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By providing local-level data on diverse populations, the California Health Interview Survey paves the way for community-based organizations to achieve health goals.
In Long Beach and Boyle Heights, CA, 54 residents concerned about health risks from emissions generated by the many diesel-powered freight trucks in and around their neighborhoods were educated in how to access relevant data from the California Health Interview Survey (CHIS). After going through the training – offered by the UCLA Center for Health Policy Research, the Fielding School-based center that conducts the ongoing survey – the residents, many of them Latino immigrants, educated others in the community, further fueling opposition to the proposed expansion of a train and diesel truck facility and construction of a new rail yard.
In Bakersfield, leaders of the Central California Regional Obesity Prevention Program used CHIS data showing high rates of obesity among the community’s Latino population to rally police, parks-and-recreation officials and residents behind an initiative to make a local park safe for physical activity. The Oakland-based California Pan-Ethnic Health Network (CPEHN) used an analysis by the California Simulation of Insurance Markets – a micro-simulation model developed by UCLA and UC Berkeley that draws on CHIS data to estimate the likely impact of initiatives under the Affordable Care Act – to alert policymakers to the potential for more than 100,000 Californians being deterred by language barriers from enrolling in Covered California, the state’s Health Benefit Exchange. Following CPEHN’s efforts, Covered California committed to translating its materials in multiple languages, as well as ensuring the availability of bilingual customer service representatives.
“Even when we know that language access needs to be a priority, the data is critical to making the case and without CHIS, we don’t have the data,” says Ellen Wu, CPEHN executive director.
As the nation’s largest state health survey, CHIS is viewed as an invaluable resource by many policy-makers, researchers and advocates for the detailed portrait it paints of the health and health care needs of California’s diverse population. Smaller surveys, for example, are rarely able to provide sample sizes significant enough to enable users of the data to glean meaningful information about local health trends in a community, or the health status and/or access to care of a racial or ethnic subpopulation.
Beyond standing apart as a large survey, CHIS has proved particularly useful to community-based groups because the survey design is responsive to their needs. “From the start, CHIS has had advocates at the table alongside academics to ensure that we accurately depict the diverse populations of the state,” says Dr. Ninez Ponce, a Fielding School professor and principal investigator of CHIS. “And because the design is meaningful for communities, the data we get from it is often used by community-based groups to promote change.”
CHIS data is easily accessed thanks to AskCHIS, a free online tool that allows anyone to quickly and easily generate customized statistics from the survey. Approximately 10,000 queries are run through AskCHIS per month. To promote use of the system, the center regularly holds no-cost workshops up and down the state and online, now funded by The California Endowment and Kaiser Permanente; through these workshops, more than 5,000 community representatives have been trained in how to use AskCHIS. “We’re building capacity to access and evaluate data in the context of what people are trying to do within their community,” says Peggy Toy, director of the center’s Health DATA program, through which the training sessions are offered. “These sessions help people to feel comfortable using the data to communicate what it says about their community.”
Eric Wat participated in a Health DATA training nearly a decade ago, not long after he joined Special Services for Groups, a nonprofit health and human service organization in Los Angeles dedicated to building and sustaining community-based programs that address the needs of vulnerable populations. Wat has been a regular user of the CHIS data ever since, most recently as part of a collaboration with Kaiser Permanente Southern California to conduct community health needs assessments for six of its medical centers. “You can have good epidemiological data, but sometimes you need more details to make sense of why certain diseases are more prevalent now than at other times,” Wat says. “CHIS includes issues around access to care and health behavior that tell us not only which diseases we need to focus on, but how.”
The ability to home in on health data at the ZIP code level proved vital to groups that successfully argued for a 2008 Los Angeles city council ordinance placing a moratorium on new fast-food restaurants in South Los Angeles. At the request of the Los Angeles Department of City Planning, CHIS provided data on obesity and diabetes in Los Angeles County service planning areas, along with statistics on the density of fast-food establishments. This came after Community Health Councils, a nonprofit health-policy education group that was a leader in the fight for the moratorium, approached the center seeking data on the connection between the food environment and rates of obesity and diabetes in South Los Angeles. “It’s really difficult to find data at the granular level that we need, and CHIS provides that,” says Gwendolyn Flynn, policy director of Community Health Councils.
Although the survey itself is confined to California, the influence of CHIS is increasingly national, as many states and cities – from Ohio and Colorado to Houston and New York City – look to emulate its success. To assist them in establishing their own surveys, the UCLA Center for Health Policy Research has led an informal national network that provides technical assistance and advice while promoting comparable data collection processes for research and policy-making purposes. Twenty-three states are represented in the network.
Dr. Jessica Dalesandro Mindnich, director of research at Oakland-based Children Now, knows her counterparts in other states would welcome the addition of a CHIS-like survey. Children Now has relied on CHIS data as part of its technical assistance to Building Healthy Communities, a 10-year project of The California Endowment to help 14 communities throughout the state develop into places where children are healthy, safe and ready to learn.
“The compelling one-off stories are important,” Dalesandro Mindnich says, “but when you can back them up with solid data on children’s needs you have a much stronger case, and that’s what CHIS allows us to do.” Dalesandro Mindnich says she frequently hears from children’s advocates outside of California who are envious of her ability to apply CHIS data. As the survey’s success inspires similar efforts across the nation, communities across the country may soon have numbers of their own.