Future Directions for Comprehensive Public Health Surveillance and Health Information Systems in the United States

Public health surveillance can have profound impacts on the health of populations, with COVID-19 surveillance offering an illuminating example. Surveillance surrounding COVID-19 testing, conﬁrmed cases, and deaths has provided essential information to public health professionals about how to minimize morbidity and mortality. In the United States, surveillance has also pointed out how populations, on the basis of geography, age, and race and ethnicity, are being impacted disproportionately, allowing targeted intervention and evaluation. However, COVID-19 surveillance has also highlighted how the public health surveillance system fails some communities, including sexual and gender minorities. This failure has come about because of the haphazard and disorganized way disease reporting data are collected, analyzed, and reported in the United States, and the structural homophobia, transphobia, and biphobia acting within these systems. We provide recommendations for addressing these concerns after examining experiences collecting race data in COVID-19 surveillance and attempts in Pennsylvania and California to incorporate sexual orientation and gender identity variables into their pandemic surveillance efforts. (Am J Public Health. Published online ahead of print June 10, 2021: e1–e7. https://doi.org/10.2105/AJPH.2021.3062727 )

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Collection of Data on Race, Ethnicity, Language, and Nativity by US Public Health Surveillance and Monitoring Systems: Gaps and Opportunities

Public Health Reports ◽

10.1177/0033354917745503 ◽

2017 ◽

Vol 133 (1) ◽

pp. 45-54 ◽

Cited By ~ 4

Author(s):

Alfonso Rodriguez-Lainz ◽

Mariana McDonald ◽

Maureen Fonseca-Ford ◽

Ana Penman-Aguilar ◽

Stephen H. Waterman ◽

...

Keyword(s):

Public Health ◽

United States ◽

Data Collection ◽

Public Health Surveillance ◽

The United States ◽

Health Surveillance ◽

Monitoring Systems ◽

Primary Language ◽

Use Of Data ◽

Race Ethnicity

Objective: Despite increasing diversity in the US population, substantial gaps in collecting data on race, ethnicity, primary language, and nativity indicators persist in public health surveillance and monitoring systems. In addition, few systems provide questionnaires in foreign languages for inclusion of non-English speakers. We assessed (1) the extent of data collected on race, ethnicity, primary language, and nativity indicators (ie, place of birth, immigration status, and years in the United States) and (2) the use of data-collection instruments in non-English languages among Centers for Disease Control and Prevention (CDC)–supported public health surveillance and monitoring systems in the United States. Methods: We identified CDC-supported surveillance and health monitoring systems in place from 2010 through 2013 by searching CDC websites and other federal websites. For each system, we assessed its website, documentation, and publications for evidence of the variables of interest and use of data-collection instruments in non-English languages. We requested missing information from CDC program officials, as needed. Results: Of 125 data systems, 100 (80%) collected data on race and ethnicity, 2 more collected data on ethnicity but not race, 26 (21%) collected data on racial/ethnic subcategories, 40 (32%) collected data on place of birth, 21 (17%) collected data on years in the United States, 14 (11%) collected data on immigration status, 13 (10%) collected data on primary language, and 29 (23%) used non-English data-collection instruments. Population-based surveys and disease registries more often collected data on detailed variables than did case-based, administrative, and multiple-source systems. Conclusions: More complete and accurate data on race, ethnicity, primary language, and nativity can improve the quality, representativeness, and usefulness of public health surveillance and monitoring systems to plan and evaluate targeted public health interventions to eliminate health disparities.

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Implementing Strategies to Enhance Public Health Surveillance of Physical Activity in the United States

10.17226/25444 ◽

2019 ◽

Cited By ~ 2

Author(s):

◽

Keyword(s):

Public Health ◽

Physical Activity ◽

United States ◽

Public Health Surveillance ◽

The United States ◽

Health Surveillance ◽

Implementing Strategies

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Understanding and Addressing Latinx COVID-19 Disparities in Washington State

Health Education & Behavior ◽

10.1177/1090198120963099 ◽

2020 ◽

Vol 47 (6) ◽

pp. 845-849

Author(s):

Barbara Baquero ◽

Carmen Gonzalez ◽

Magaly Ramirez ◽

Erica Chavez Santos ◽

India J. Ornelas

Keyword(s):

