How a state agency built a public health database

Any good public health organization knows that when it’s designing a community intervention, it has to back it up with evidence. At Activate Allen County, a public health collaborative in Ohio, the group’s Health Atlas is laying the groundwork for interventions with a public health database.

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“Everything that Activate does in terms of our programs, the spaces that we get into, is all database, evidence-based programming, things that we know we can go back to and continue to track year after year,” Kayla Monfort, the co-director of Activate Allen County, said in an episode of the Healthcare Strategies podcast.

Data has been the bedrock for Activate Allen County, Monfort added, ever since the collaborative was formed in 2012. Created in response to Allen County’s dismal 83rd out of 86 counties for health behaviors at that time, Activate Allen County serves to convene community stakeholders around improving resident health.

“We've expanded the term ‘health’ here in Allen County to mean more than just being tobacco-free, being physically active, and eating healthy,” Monfort explained. “We're expanding that term to create space to talk about transportation, to talk about housing, to talk about maternal and infant health, to talk about mental health. Those are really key components to how a resident can be as healthy as possible and where you live, what you have access to.”

If Activate’s primary mission is to improve the opportunity to achieve health and well-being for all of Allen County’s residents, its secondary mission is to make sure public health funding is well-spent. After all, funding for public health initiatives can be scant and sometimes piecemeal. Any good public health organization knows that it needs to have a data-driven use case for its interventions and, ideally, expose that intervention to the populations who truly need it.

That imperative, plus Allen County’s local hospitals’ imperative to complete community health needs assessments (CHNAs) and publish community health improvement plans, served as the impetus for Activate Allen County’s Health Atlas.

The Health Atlas pools community health data from any of Activate’s stakeholder organizations, including the regional hospitals, member public health agencies, mental health boards, regional planning commissions, and many others. The database provides updated community and public health information for member organizations to leverage for their own programming.

In the case of hospitals conducting their CHNAs every three years, the Health Atlas serves as a key resource. Monfort also said public health agencies can use the Atlas to pinpoint census tracts that would benefit most from certain public health campaigns or to fill out funding applications.

But the Health Atlas isn’t just a public health data dumping ground, Monfort explained. Part of Activate Allen County’s role in designing the database was being judicious about the kind of data going into the system.

“There's thousands upon thousands of data pieces, data resources,” she said. “But we wanted to pull those indicators that actually made sense for our community in terms of what we were actually working on so the community could then go back and track.”

Much of the data first included in the Health Atlas related to community health needs assessments. Monfort explained that Activate wanted to leverage data that helps organizations better understand the current needs of the community and would help them track progress over time. In an attempt to avoid data overload, Activate omitted data that did not relate to the community’s current needs.

“When you think about the number of pieces of data that you could track and what would be helpful to a community, you can probably think of thousands upon thousands of indicators that would probably be helpful to track, Monfort stated. “But we feel the value of starting small. We've talked about keeping it really congruent with what our community health improvement plan has in it.”

Right now, the Health Atlas has about a hundred indicators in it. By keeping it small, Activate has been able to keep information updated on a yearly basis. This is a big improvement over the every three years most CHNAs publish.

The other key benefit of a more tailored database is the community accessibility aspect.

“Our goal was to be forward facing to the community to allow this tool to live on our web portal that was accessible 24/7 to any resident who desired to take a peek at that,” Monfort noted.

But some residents—in fact, most residents—are not statisticians, so a wide array of data would not be palatable for them to consume. Keeping it small has been a key step to overcoming data literacy issues.

Activate still faces some challenges in terms of data integration. For one thing, the data collection isn’t always standardized year-over-year. A community health survey might include different questions from one year to another, for example, so it can be hard to make apples-to-apples comparisons.

Monfort added that it can be hard to manage regularly updating the database, stressing the importance of picking a good vendor partner that can simplify that process.

Ultimately, having databases that are simplified and publicly available is essential to backing up public health initiatives. By giving experts the insights necessary to target interventions, plus giving funding sources a view into need and progress, a clear view of public health data will be key.

“We're in a society that likes to be told one thing, and it happens the next day. But that's really not the nature of public health and data because it's slow, and it takes a long time to see change, which is sometimes hard to accept,” Montfort concluded. “But over time, as we continue to collect that same data, we are seeing the positive results of working together and of having a programmatic, evidence-based approach to our work.”