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Volume 1:
No. 4, October 2004
COMMENTARY
Digital Government and
Public Health
Jane E. Fountain
Suggested citation for this article: Fountain JE. Digital government and
public health. Prev Chronic Dis [serial online] 2004 Oct [date
cited]. Available from: URL:
http://www.cdc.gov/pcd/issues/2004/
oct/04_0084.htm.
Abstract
Digital government is typically defined as the production and delivery of
information and services inside government and between government and the
public using a range of information and communication technologies. Two
types of government relationships with other entities are
government-to-citizen and government-to-government relationships. Both offer opportunities and challenges. Assessment of a
public health agency’s readiness for digital government includes examination
of technical, managerial, and political capabilities. Public health agencies
are especially challenged by a lack of funding for technical infrastructure
and expertise, by privacy and security issues, and by lack of Internet
access for low-income and marginalized populations. Public health agencies
understand the difficulties of working across agencies and levels of
government, but the development of new, integrated e-programs will require
more than technical change — it will require a profound change in paradigm.
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Definition of Digital Government
Digital government — also called e-government or virtual government —
refers to governance affected by Internet use and other information
technologies (IT). Digital government is typically defined as the production
and delivery of information and services inside government and between
government and the public using a range of information and communication
technologies (1,2). The public includes individuals, interest groups, and
organizations, including nonprofit, nongovernmental organizations, firms,
and consortia. Because government functions exist at multiple levels in the
United States, the impact of digital government varies widely across the
country. The definition used here also includes e-democracy, that is, civic
engagement and public deliberation using digital technologies.
The concepts of digital government that are relevant to organizational
and institutional change arise from three fields of study: political
science, organization theory (including social capital), and interactions of
technology and organizational structure. The interplay among these ideas is
highlighted in the uses of IT and the opportunity and challenges it
presents.
Critical e-government topics include both societal and technical
challenges and interactions between the two. On the societal level,
the adaptation of government and civic engagement to increasingly
computerized environments raises political, organizational, and social
questions concerning use, context, reciprocal adaptation mechanisms,
learning and the design of government work, the design of political and
civic communities of interest, and the design of nation states in addition
to international governance bodies (3).
On the technical level, IT is a tool, not a solution, but organizations rapidly
absorb this sophisticated tool into everyday functions, so that IT becomes
an essential part of the infrastructure of the organization. However,
the most challenging role of IT is when it becomes a catalyst for change.
If a government agency cannot effectively manage these changes, the
organization may be overwhelmed (4).
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Historical Development
Initial efforts by government agencies to develop e-government entailed
simply digitizing and posting static government information and forms on the
Web using the language, displays, and design of existing paper-based
documents. During the 1990s and continuing into the present, many government
agencies have begun to adapt operations, work and business processes, and
their interface with the public to simplify and integrate information and
services in online environments.
The central governments of the United States, Canada, Finland, and
Singapore are among those at the forefront of e-government in terms of the
amount of information and interactivity available to the public and
attention to system development and interface architecture. One of the key
types of country-level initiatives is the country-level Web portal designed
to help individuals navigate and search information for entire central
governments. The U.S. government Web portal, www.FirstGov.gov, is an
interface with a search tool meant to serve as a single point of entry to
U.S. government information and services. The central government of
Singapore developed a single Web portal, called Singov (www.gov.sg*), to
simplify access to government information for visitors, citizens, and
businesses. Similarly, the Web portal for the Government of Canada,
www.canada.gc.ca*, was designed for three main constituents: Canadians,
non-Canadians and Canadian businesses.
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Government Relationships
This section describes two types of government relationships with other
entities. These are government-to-citizen (G2C) and government-to-government
(G2G) relationships.
Government-to-citizen
Digital G2C defines “citizens” as individuals and corporations. At
present, digital government is most prized for its ability to improve
communication with citizens (4-6). G2C exists in several forms, including
agencies that offer e-based services, agencies that create a Web-based
information site that allows searching and use of existing services, and
virtual government portals that allow access to the services of multiple
agencies. These efforts vary in interactivity and complexity. Maintaining a
Web site increases outreach rapidly because the increased number of citizens on
the Web increases the benefit to both government and citizens. In
essence, G2C represents the first wave of governmental use of information
technology: to provide information and services to citizens. It focuses on
design and usability of Web sites but generally does not require extensive
collaboration among government agencies. It emphasizes the first two roles
of IT: tool and infrastructure.
