Failure to Connect: Intergovernmental Information Flow and the Public’s Health

Much of the value of governmental public health practice derives from the value of the information that public health agencies generate and disseminate. This information allows for the early detection and containment of disease outbreaks, for the targeting of health interventions to populations at greatest risk, for the tailoring health communication and education strategies to diverse population groups in ways that facilitate comprehension and informed decision-making, and for efficient inter-organizational coordination in the delivery of health promotion and disease prevention activities. Indeed, public health agencies accomplish much of their work through information acquisition, aggregation, analysis, and dissemination. This is why a new study documenting large structural gaps in information flow between state and local public health agencies is so troubling.

The new study by Cornell’s Joshua Vest and UNC-Charlotte’s Michele Issel analyzes measures of the structural capacity to share information between state and local public health agencies across the U.S. This type of intergovernmental information flow is particularly important in public health because the earliest opportunities to acquire health-related information and the earliest opportunities to act on this information may arise at different locations within the state-local public health system at any given point in time – and timing can be everything when it comes to mounting an effective public health response. The authors find that structural barriers to intergovernmental information flow are highly prevalent across the U.S., existing in 34% of communities for immunization records, in 70% of communities for vital records, and in 82% of communities for reportable communicable diseases.

These findings imply that the potential health and economic value of investments in U.S. public health programs and services may go partially unrealized because of deficits in intergovernmental information infrastructure. These findings, however, should be interpreted with caution given the study’s reliance on indirect measures of structural barriers rather than data on actual information flows, and given that the measures were collected in 2007-08 prior to the latest wave of federal investments in health information technology. Nevertheless, the results clearly signal that opportunities exist for improving the effectiveness and efficiency of public health practice through improvements in intergovernmental information flow.

This research study was supported through the predoctoral and postdoctoral research award program of our own National Coordinating Center for Public Health Services & Systems Research, based at the University of Kentucky and funded by the Robert Wood Johnson Foundation. The new study appears in the February 2014 special issue of the journal Health Services Research devoted to health information technology.

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