Saturday, July 25, 2015

Measuring What Matters: Using Data To Drive Action

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Editor’s note: This article is part of a series of blog posts by leaders in health and health care who participated in Spotlight Health from June 25-28, the opening segment of the Aspen Ideas Festival. This year’s theme was Smart Solutions to the World’s Toughest Challenges. Stayed tuned for more.

We must focus on measuring what matters. Data that only serve to illustrate that a problem exists—or even that progress is being made—are not enough. At the Robert Wood Johnson Foundation (RWJF), we are working to catalyze a social movement to help build a “Culture of Health.” To accomplish this goal, we need data that illustrates for people and organizations—across a wide range of sectors—the roles they can play, the actions they can take, and the relevance to their communities.

Here’s an example. At RWJF, we believe that multisector collaboration will make a significant contribution to building a Culture of Health. (The thinking is that if the factors that influence our health exist where we live, work, and play, then the diverse decision makers who influence those settings will, in turn, influence our health.)

Therefore, quantifying the percentage of health departments collaborating with community-based organizations to provide services or identify needs is at least one valuable measure. Through it, we are not only able to assess progress toward a goal, we are clearly signaling what we believe needs to happen—collaboration—and those who should take action by collaborating: health departments, community-based organizations, and the policy makers who influence their budgets and actions.

Let me give you another example. We want to measure residential segregation—or what is known as the index of dissimilarity—to assess the evenness with which racial and ethnic groups are distributed across communities. It is also an actionable measure to assess income inequality’s impact on health; residential segregation has a high correlation with negative health outcomes.

But this measure does more than elucidate the current situation or prove a point; it serves as a catalyst to action in urban development. The data urge city planners to create policies that lead to greater integration, thereby improving health outcomes AND engaging stakeholders who may not have previously chosen to have a seat at the table.

At this year’s Spotlight Health segment of the Aspen Ideas Festival, I spoke on a panel on the topic of “Measuring Public Health Success.” My fellow panelists included Matthew Bishop, the co-founder of the Social Progress Index, which encourages countries to look beyond gross domestic product (GDP) as a measurement of their wellbeing, and Lucy Hurst, who is working with the Bill & Melinda Gates Foundation on No Ceilings, which measures the progress made by and for women and girls over the last two decades.

While both Bishop and Hurst spoke of gaps in data, the goals of their efforts reflect their consensus that data should be used to drive action. The Social Progress Index compares measures across countries with similar income levels to isolate what is accelerating or serving as a barrier to social progress. And it uses that information to propose policy solutions.

For No Ceilings, Hurst may be measuring the progress that has been made, but she and her team are doing so with an eye toward identifying the gaps that remain. This information will guide the development of strategic solutions. It will drive action.

Measuring Progress Toward Building A Culture Of Health

For decades, many of us have worked to improve health by focusing primarily on the health care system. But we know that our health is influenced by complex social factors: where we live, how we work, the safety of our surroundings, and the resilience of our families and communities.

Sixty-nine years after the World Health Organization redefined health as “a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity,” more of us in the United States have finally moved away from defining health as just the absence of illness. But knowing this has not yet led to widespread progress.

In collaboration with the RAND Corporation—and with valuable input from partners and colleagues across the country—RWJF is developing an Action Framework to chart, but more importantly, to catalyze our nation’s progress toward building a Culture of Health.

This Action Framework includes forty-one measures across four different Action Areas:

  • Making health a shared value;
  • Fostering cross-sector collaboration;
  • Creating healthier, more equitable communities; and
  • Strengthening the integration of health services and systems.

Each Action Area includes a set of corresponding Drivers and Measures. The Drivers are the engine of the Action Framework, providing a set of priorities for national investment that will remain constant over time. The Measures are expected to change; they are a call to action about what needs to be accomplished to dramatically, and with more urgency, improve health and wellbeing.

Driving Action

Besides demonstrating the role of various stakeholders, there is more that we can do to make data actionable.

We Need To Make Data Relevant To Communities

For a number of years, RWJF has collaborated with the University of Wisconsin Population Health Institute on the annual County Health Rankings & Roadmaps. These rankings measure health factors (for example, high school graduation rates, obesity, smoking, access to healthy foods) in nearly every county in the country.

While these rankings help to illustrate where we are, they more importantly serve to drive action in communities. Local leaders react to the data by developing strategies to sustain positive progress or reverse negative trends. Through the Roadmaps, we help them understand the data and provide suggestions for actionable steps. By localizing the data, we have increased the likelihood of action. For example, the United Way of Greater Philadelphia and Southern New Jersey responded to the news that Camden County ranked 17th out of 21st counties in New Jersey by developing initiatives to improve educational outcomes, increase access to healthy food, and encourage physical activity in safe spaces.

We Need An Increased Focus On Measures Of Prevention Opportunities Rather Than Utilization Of Treatment Services

We can also make data more actionable—particularly to improve mental health outcomes—if we focus on measures that provide assessment well before the stage of treatment utilization. For example, if we want to support the mental health of young families and mitigate the impact of trauma (a strategic priority for RWJF), what measures can allow us to prevent adverse childhood experiences (ACES) as opposed to simply measuring their existence? What measures can help to illustrate what we need to do in early childhood to redirect a path away from desperation and despair?

We Need To Identify Assets

Finally, we need to know more about data on the asset side versus a needs-based or problem-focused approach. If we can achieve more granularity in understanding what can be done to prevent poor outcomes even in tough situations, we can use that data to take action and replicate those assets.

Using Emerging Data

For more than forty years, RWJF has invested in research that has contributed to a common understanding of the major health and health care issues and that has guided our investments. We believe strongly in evidence-based solutions and always will.

Nevertheless, we cannot have unreasonable barriers to data if our true goal is to use data to drive action. Randomized control trials should not be the gold standard. Biomarkers are not enough. We need to be able to accelerate the potential for change by operating with suggested data and focus on proving outcomes down the line.

And to build a Culture of Health, we will need to push ourselves to consider generating and using data that is emerging and unfamiliar. Big data and social media data abound, but we have not yet channeled it in a way that aligns with the critical issues in health that are holding us back. We need to get there.

We have the data. The emphasis must now be on putting it to work.

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