Public Health ◽

United States ◽

Medical Care ◽

Public Health Surveillance ◽

Health Inequities ◽

The United States ◽

Health Surveillance ◽

Washington State ◽

Key Factors ◽

Taking Action

The COVID-19 pandemic has exposed, and intensified, health inequities faced by Latinx in the United States. Washington was one of the first U.S. states to report cases of COVID-19. Public health surveillance shows that 31% of Washington cases are Latinx, despite being only 13% of the state population. Unjust policies related to immigration, labor, housing, transportation, and education have contributed to both past and existing inequities. Approximately 20% of Latinx are uninsured, leading to delays in testing and medical care for COVID-19, and early reports indicated critical shortages in professional interpreters and multilingual telehealth options. Washington State is taking action to address some of these inequities. Applying a health equity framework, we describe key factors contributing to COVID-19–related health inequities among Latinx populations, and how Washington State has aimed to address these inequities. We draw on these experiences to make recommendations for other Latinx communities experiencing COVID-19 disparities.

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Strategic Use of State and Local Regulatory and Public Health Surveillance Resources to Address the Growing Demand for Food Safety Oversight in the United States

Foodborne Pathogens and Disease ◽

10.1089/fpd.2008.0131 ◽

2008 ◽

Vol 5 (6) ◽

pp. 747-753 ◽

Cited By ~ 2

Author(s):

Nkuchia M. M'Ikanatha ◽

Daniel H. Rice ◽

Sean F. Altekruse

Keyword(s):

Public Health ◽

United States ◽

Food Safety ◽

Public Health Surveillance ◽

The United States ◽

Health Surveillance ◽

State And Local

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Measuring the HIV Care Continuum Using Public Health Surveillance Data in the United States

JAIDS Journal of Acquired Immune Deficiency Syndromes ◽

10.1097/qai.0000000000000788 ◽

2015 ◽

Vol 70 (5) ◽

pp. 489-494 ◽

Cited By ~ 16

Author(s):

Catherine R. Lesko ◽

Lynne A. Sampson ◽

William C. Miller ◽

Jacquelyn Clymore ◽

Peter A. Leone ◽

...

Keyword(s):

Public Health ◽

United States ◽

Public Health Surveillance ◽

The United States ◽

Health Surveillance ◽

Surveillance Data ◽

Hiv Care ◽

Hiv Care Continuum ◽

Care Continuum ◽

Health Surveillance Data

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Clinical Decision Support for Immunization Uptake and Use in Immunization Health Information Systems

Online Journal of Public Health Informatics ◽

10.5210/ojphi.v12i1.10602 ◽

2020 ◽

Vol 12 (1) ◽

Author(s):

Lauren Shrader ◽

Stuart Myerburg ◽

Eric Larson

Keyword(s):

United States ◽

Decision Support ◽

Information Systems ◽

Health Information ◽

Clinical Decision Support ◽

Health Information Systems ◽

Clinical Decision ◽

The United States ◽

Precise Integration ◽

Vaccine Recommendations

Context: In the United States, immunization recommendations and their associated schedules are developed by the Advisory Committee on Immunization Practices (ACIP). To assist with the translation process and better harmonize the outcomes of existing clinical decision support tools, the Centers for Disease Control and Prevention (CDC) created clinical decision support for immunization (CDSi) resources for each set of ACIP recommendations. These resources are continually updated and refined as new vaccine recommendations and clarifications become available and will be available to health information systems for a coronavirus disease 2019 (COVID-19) vaccine when one becomes available for use in the United States. Objectives: To assess awareness of CDSi resources, whether CDSi resources were being used by immunization-related health information systems, and perceived impact of CDSi resources on stakeholders’ work.Design: Online surveys conducted from 2015–2019 including qualitative and quantitative questions.Participants: The main and technical contact from each of the 64 CDC-funded immunization information system (IIS) awardees, IIS vendors, and electronic health record vendors. Results: Awareness of at least one resource increased from 75% of respondents in 2015 to 100% in 2019. Use of at least one CDSi resource also increased from 47% in 2015 to 78% in 2019. About 80% or more of users of CDSi are somewhat or very highly satisfied with the resources and report a somewhat or very positive impact from using them. Conclusion: As awareness and use of CDSi resources increases, the likelihood that patients receive recommended immunizations at the right time will also increase. Rapid and precise integration of vaccine recommendations into health information systems will be particularly important when a COVID-19 vaccine becomes available to help facilitate vaccine implementation.

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