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Recommendations for the Framework and Format of Healthy People 2020

Appendix 11.
Measuring Health Disparities and Health Equity

Measuring Health Disparities

Measuring disparities in health status requires three basic components:

  1. An indicator of health status (e.g., life expectancy at birth, infant mortality, chronic disease rates)
  2. An indicator of social grouping associated with different levels of social advantage or disadvantage (e.g., racial or ethnic groups, income groups categorized in relation to the federal poverty level, groups with different levels of educational attainment); and
  3. A method for comparing the health indicator across social groups (e.g., a ratio of the health indicator rates in two different social groups, typically the best-off and the worst-off; the absolute difference in the health indicator rates in two different social groups; or more complex methods, such as the slope and relative index of inequality and the concentration index that consider the health indicator rates in all social groups, not only the extremes.) [Wagstaff; Pamuk]

Measuring disparities in health care also requires 3 basic components:

  1. An indicator of access to care or quality of health care;
  2. A social group indicator as above; and
  3. A method for comparing groups on the selected indicator of health care.

Measuring disparities in living and working conditions that influence health similarly requires 3 basic components:

  1. An indicator of the key social conditions that strongly influence health (e.g., poverty, low educational attainment, living in a disadvantaged neighborhood, lack of control over working conditions, exposure to chronic stress due to discrimination);
  2. A social group indicator as above; and
  3. A method for comparing groups on the selected social determinant of health.

Measuring Health Equity

Measuring health equity requires, at a minimum, having population-based data on health status, health care, and the social determinants of health that can be disaggregated (with adequate sample sizes for reliable estimates) by:

  • Race or ethnic group;
  • Markers of socioeconomic status or position, such as income, education, and wealth; and
  • Gender.
  • Disability status, sexual orientation, and other characteristics that have been associated with social stigma should also be considered; existing routine data systems have known limitations for examining race and socioeconomic status, but are particularly inadequate for capturing these other important dimensions of equity.

Key challenges in measuring health equity that should be addressed as part of efforts to eliminate health disparities include:

  • Inadequate numbers of certain highly disadvantaged groups such as American Indians in many routine data sources to obtain reliable estimates regarding their health needs;
  • A complete absence of data on some groups, such as sexual orientation minorities;
  • Inadequate information about social and economic conditions to understand either racial and ethnic or socioeconomic disparities, often resulting in erroneous assumptions regarding underlying reasons for the disparities.

Measurement Reference

See: Harper S, Lynch J et al., 2007 [NCI]

http://seer.cancer.gov/publications/disparities/measuring_disparities.pdf [PDF File - 1.5 MB]

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Continue to Appendix 12. The Multi-Level Nature of Health Determinants: Dimensions for Intervention
Back to Appendix 10. Clarification and Examples of Health Disparities and Health Equity
Return to Phase I Report Table of Contents

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Last revised: December 11, 2008