Governing real-world health data as a public utility.

It can take many years for evidence generated in research to influence health care guidelines (1). Meanwhile, the vast data collected during everyday life, particularly during engagement with the health care system, remain largely untapped for public health, precision medicine, postmarket safety, and real-time decision-making (2, 3). These "real-world data" (RWD) remain fragmented, proprietary, noninteroperable, and inconsistently governed. Although some approaches to RWD have demonstrated value in limited settings, their impact has remained constrained by uneven incentives, voluntary compliance, and the absence of routine auditability of data access and use. To address this, health data should be governed through federated, standards-based, community-driven models that reflect their public benefit, empower patients and communities, and foster public trust and participation. To help achieve these goals, we propose governing health data as essential infrastructure by using public utility models, defined by their public good, distributed stewardship, and public oversight. [ABSTRACT FROM AUTHOR]