31 J.L. Med. & Ethics 663 (2003)
Health Information Privacy an Public Health

handle is hein.journals/medeth31 and id is 661 raw text is: Health Information Privacy
and Public Health

James G. Hodge, Jr.

p rotecting the privacy of individually-identifiable
health data and promoting the public's health often
seem at odds. Privacy advocates consistently seek
to limit the acquisition, use, and disclosure of identifiable
health information in governmental and private sector
settings. Their concerns relate to misuses or wrongful
disclosures of sensitive health data that can lead to dis-
crimination and stigmatization against individuals. Public
health practitioners, on the other hand, seek regular,
ongoing access to and use of identifiable health informa-
tion to accomplish important public health objectives. The
collection and use of identifiable health data by federal,
tribal, state, and local health authorities support nearly all
public health functions and goals.'
Identifiable health data are the lifeblood of public health
practice. When aggregated, these data help authorities moni-
tor the incidence, patterns, and trends of injury and disease
in populations. Health data are acquired by public health
authorities through testing, screening, and treatment
programs. Carefully planned surveillance and epidemio-
logical investigations at the state and local levels facilitate
rapid identification of health needs, including: the spread
of communicable (e.g., TB, SARS) or sexually transmitted
(e.g., HIV, syphilis, gonorrhea) infection or disease;
clusters or outbreaks of bacterial or viral infection (e.g.,
Legionnaire's disease, hantavirus, E. Coli) from naturally
occurring sources or from acts of bioterrorism; risk behav-
iors in sub-populations (e.g., smoking among adolescents
or ethnic minorities); and harmful conditions such as child
or spousal abuse, lead poisoning, or iatrogenic injuries.2
Privacy and public health proponents often disagree
over the extent to which public health needs for health
Journal of Law, Medicine & Ethics, 31 (2003): 663-671.
© 2003 by the American Society of Law, Medicine & Ethics.

data override the legitimate privacy interests of individuals.
To resolve these differences, law and policy-makers seek
to balance individual privacy rights against the public's
interest in promoting public health outcomes. The result is
a framework for sharing health data responsibly with
public health authorities while respecting individual
privacy. This framework is a central feature of the Depart-
ment of Health and Human Services' (DHHS) Privacy Rule,
created pursuant to the Health Insurance Portability and
Accountability Act of .1996 (HIPAA).3
Privacy and public health, however, are not necessarily
in conflict. In fact they are best understood as synergistic.
Protecting the privacy of identifiable health data is critical
to accomplishing public health goals. People will not
tolerate known and objectionable privacy abuses by
government or in the private sector. Failing to respect the
sensitivity and privacy of a person's health information
predictably leads individuals to avoid, or limit their partici-
pation in, public health programs, human subject research
and clinical care. When measured across populations, these
collective decisions can skew the accuracy of public health
information. In tum, this affects public health programs
and outcomes. Protecting privacy is thus essential to
protecting the public's health.4
Conversely, everyone needs public health. No single
person can ensure the conditions in which he or others can
be healthy. Protecting the public's health is a community
goal: it depends on the active cooperation and participation
by each individual as a member of society. For everyone to
benefit from public health improvements, people must be
willing to confidentially share their health data for public
health purposes. Each person; that is, recognizes some dimi-
nution in their informational privacy expectations in the
interests of public health. Just as the public's heath can never
completely be accomplished (i.e., there will always be

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