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Appendix 11.
Measuring Health Disparities and
Health Equity
Measuring Health Disparities
Measuring disparities in health status requires three basic
components:
- An indicator of health status (e.g., life expectancy at birth, infant
mortality, chronic disease rates)
- 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
- 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:
- An indicator of access to care or quality of health care;
- A social group indicator as above; and
- 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:
- 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);
- A social group indicator as above; and
- 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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