Innovator's Dilemma: How SF's Rajiv Bhatia Pioneered Open Health Data and Ruffled Feathers
BY Sam Roudman | Thursday, February 6 2014
During his seventeen-year tenure at San Francisco’s Department of Public Health (DPH), Dr. Rajiv Bhatia excelled. By measuring the health impacts of proposed laws and policies, he created powerful tools to advocate on behalf of the disadvantaged. Gentrification is innately distasteful to many: Bhatia showed how it could be harmful. His work contributed to today’s civic obsession with open data and transparency before those words began to buzz in the ears of bureaucrats, civic hackers and entrepreneurs. He looked at data politically, and searched for political fights to deploy it in. At least he did until June of last year.
“One day I came back from vacation and I found myself turned into a cockroach,” says Bhatia, who was the department's environmental health director. Without warning, he was put on administrative leave. An anonymous and ultimately meritless whistleblower complaint was lodged against him. After a month of leave he was brought back, but essentially stripped of power, removed from the projects he was leading, and barred from contacting the staff supporting his work. The city recently settled with him for $155,000.
“So, this was a very expensive and complicated way of firing me.”
These days, open data is touted as a major opportunity for cities and entrepreneurs. A recent report by McKinsey suggested open data could be the key to unlocking a three trillion dollar market. What’s often missing from this formulation is the notion that data might be used to accomplish social and political goals as well; that government data might not just be used in a private company's app to report a pothole (a laudable goal), but that it might be used to improve the health and safety of public housing residents.
In fact, there are many ways to use civic data that treat citizens as more than mere consumers of government services, and Bhatia’s work in San Francisco provides a primer on how to do just that. From the unlikely perch of environmental health director, he dove into controversies over food, land use, zoning, transportation and the living wage. But given the freedom to develop new uses for data, and create new zones of influence for public health, he also created friction within his own department, and with others. Bhatia’s work in San Francisco shows how increasing transparency and opening up information locked in a city bureaucracy can alter policy and improve people’s lives, but it also illuminates the political challenges open data advocates face as well.
A Tenure of Health Impact
In municipal government, entrenched, top-down bureaucracies can easily hamper efforts to pioneer new services. But Bhatia was given freedom from the beginning to experiment. Dr. Mitchell Katz, the head of DPH and Bhatia’s boss from 1998 through 2010, hired him because of his previous work as a physician, and his work in low-income communities.
“I don’t try to micromanage people’s work, I try to add value to their work,” says Katz, who now directs the Los Angeles County Department of Health Services.
Bhatia says Katz “allowed us to both be autonomous and innovate,” as well as “develop our own source of power.”
Developing his own source of power was important because Bhatia’s take on what counted as environmental health exceeded its typical boundaries. Normally environmental health is concerned with things like food safety, restaurant inspections, and rodent control.
“Rajiv brought in from his own experience, a sense of public health that is much larger than that,” says Bob Prentice, a former deputy director at DPH in San Francisco, who left the department in 1999.
Not content with rodents and restaurants, Bhatia took into account the social environment, examining the health consequences of displacement, or the benefits of paid sick leave. Bhatia stretched not just environmental health, says Prentice, “but even public health more generally.” Eventually Bhatia’s power would be housed in a semi-autonomous DPH unit called the Program on Health Equity and Sustainability.
“We collected and exposed in public processes data that [other agencies] weren’t collecting,” says Bhatia. His conception of public health was not only expansive, it was activist. "I think you can see all these as forms of transparency," he adds.
The central tool Bhatia developed to expand public health is what’s known as a Health Impact Assessment. Now performed across the country, HIAs look systematically at the health impacts of a city’s policy decision, and then break down how it will affect different groups according to socio-economic status or ethnicity. It’s a way of inserting health issues into questions of housing, transportation, land use, labor or most any potential city policy.
“Instead of choosing a side, the health impact assessment was a way to say government has a role as a convener and provider of neutral data,” says Katz. The idea was “to create a data-driven consensus building way to resolve these issues of urban life.”
One of Bhatia’s earlier uses of an HIA was in a debate over a living wage ordinance in 1999. It showed substantial benefits for the poor:
“Adoption of the increased wage was estimated to result in decreases in the risk of premature death by 5% for adults 24-44 years of age in households whose income was around $20,000. For the offspring of these workers, a living wage would result in an increase of a quarter of a year of completed education, a 34% increased odds of high school completion, and a 22% decrease in the risk of early childbirth.”
