Frontline Blog

Live Today: The Big Cities Health Inventory 2.0 – Success and Challenges

November 2016


By Chrissie Juliano, MPP, Director of the Big Cities Health Coalition

Today we launch version 2.0 of our Big Cities Health Inventory (BCHI), an online, open access data platform that allows the public health field, media, researchers, the public, and policymakers to look across more than 50 health and socio-demographic indicators from 28 cities – in total more than 17,000 data points. We also have a number of case studies available, highlighting innovative work in our member cities.

Chrissie Juliano, MPP

Many American cites have collected public health data for years. What this platform gives us for the first time are data that are comparable across jurisdictions. This is a real step forward for urban public health, where cities are often falsely compared to non-urban jurisdictions that have vastly different median ages, incomes, and racial and ethnic make-ups in their populations – which disproportionally affect their health.

We are grateful to the many experts who weighed in on this project – most especially, our member cities’ staff who provided data and guidance in this process, and our funders and partners, all of whom enabled this work to be done.

Below are the answers to some FAQs related to the Big Cities Health Inventory Data Platform.

Why is there a need for city level data?

Public health is the science of protecting and improving the health of families and communities through promotion of healthy lifestyles, research for disease and injury prevention, and detection and control of infectious diseases. Metropolitan areas are now home to almost 83% of Americans, and BCHC member health departments serve about 54 million or 1 in 6 Americans.

It cannot be emphasized enough that effective public health practice depends on having reliable and current information regarding the health of every community. Without it, policies can neither be targeted to those populations most in need, nor can the impact of policy change be measured. Data is also critical to partnerships with community-based organizations, clinical providers, and other governmental agencies.

Most national reports on health status, however, make comparisons at the state level, and sometimes, the county level. Federal and local leaders have expressed a continuing need for more comprehensive data and comparative perspective on the most pressing health issues facing the nation’s urban areas. Many of these jurisdictions struggle with significant health disparities but often lack the information needed to help the public, policymakers, and even health officials, tackle key winnable health battles. For highly diverse urban populations in particular, understanding the root causes of inequities is essential to improving the health of the overall population – and having the requisite data to do so should not also be a challenge.

Further, particularly regarding emerging public health problems, data points collected across cities vary and, often, cannot be appropriately compared. This problem can be addressed by developing a consensus on the practical definitions of key health indicators and widely disseminating those conventions. Data collection methods also need to be standardized so that the data is comparable between jurisdictions.

Where do these data come from?

For the most part, the health indicators included in the BCHI have come directly from the cities themselves. Some key exceptions are preschool enrollment and high school graduation rates, as well as a number of other demographic indicators, which come from publicly available data sets using FIPS (city codes). While these codes do not always track jurisdictional lines exactly, they give us the best data available for a number of indicators.

We have, to the best of our ability, used standard definitions and adopted a methodology that allows for comparability across cities. We left out data that are not fully comparable. More information can be found on the methodology page that includes a glossary of terms. The glossary shares what age-adjusted vs. crude rates are, and also discusses some of the more complicated definitions, like the various HIV/AIDs case definitions. Suffice to say here, that we made decisions about whether to use age-adjusted vs. crude rates according to standard practice and with the guidance and support of our advisory committee of city epidemiologists.

What can these data show?

This data is the best “snapshot” of health that can be compared across a number of big cities that are more alike than they are different. These are intended for researchers to download and analyze. For the first time, cities can look at their peers to determine who’s ahead of the curve and start to ask why. The platform was designed to be understandable and accessible for everyday city residents, who can be powerful advocates for the health of their communities when armed with the right information. And finally, it is meant for policymakers to see that while much progress has been made, so much more can be done to combat the health challenges that often disproportionately affect urban areas. In sum, this platform is meant for anyone who wants to explore the state of public health in urban America and push policymakers to prioritize scarce resources with the best evidence available to date. Opening access to this data is the best way to expand and improve it.

What challenges remain in accessing good, timely, local data?

In a 2016, when technology companies seem to know just about everything about everyone, and health care providers have significantly advanced their data systems, how are we still struggling to collect good, timely, local health data at the local level? Good question.

America has a fragmented governmental public health system in which activities are funded mostly for categorical programs (i.e. cancer or diabetes) but few dollars are available for infrastructure or technology. Thus, public health data systems sometimes do not keep up with the times. Despite an approximately $30 billion federal investment to various health care sector entities to incentivize electronic health records and build data capacity, similar resources and incentives have been shared with the public health sector. By and large, governmental health departments have seen no federal investment in infrastructure that allows for data sharing to better monitor the overall health of the community and pinpoint emerging health threats.

Further, the way we collect data, and more generally fund governmental public health is almost entirely state focused. Data collection often happens at the state or national level, and localities often have to request local data from their state partners.

City health departments are policy innovators, experimenting in exciting new ways to solve some of the greatest public health problems of our time. Our Coalition was formed more than a dozen years ago to help city leaders share ideas, challenges, and solutions. This data platform furthers that mission, allowing policymakers and every day citizens alike to learn more about the communities in which they live, and the status of health in their cities.