For years, those of us in public health have known that funding falls short of what’s needed. This chronic underinvestment has affected many fundamental components of our health system, including our public health data infrastructure. During the pandemic, it became obvious that not all local health departments (LHDs) could equally collect, analyze, and share critical health data as they tried to report case counts, track hospitalizations, and coordinate vaccine distribution. In a recent article published in the Journal of Public Health Management and Practice, Dr. Brian Dixon and I explored this digital divide within public health and offered recommendations aimed at achieving equitable data modernization (DM).

In our commentary, we highlighted a clear disparity in data modernization efforts across local health departments (LHDs). Specifically, we found a substantial gap between large and small LHDs: while 94% of large LHDs (serving populations over 500,000) reported engaging in DM projects, only 44% of small health departments (serving populations under 50,000) did so. The difference between urban (68%) and rural (44%) LHDs was notable but not as extreme.

Between 2020 and 2023, larger LHDs were more successful in securing extra funding for DM than smaller ones. Funding gaps directly impact workforce capacity – while 78% of urban LHDs employ dedicated information systems specialists, only 34% of rural departments have similar roles. Without these specialized professionals, many LHDs struggle to implement even basic informatics functions like electronic disease reporting or digital contact tracing.

This digital divide isn’t merely about technological convenience; it fundamentally undermines health equity. When rural and under-resourced LHDs lack robust data systems, they cannot effectively identify or address health issues facing their communities. During COVID-19, we witnessed how LHDs with advanced informatics capabilities could rapidly implement targeted interventions to the most affected populations. Meanwhile, those without such systems were slower to respond or unable to respond, delaying distribution of supplies (eg, personal protective equipment, testing resources, and vaccines). The impact of this digital inequity extends far beyond emergency responses, affecting routine functions of public health. LHDs with robust informatics capabilities can leverage a range of informatics tools, including in-depth analyses of social determinants of health, participation in health information exchanges with clinical partners, as well as the development of data dashboards that inform community partners and the public. These capabilities enable public health systems to implement evidence-based interventions that directly address the significant health challenges in a community.

What drives this digital divide?

First, sustainable funding remains elusive for many smaller LHDs. Federal investments in public health informatics often flow through competitive grant mechanisms that advantage departments with grant-writing expertise and established IT infrastructure – resources many rural LHDs lack. This creates a cycle where the most technologically advanced departments continue receiving support while others fall further behind.

Second, workforce challenges persist in public health systems, particularly in rural areas. Even when funding becomes available, LHDs struggle to recruit and retain skilled IT professionals who can command higher salaries in the private sector. This talent gap makes implementing and maintaining advanced informatics systems difficult.

Third, LHDs operating under state authority often have different access to technical support than locally governed departments. These variations create uneven informatics landscapes even within the same state. Addressing these challenges requires coordinated actions at federal and state levels.

What can be done to bridge the divide?

To ensure equitable benefits from data modernization for all local health departments, we recommend a multi-faceted approach.

First, policymakers and federal agencies should prioritize equitable DM opportunities by creating tailored funding streams for under-resourced LHDs, together with technical assistance. This can be further supported by capacity-building grants to enhance administrative and informatics capabilities, potentially through alliances with larger LHDs or state agencies. Furthermore, flexible funding mechanisms are needed to enable sustained investments in data infrastructure, addressing the limitations of short-term grants.

Second, regional collaboration fosters health departments to maximize resource utilization, incentivizing resource pooling and expertise sharing among rural and small LHDs. State agencies can play a crucial role by offering collaborative services or acting as intermediaries.

Third, partnering with external entities could bring additional resources and expertise to DM efforts, leveraging public-private collaborations and academic institutions. Examples include the United States Digital Service’s pandemic support and partnerships facilitated by what was formerly known as the Office of the National Coordinator, now the Assistant Secretary for Technology and Planning, with university partnerships for public health informatics training, particularly with minority-serving institutions.

Read Our Article in the May Issue of JPHMP

Lastly, substantial investment in the existing LHD workforce is crucial, including basic informatics training for leaders and specialized training for epidemiologists and DM personnel. Loan repayment or scholarship programs can aid in recruiting and retaining informatics professionals in small LHDs. These interconnected strategies, when implemented cohesively, can create a more robust and equitable public health data ecosystem that benefits communities of all sizes.

Achieving equitable data modernization requires that we acknowledge and address the uneven distribution of resources within our public health system. As detailed in our JPHMP article, bridging the digital divide is more than just a technical issue; it is fundamentally about ensuring health justice. Despite the current climate of funding instability and systemic turmoil, we must leverage existing resources and persistently work to meet public health needs. When every local health department has the capacity to collect, analyze, and act upon high-quality data, we move closer to our shared goal of protecting health and promoting well-being for all communities.

Brian E. Dixon, PhD, MPA, serves as the director of Public Health Informatics at Regenstrief Institute. He is a professor at IU Fairbanks and a VA investigator. His work focuses on applying informatics methods and solutions to improve population health in clinical as well as public health organizations.