www.healthpolicy.ucla.edu

“No Data, No Problem!” — Data, Research and Policy Advocacy

to Reduce Health Disparities

E. Richard Brown, Ph.D. Director, UCLA Center for Health Policy Research

Professor, UCLA School of Public Health

AcademyHealth Annual MeetingJune 7, 2004

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Health disparities addressed through change in professional practice and public policy

Personal experiences are core knowledge of health disparities — but they are “just anecdotes”

Research has confirmed those personal experiences and helped make health disparities a social issue

Reducing health disparities requires translating research evidence into change: In professional practice and

In public policies

I will focus on using research and data to change public policy

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Research and data do not change policy — advocacy and leadership do

Policy change results from strategic advocacy and political leadership Researchers help by providing credible analysis and data that advocates

and policy leaders use Data and analysis are essential

To making good policy (evidence-based policy) and To moving issue through policy process

As researcher Can align with advocates and policy leaders, or Can remain independent of them Effectiveness requires retaining intellectual independence and scientific

credibility

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Agenda Setting

First step is to get issue on policy agenda

Getting policy-makers and leaders to pay serious attention to issue

Help make case and make it credible

“No Data, No Problem!”

Data and research help make health problems visible to public and policy makers

Absence of data keeps issue invisible or seen as “unworthy” of public policy

Data and research in policy process

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You can frame your research to help answer important policy and political questions How big a health problem is it? — how many people it affects How severe a problem is it? — its health effects, social consequences,

and economic costs Who is most affected? — characteristics of groups at greater risk What causes or contributes to problem? — factors that contribute to

problem or increase risk Individual characteristics? Individual behavior or actions? Institutions or systems or policies?

Frame issue to emphasize important policy perspectives and values

Data and research in policy process

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Data and research in policy process

Specifying policy alternatives Provide evidence about relative effectiveness of different policy

options Research, data and publications that

Discuss explicit policy implications Show extent that policy options address problem Show extent that they are feasible

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Adoption of policy

Provide evidence that policy makers and advocates use to argue for one policy versus another

Research and data play minor role

Is policy good technically?

Politics and argument dominate

Is policy good politically?

Data and research in policy process

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Implementation of policy

Focus attention and provide evidence on whether policy is being adequately implemented

Research and data that include

Process measures

Outcome measures

Data and research in policy process

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Summary Identify stage of policy process

1. Agenda setting2. Specifying policy alternatives3. Adoption of policy4. Implementation of policy

Make implications explicit Discuss policy implications related to data or findings Identify how specific public policies (or absence) affects outcomes Make policy recommendations clear and specific

Target research publications directly to policy makers and advocates as well as to journals

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California Health Interview Survey: Data to Address Social Disparities in Health and Health Care

California Health Interview Survey (CHIS) — Designed to meet state and local needs for population-based health data Very large biennial survey of California population Estimates for many health and social indicators and health care access

Data used: To understand and measure health needs and disparities among

California’s diverse population — diverse in ethnicity, social class, and geography

To support decision making at local level and statewideFor public health & health care policy analysis, development and advocacyFor planning public health & health care services and programs

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CHIS invests substantial resources in dissemination to reach many constituencies

Extensive dissemination through multiple channels to maximize use of CHIS data and results by wide range of constituencies Designed to meet needs of policy makers, advocates, media, analysts,

and researchers Publications with analytic results

Designed to reach variety of constituencies, disseminated by mail, electronically, and through conferences

Electronic data estimates — AskCHIS Easy-to-use online data query system Democratizes access to both data and analysis

Electronic data files for analysis by other researchers and analysts Workshops and community briefings

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CHIS publications targeted to constituencies and widely disseminated

UCLA Center for Health Policy Research has published many CHIS-based publications that reach different types of constituencies Policy research reports ~ for policy wonks, specialized policy makers,

and focused policy advocates Policy briefs ~ for those interested in issue but not deeply involved Fact sheets ~ to interest people in issue, even those not focused on it Journal articles ~ for researchers and policy analysts

Other groups use CHIS data in their own publications Effective systems to disseminate publications directly to broad policy

audience and to larger public Web site dissemination Printed copies mailed to key leaders

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AskCHIS is easy-to-use quick way for all types of users to get analyses from CHIS

CHIS provides access to statewide and local data through fast, user-friendly Web-based data query system — AskCHIS

Enables non-technical users to obtain easily-tailored customized data results

AskCHIS democratizes access to data and analysis

Screenshot of AskCHIS results

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CHIS is used to change public health policy “Community Action to Fight Asthma” uses CHIS data to support policy

and education efforts of local grantees to address environmental triggers of asthma symptoms among school-aged children Asthma symptom rates are highest among populations of color

Fresno County public health officer used CHIS data to identify obesity, diabetes and asthma as most important public health issues in that county and obtained additional resources to address them Conditions have high rates among Latinos, African Americans, and poor

Public health leaders, faith-based community health program, and food banks in 2 Central Valley counties relied on CHIS data in organizing “Hunger Summit” and in obtaining new USDA funding for food security project Hunger highest for Latinos, immigrants, and the poor

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CHIS is used to change health care policy Many counties use CHIS data to justify need for, and to develop, new

public-private health insurance expansion programs for children not eligible for private or public coverage Uninsured rates are highest among Latinos

Community clinic associations in several counties use CHIS data to support requests for additional HRSA and other funding to improve primary care and expand access Access barriers highest among Latinos and immigrants

AHRQ relied on CHIS 2001 data to provide estimates for Asian ethnic groups and Latinos (Hispanics) in its Congressionally mandated National Healthcare Disparities Report

16www.chis.ucla.edu