Interactive e-government services include online tax payments, license
applications and renewals, and grant applications and renewals. The
City of Baltimore Web site (http://www.ci.baltimore.md.us/*)
has won awards for its implementation of computing technology in government. The
system allows citizens to pay parking fines, property taxes, and water and
other bills. Users can search crime statistics by geographic area within the
city and track several city services, including trash removal and street
cleaning. The City of Baltimore has implemented an online version of the 311
service available in some other large U.S. cities, which allows citizens to
request city information and services over the telephone. Individuals can
report and then track the status of a request for city services, including
abandoned vehicle removal, pothole repair, graffiti removal, and
requests for a change in traffic signs. These applications not only provide
interactivity but also promote government compliance and accountability to
voters by making provision of city services more transparent to the public.
Interactivity is increasing as governments continue to develop systems
and citizens adapt to online government. For example, in the United States,
the number of online federal tax filings increased from 20,000 in 1999 to 47
million, or about 36% of individual filings, in 2002. The Environmental
Protection Agency reports that it saves approximately $5 million per year in
printing and mailing costs by providing information digitally to the public.
Government-to-government
Digital G2G delineates intergovernmental linkages. This is the second
wave of IT use. Intergovernmental linkages are more challenging to implement
because they require more integration within each governmental unit (4,7).
G2G represents the third role of IT as a catalyst for change. G2G linkages may in the long run have the most radical
impact on the function of digital government. Their establishment requires a much greater coordination within and between agencies and a
movement away from oversight and budgeting processes that reinforce
autonomous operations.
G2G development has lagged behind the activities of G2C because there is
a less immediate payoff and more stress on each government agency. Government
departments arise for a specific mission, often determined by law. These
missions do not readily adapt to changing times, in part because of the
oversight of legislative committees that are in turn affected by the advocacy
groups with interest in the mission. Each of these groups has its own, often
extensive, internal structures, and all these structures must align to allow
major changes in agency interactions.
During the 1990s, several federal agencies and state-level governments
created “virtual agencies,” online sources of information and services from
several agencies organized according to client group. For example, in the
early 1990s, the U.S. federal government developed students.gov, seniors.gov,
and business.gov to organize and display information using interfaces
designed specifically for these populations with a single point of entry
into a government portal. By the year 2000, there
were approximately 30 cross-agency Web sites within the federal government.
Beginning in 2001, the development
process shifted from a loose confederation of interested designers within
the government to an enterprise approach to e-government, centrally managed and
controlled, and used lead agencies to supervise projects. The
desire for internal efficiencies drives these projects as much as concern
for service to the public. Several payroll systems are being consolidated
into a few payroll systems for the entire government. Multiple and abstruse
requirements for finding and applying for government grants are being
streamlined into one federal online grants system called e-grants. And
myriad rulemaking processes in agencies throughout the federal government,
while not consolidated, have been captured and organized in the interface
architecture of one Web portal, called e-rulemaking. Recreation.gov uses an
architecture that organizes recreation information from federal, state, and
local governments. System design and interface architecture simplify search,
navigation, and use of information on recreation activities, recreation
areas, maps, trails, tourism sites, and weather reports by location.
Standardization, consolidation, and integration of information, operations,
and interfaces with the public have been the key drivers for e-government in
most central government efforts.
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Challenges for Public Health
A major limitation to the effectiveness of digital government is the
rigidity built into the structure of a bureaucratic state. This is why the
accumulation of more sophisticated technology and specialists is
insufficient to maximize digital government. Public health programs are well
acquainted with the difficulties of working across agencies and levels of
government. Health threats often arise from
conditions that are outside the formal purview of the health department.
An example might be a local industry that releases unhealthy pollutants into
the community. In current bureaucratic systems, multiple organizations may
have a role in addressing this problem: the public health department may
detect a rise in pediatric asthma, the highway department may report more
days of high-level pollution, and real estate companies may identify a drop
in local housing prices. Bringing these systems together to take action requires leaders prepared to use new approaches. Public health leaders must look at the entire system to develop new,
integrated programs. This is not a technical change but a profound change in
paradigm.
