age, race, ethnicity, and language, and sexual orientation, gender identity. Through an iterative design thinking process, we created data visualizations for an interactive interface that tells a story about the ED patient's experience and enables any staff to explore up-to-date trends in patient care. To assess and improve usability of the dashboard, we conducted a survey of end-users using custom questions, as well as the System Usability Scale and Net Promoter Score, both of which are validated health technology use instruments. The Equity Dashboard is of particular use for quality improvement initiatives, as it reflects common departmental challenges including delays in clinician events, inpatient boarding, and throughput metrics. This digital tool further helps demonstrate how these operational factors differentially affect our diverse patient population. The dashboard ultimately enables the ED team to measure current performance, to identify our vulnerabilities, and to design targeted interventions to address disparities in clinical care.