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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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