In a debate otherwise dominated by reports from the Chamber of Commerce and the local restaurant industry lobby, Bhatia says the HIA “helped balance the scales a little bit.” The study informed the debate around a living wage, and was used to bolster the arguments of those in favor of it. San Francisco passed its progressive minimum wage ordinance in 2003.
“The combination of the objective data, the authoritative voice of the health agency and the community now with new evidence I think were pretty powerful forces,” says Bhatia.
Data That Matters
The case for open government data is often made using a hazy technocratic terminology. It is something that "reduces friction in processes" or "increases trust in government." While laudable, Bhatia's work suggests that a city government can use data in more ambitious, and socially useful ways.
“SFDPH did a half dozen HIA’s between 1999 and 2005 and I think they showed that the experience was effective,” says Lilli Farhang, who worked under Bhatia for seven years, “It became a more viable tool for others around the country to use.”
In those days--well before vendors like Socrata made it easy--Bhatia and his team learned how to gather and compile data from a variety of sources, and store it so that if they needed it for a new study, they wouldn’t have to go crawling through the catacombs to find it. “They realized that there was a real information deficit,” says Jason Corburn, a planning professor at Berkeley who has worked with Bhatia. While the broader approach towards environmental health was becoming a trend during Bhatia’s tenure, Corburn credits Bhatia with finding any number of new ways to actually put it into practice.
Bhatia’s approach was especially influential for the planning department.
“There was very little interaction between public health and neighborhood planning, or land use planning at large,” says Miriam Chion, a former senior planning in San Francisco’s planning department. She says Bhatia was able to “build that bridge, and give us some very concrete reference tools, information.” Bhatia’s work informed a contentious nearly decade-long effort to plan for development in San Francisco’s eastern neighborhoods.
“It allowed us collectively to contain some of the displacement, and support the residents of the neighborhoods,” says Chion, who left the planning department in 2005, three years before the eastern neighborhood plan was complete. In particular, she says Bhatia’s work helped protect low-income residents. Work on the eastern neighborhoods plan led to the development of a broader tool, the sustainable communities index, which details a set of 100 measurements to account for sustainability at the neighborhood scale, and apply it to planning and policy decisions.
As an infrastructure devoted to transparency and open data took shape around him, and with the rise of organizations like Code for America and the San Francisco’s Mayor’s Office of Civic Innovation (MOCI), Bhatia was primed to play a key role the last few years.
“Before I met the open data cult,” Bhatia says with a laugh, “I spent a decade understanding where there were accountability problems that needed to get exposed in government.”
Along with Jay Nath at MOCI and Code for America, he helped develop a couple of innovative open data programs last year. The Local Inspector Value Entry Specification, or LIVES, provided an open data standard for cities to publish restaurant inspection data to Yelp, or any other website. It proved to Bhatia that there was a way to bring tech companies into the fold, so that, as he puts it, the "Yelps of the world become an interested party in better regulation, kind of on the side of government, on the side of the public’s interest."
LIVES led to a similar approach for residential building inspection data called the House Facts standard, which provides a standard format for cities to upload it to Trulia.
According to Jack Madans of Code for America, the specifications solve two problems. “No longer does the government worry about creating a readable easy-to-use interface, or struggle to get an audience around it.” The standards allow them to plug their data into the places where citizens are already searching for similar information.
“Dr. Bhatia is an exception,” says Madans, and “is the exact kind of person with the biographical credibility and domain [expertise] that we look for to advise us on what these standards should look like.”
This compliment is seconded by Jess Montejano, a legislative aide to San Francisco Supervisor Mark Farrell.
“Bhatia was one of the first within city government to push for appropriate government data sets, which was revolutionary at the time.” He says the example set by Bhatia and the DPH standardizing and releasing their data sets influenced San Francisco’s recent open data initiative pushed by Supervisor Farrell.
Although Bhatia is generally supportive of work that's being done using open government data, he thinks it is shying away from having real impact.
"All the energy on apps that help people get better parking spaces, for me that’s not the highest social need in this country right now." He thinks groups like Code for America and SF MOCI are too focused on developing open government data as part of a business proposition. "They’re not necessarily aligned with people working on housing rights and food rights, or aligned with low income less technologically sophisticated groups. And those groups advocating for those needs are the least technologically sophisticated."
