Op-ed: Health equity in California must start with health data


Soraya Marashi


This pandemic has amplified long-standing health inequities and exposed a fundamental truth: The information infrastructure of public health systems is severely under-resourced, outdated, and fragmented. Years of federal and state disinvestment have taken their toll on California. I’ve seen it through my decades of public health work in four California counties.  

Health inequities are driven by numerous factors, including employment, housing conditions, food insecurity, lack of transportation, and access to health coverage and care, and we should have a view across all of it. Without accessible and actionable health data, public health cannot monitor and meaningfully understand diseases, predict risks, or develop targeted plans for advancing health justice. Yet too many health departments do not have the basic capacity to collect and store their own data, much less receive outside data about their communities.  

But there is hope. During my tenure as county health director in Santa Cruz County, we were able to minimize COVID-19 vaccination equity gaps by putting data into action to reduce health disparities and protect the most vulnerable. Using guidance from the California Department of Public Health and data from the California Healthy Places Index, we micro-targeted limited resources to census tracts and zip codes to save the most lives. Over time, data showed there was essentially no gap between the vaccination rate in our well-resourced, mostly white communities and more vulnerable communities of color. This targeted outreach helped our county buck a national trend of stark income gaps in vaccination rates. Health Plan of San Joaquin was also able to use merged health data to identify the highest COVID-risk residents in their area and more than tripled the vaccination rate, and Riverside County ran a similar COVID education campaign, both using data from Manifest MedEx, California’s largest nonprofit health data network.  

Last summer, Governor Gavin Newsom signed into law AB 133, with a goal that by January 31, 2023, county health, public health, and social services providers will connect to the CHHS Data Exchange Framework and exchange health information in real time with the state and participating healthcare entities. Just this week, Governor Newsom unveiled a proposed budget that includes more than $500 million of potential investments in state and local public health data collection and integration, IT systems, and infrastructure, providing a possible funding pathway to bolster state-level public health information technology and data exchange. 

This is the crucial moment for California to build what health leaders call “a comprehensive, digital, real-time, integrated data infrastructure for public health” that will help us address inequities, improve the health of our residents, and build trust in our state as a leader advancing a more equitable future for citizens. 

Accurate, actionable data is essential to improving health outcomes and knocking down health barriers faced by the diverse residents of our state, as seen in the powerful outcomes from Santa Cruz, San Joaquin, and Riverside counties. We need a statewide health data infrastructure, and we need every healthcare organization to be connected to it — including public health departments. This is the time to invest in foundational health information sharing and data management infrastructure for the entire public health ecosystem. Our state is making bold moves on healthcare for Californians — but it needs to be built upon a solid foundation of shared data.

Mimi Hall, MPH, recently moved from a career in local public health departments including Santa Cruz, Yolo, Plumas, and Sierra counties to leading Public Health Innovation with California’s largest health data network, Manifest MedEx, a nonprofit delivering health records for nearly 29 million residents.

This op-ed was provided by Mimi Hall, Director of Public Health Innovation at Manifest MedEx.