Privacy and Public Health at Risk: Public Health Confidentiality in the Digital Age

By Myers, Julie Frieden, Thomas R; Bherwani, Kamal M; Henning, Kelly J:

Public health agencies increasingly use electronic means to acquire, use, maintain, and store personal health information. Electronic data formats can improve performance of core public health functions, but potentially threaten privacy because they can be easily duplicated and transmitted to unauthorized people. Although such security breaches do occur, electronic data can be better secured than paper records, because authentication, authorization, auditing, and accountability can be facilitated. Public health professionals should collaborate with law and information technology colleagues to assess possible threats, implement updated policies, train staff, and develop preventive engineering measures to protect information.

Tightened physical and electronic controls can prevent misuse of data, minimize the risk of security breaches, and help maintain the reputation and integrity of public health agencies. (Am J Public Health. 2008;98:793-801. doi:10.2105/AJPH.2006.107706)

BALANCING PERSONAL AND societal interests has always been a challenge. As a society, we place great value on individual rights and uphold the importance of protecting personal information from external, and especially governmental, intrusion.1 However, the acquisition, storage, and use of personal health information are required for many core public health activities.2

Concerns about confidentiality have fueled debates about the proper balance of individual and societal interests. Disease surveillance and reporting have often been controversial, particularly for sexually transmitted disease and tuberculosis in the first half of the 20th century3 and more recently regarding HIV4 and diabetes.5 New York City’s public health champion of the early 20th century, Hermann M. Biggs, MD, recognized that the only way to make public health reporting more acceptable was to ensure confidentiality. As Biggs explained in 1897 when emphasizing the confidentiality of tuberculosis reporting, “Notification to [public health] authorities does not involve notification to the community at large.”6(p155)