Making a Powerful Connection: the Health of the Public and the National Information Infrastructure. 8.0 What Barriers Need to Be Overcome to Make the Vision of the Nii and Population Health a Reality?


Important first steps have been taken in applying NII technology to the information needs of population-based public health. Nonetheless, a much stronger connection between the NII initiative and the public health community will be needed to make the kinds of scenarios described earlier in this paper a reality.

As we move forward, it is important to remember that while the NII has an important role to play in addressing public health's information problems, it is not, by itself, a "silver bullet." A broad range of barriers currently hamper the public health community in meeting its information needs. Some are unique to public health, such as the fragmented organization of public health programs and information systems, the separation of public health from the bulk of the medical care system, the declining level of financing for essential public health services, and the paucity of informatics exposure in public health training. Others, such as the lack of nationally uniform policies related to privacy, data standards, unique identifiers, and data sharing affect many sectors, but are critical in a field like public health, which depends on bringing together many different types of data from diverse sources. The challenge, then, is to identify key issues that must be addressed in order for population-based public health to realize the benefits of the NII and to devise effective strategies for making progress on these issues.

In the discussions before and during the April meetings, five major barriers to enhancing public health applications of the NII emerged, above and beyond basic resource constraints and the limited appreciation by both the public and policymakers of the importance of population-based public health. These barriers, which are discussed further below, include:

  • a lack of nationally uniform policies to protect privacy while permitting critical analytic uses of health data;
  • a lack of nationally uniform, multipurpose data standards that meet the needs of the diverse groups who record and use health information;
  • insufficient awareness of the applicability of NII technologies in meeting the information needs of population-based public health;
  • a public health workforce that lacks essential information technology skills; and
  • organizational and financing issues that make it difficult to integrate information systems or bring potential partners together.