Public health agencies are especially challenged by limited resources.
Lack of funding for technical infrastructure and expertise means that the
agency must be thoughtful about the technology it needs. IT
offers many intriguing opportunities, but public health managers must
identify the kinds of technology most critical to their mission. Managers, staff, customers, and IT specialists should be involved in such
decision making. But how can programs assess their readiness for digital
government?
- Technical readiness refers to both internal and external factors.
Externally, are the agency’s constituents able to access the Internet with
sufficient skill and resources to benefit from the agency’s Internet
services? Internally, does the agency have sufficient infrastructure and
skilled workers to support such services?
- Managerial readiness is independent of technical infrastructure. Does
the agency have the organizational structure and culture to manage change?
Do the managers as well as the IT specialists understand the potential
impact of IT?
- Political readiness examines whether e-government is politically
feasible. Will employees accept it? Will constituents? Will changes in the
political arena affect support for e-government programs?
Many public health priorities are directed
toward low-income and marginalized populations in which Internet use may be
limited. Unequal access, roughly divided between those with education and those
without, and highly correlated with income and political participation,
maintains a digital divide in e-government despite advances in
human-computer interaction (8,9). Lack of literacy and computer literacy
exacerbates the digital divide. Disparities between rich and poor nations
parallel digital divide challenges within countries. Yet innovations in several
developing countries and in rural areas invite some degree of
optimism. Rural farmers and crafts people are beginning to connect through
the Internet to enhance their economic well-being. Rural communities in
China are using the Internet, as yet on a modest scale, to decry local
corruption and, in some cases, have forced the central government to
intervene in local affairs.
Privacy and security concerns are issues for public health on
several fronts. If an agency provides direct patient care, multiple
regulations protect the confidentiality of medical records. If the vital
statistics office is within the department of public health, state laws
often indicate who has access to certificates and whether portions of
certificates are confidential. The development of state and national systems
linked to provide early alerts of potential environmental and biological
terrorism raises issues of homeland security. These considerations are an
essential aspect of IT programs and should be considered from the beginning
of the design process.
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Conclusions
The technological potential exists for individuals, groups, and
communities to participate in and shape government in new ways. Some
observers speculate that increased access to government online will lead to
greater interest, knowledge, and discussion of politics. The Internet might
allow citizens to organize and mobilize resources in powerful new ways. Groups
already civically engaged use computers to enhance their activities.
However, the
propensity to simplify and distort information in public discourse is not
abated by changes in media.
Human-computer interaction begins with the study of the mutual adaptation
of social and technical systems. It is not possible to predict the path or
outcome of the many and varied complex adaptation processes now in play. One
of the chief sources of learning for designers of e-government has been to
focus on tools for building and sustaining democracy. While researchers learn more about human cognition,
social interaction, and motivation within computer-mediated environments, and
while designers are developing new tools and interfaces to encompass a wider
range of activities and discourse within online environments, large-scale
adaptation continues between societies, governments, and technology.
Deep-level changes in relationships among government agencies, the
private sector, and nonprofit groups that maximize the opportunities of
digital government require social capital. Social capital emphasizes mutual
trust and support among entities and develops over years of interaction.
While the term social capital is often used in discussions of geographic
communities, it is equally important in virtual communities, and perhaps
more so, because face-to-face encounters may be much less common in
government relationships.
This social capital may offer the greatest benefit to public health as
digital government moves forward. The synergy of different sectors working
together can create innovations beyond the capacity of a single institution.
While it may take several decades for government to maximize the adoption of
G2G, agency interactions to promote good health for
citizens is an essential element of public health. Public health leaders
have a special responsibility to understand and expand the beneficial uses
of digital government.
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Acknowledgments
This material is based upon work supported by the National Science
Foundation under Grant No. 0131923. Any opinions, findings, and conclusions
or recommendations expressed in this material are those of the author and
do not necessarily reflect the views of the National Science Foundation.
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Author Information
Corresponding author: Jane E. Fountain,
Director, National Center for Digital Government, John F. Kennedy School of
Government, Harvard University, Cambridge, MA 02138.
Telephone: 617-495-2823. E-mail: jane_fountain@Harvard.edu.
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service to our users. URLs do not constitute an endorsement of any organization
by CDC or the federal government, and none should be inferred. CDC is
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