Innovation Becomes a Political Liability
One of Bhatia’s central goals was to compel city agencies to recognize the social and health impacts of their policies. Sometimes this meant taking other agencies to task, forcing the Building Department to enforce longstanding code requiring studies on building noise, or getting San Francisco public schools to desegregate their paying and subsidized lunch lines. Other times it meant adding steps to already elaborate and drawn out development planning. These efforts were not always greeted warmly.
“Sections of the planning department in the planning process…were not necessarily thrilled by the complication that were added dealing with these issues,” says Miriam Chion. The commercial interests behind development were often less than pleased as well. But none of these conflicts deterred Bhatia.
“It’s pretty hard to say ‘Ehh, you know, I’m the health department, it’s not my job,’” says Bhatia, “but I think that is the prevalent attitude within government.” Over the years he says relationships improved with a number of city agencies. But while his work changed the thinking of those working in planning, or helped SF MOCI to change how cities might use data, many within his own department never went along.
“I think there was a resentment from the very beginning,” says Prentice. He credits the inner-department ill will to Bhatia expanding the scope of environmental health. Many of these complaints can be seen in the comments in San Francisco Bay Guardian article last July, after Bhatia was placed on leave pending the meritless investigation that forced him out. The comments complain about Bhatia’s lack of background in the traditional work of environmental health, his lack of bedside manner, and his arrogance.
“There was a very reactionary kind of wing of the environmental health group that resisted and complained and tried to find fault over a lot of the modernization over the past 10 years,” says Bhatia.
The anonymous whistleblower complaint that was filed against him reflects anxiety over an expanded role for environmental health. Specifically, it called into question Bhatia’s participation in a nonprofit called Square Plate, that worked alongside with the food industry to promote sustainability. The complaint fails to mention that Square Plate and the collaboration it fostered were the products of an executive directive from then-San Francisco Mayor Gavin Newsom in 2009.
“There was a sense [among some in environmental health] that Rajiv was violating the relationship between a regulatory agency and the restaurants that they were supposed to inspect and hold accountable by a nonprofit that works together with them,” says Prentice, “It’s a cultural shift that was really impossible for some people to accept.”
According to Bhatia, another factor leading to his exit from DPH was a more conservative, stability-minded turn in city government after Mayor Ed Lee took over from Gavin Newsom in 2011. It was near then that Mitch Katz left his post overseeing DPH, and was replaced by Barbara Garcia. Katz’s looser management style was replaced with a more top-down approach.
“She came in with a whole set of rules that were intended to bind me,” says Bhatia. “You can’t talk to the politicians, you can’t talk with the press, any discussion with the mayor’s staff has to go through me,” he recalls her saying, as well as informing him that the mayor wanted him out (Garcia declined to comment for this article). He sees the whistleblower investigation as a pretext to do just that.
In December, Bhatia’s ordeal ended with his resignation and a $155,000 apology/settlement from the city. He's now keeping busy developing projects with the National Center for Healthy Housing and a variety of other nonprofits and academic institutions in addition to the Department of Housing and Urban Development, and the World Health Organization.
Bhatia's exit comes in the midst of heightened tensions over gentrification and the role of the tech industry in San Francisco. There have been protests over private tech industry busses taking up public bus stops, and complaints over cultural change, rent hikes, and the lax corporate citizenship of newly settled tech firms flush with cash. Mayor Lee recently added some fuel to the fire by describing San Francisco’s middle class as those people who earn between $80,000 and $150,000 (the median income in San Francisco, is apparently near $73,000).
Technocentric thinking makes it easy to imagine government data as a mystical autonomous force waiting to to be unlocked to create a wave of sparkling innovation. Bhatia showed you can't take the government out of open government data, that for better and worse, it's also political. Bhatia found a way to balance San Francisco’s longstanding reputation for social justice with its recent technophilic fervor. He applied methods associated with the new tech elite –-open data, transparency, etc. -– and showed how they could be used to help the underserved.
He is not optimistic those working for San Francisco now will have the freedom able to do the same.
“Initiative on the inside is not being supported at all, it’s being cooled down and slowed down,” he says, “it’s a radical difference from the past.”