As state and local policymakers work to promote health equity—the guiding principle that disparities in health outcomes caused by factors such as race, income, or geography must be addressed and prevented by providing opportunities for all people to be as healthy – they often lack qualitative data on specific problems and affected populations. Restrictive or unclear data sharing policies and privacy concerns can contribute to this lack of sufficient data. Other factors may include limited technical expertise, financial resources, and personnel to integrate data into systems that are often not designed for such information sharing.
Having complete and timely data equips policymakers to understand affected populations and target resources, track progress, and promote accountability as they develop and implement solutions to reduce long-standing inequities. Officials can also ensure that equity concerns are taken into account in the data collection process by partnering with community members to ensure that the information they have is relevant and accurate for all demographics and on neighborhood or community level. They should also work to provide context for the circumstances behind the data.
To help focus attention on these equity issues, the Health Impact Project, a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts, launched Calling All Sectors: State Agencies Joined for Health in 2019. Across the country, this initiative supports 10 cross-sector teams of community partners and government agencies in implementing strategies to identify and collect data from multiple sources. This data is used to prioritize, design improvements, address inequity and measure progress. Here are three methods grantees are using to ensure decision makers have access to the data they need to increase health equity.
Mapping existing systems
Some Calling All Sectors grantee teams are engaging in “systems mapping” to understand what is and is not known about a current public health problem and what services may be available to address it. This process begins with scoping to learn which organizations and programs serve specific populations of interest, sources of program or population-level data, disparities revealed by or in available data, and ideas for developing or improving services and policies.
The Minnesota grantee team is using this exercise to better understand homelessness during pregnancy, identify barriers and service gaps, and pursue targeted initiatives related to early childhood development, prenatal care policies, and funding. Meanwhile, in Kansas, the Departments of Children and Families, Health and Environment, and Aging and Disability, as well as DCCCA, a community partner and service provider, used system mapping to improve how the state and partners connect pregnant individuals with a disorder, substance use to health and social care providers. This will help ensure that they receive high quality treatment and prenatal care. The information collected is used to inform the development of provider training on these topics.
Conducting interviews and focus groups
Other efforts seek to speak directly to those closest to the problems states are trying to solve. Calling All Sectors’ partner organizations – often the actual service providers themselves – have close links with communities facing significant health inequalities and have gained the trust of local people as staff are usually local. Conducting focus groups allows organization representatives to interview community members with lived experience of local health and social services to assess their concerns, recognize barriers and identify sustainable solutions.
In Washington State, one nonprofit partner, Byrd Barr Place, provides direct services and promotes systemic change to help Black families across the state move from poverty to self-sufficiency. Program staff work to help community members enroll in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC), the federal initiative that helps protect the health of low-income families at nutritional risk . Byrd Barr Place is leading efforts with WIC and WIC-eligible participants to learn about their experiences with the program and any barriers to participation. The data is then used to change state and local WIC policies and practices where possible to make the program more responsive to people’s needs.
In Michigan, community partner Focus: Hope is a civil and human rights organization dedicated to overcoming racism, poverty and injustice. It also conducts focus groups to help state agencies understand the barriers community organizations face when trying to contract with them to address maternal and infant health issues.
Finally, the Mississippi Department of Health this spring held listening sessions with pregnant black women and mothers to document birth experiences and any barriers encountered in clinical settings such as hospitals. This research highlighted disparate treatment based on race, feelings of patients not being listened to, and persistence of racial stereotypes. The answers will help inform the work of the Mississippi Perinatal Quality Collaborative, a statewide partnership that aims to implement evidence-based quality improvement initiatives in hospital and community settings to ensure better birth outcomes in Mississippi.
Filling quantitative gaps
Government grantee teams are also working to close critical quantitative data gaps that can prevent policymakers from properly understanding the scope of community problems. For example, New Jersey is expanding the data system that supports 21 county-level Connecting NJ referral centers to connect pregnant individuals and their families to community resources, programs and services. These improvements will enable state and local partners to identify needs, connect people more quickly to services, and understand barriers and disparities in access.
And in Washington, D.C., the Department of Health is working with partners to begin pregnancy tracking among clients seeking support at the city’s Homeless Services Center for Families. The DC team is engaging with system stakeholders to add routine pregnancy data collection to the City’s Homeless Management Information System processes to facilitate more timely and coordinated referrals to services in homeless programs.
High-quality, comprehensive data play an essential role in addressing public health challenges. Without it, policymakers may be unable to identify where inequities exist, direct efforts and resources, measure progress, or establish accountability. Cross-sectoral teams, such as those demonstrated by Calling All Sectors grantees, are uniquely situated and connected to the communities most affected by long-standing inequalities. This means they are well positioned to help close critical information gaps that can impede improvements in health equity.
Maura Dwyer works on The Pew Charitable Trust’s Health Impact Project.