# Presentation: 729184

## Measuring Disparity in Healthy People 2010’s Leading Health Indicators 

- John Aberle-Grasse, MPH
- National Center for Health Statistics

## Slide 2

## Healthy People 2010 goals

- Increase quality and years of healthy life

- 2.  Eliminate health disparities

-    “The second goal of Healthy People 2010 is to eliminate health disparities among segments of the population, including differences that occur by gender, race or ethnicity, education or income, disability, geographic location, or sexual orientation.”

**Notes:**
Describe 2nd goal

What does this mean as a policy-- Implement a vision for the nation’s health, what do we want health to look like.

The support and interest in addressing disparity is broad and significant with the DHHS Initiative to Eliminate Disparities in Health, the NIH Center on Race/Ethnic Health Disparity, the Memorandum of Understanding addressing disparity between DHHS and APHA, 2 IOM committees dealing with disparities, and others as well.  So HP 2010 is part of a larger national effort to address disparity.

## Leading Health Indicators link with Healthy People 2010

- Ten national health priorities
- Measures are specific HP2010 objectives (21 measures)
- Serve as link to the 467 objectives in Healthy People 2010
- No method for measuring disparity initially specified

**Notes:**
Created by a broad coalition of experts from many sectors (HHS, IOM) 

Provide 10 national health priorities with general public as primary target for motivation

Directly and indirectly relate to all 28 Focus Areas

Provide  a “snapshot”  of the health of the Nation at regular intervals over the next decade

Considerable media outreach  including annual report card throughout the decade on LHIs (start 2002)

## Leading Health Indicators

- Physical Activity
- Overweight & Obesity
- Tobacco Use
- Substance Abuse
- Responsible Sexual Behavior
- Mental Health

- Injury and Violence
- Environmental Quality
- Immunization
- Access to Health Care

**Notes:**
Quickly mention each

## Slide 6

## Healthy People 2010 Work Group on Disparity Measurement

- Reached consensus
- Will provide recommendations to the Steering Committee for implementation
- This work is still in progress

**Notes:**
Steering committee meeting is scheduled for mid Dec.

## Contexts for measuring disparity

- At one point in time
- Over time
- Between domains of subpopulations
- Between objectives

**Notes:**
Interests within HP2010 will likely want to look at all these contexts for measuring disparity; issues 
Cross sectional- at one point in time
Between types refers to comparing race/ethnicity to socioeconomic on 1 or a set of objectives.
There is some difference in race/ethnicity data collection that needs to be considered when comparing across objectives that obtain data from different sources.
Across geographic areas seems to have added issues- When using total population as a reference Race/ethnic composition may vary significantly and this will act as a confounder so you would need to standardize on this to make comparison.
Also, the data seem to vary enough to call into question the ability to compare at the region or state level.  This needs further inquiry but is cause for question.

## Consensus

- Progress toward targets and elimination of disparity measured separately
- Relative measure of disparity
- Disparity measured in terms of a reduction in adverse outcomes
- Use “total” as reference point for all disparity measurements

**Notes:**
HP2000 treated them as distinct, but reported them together for complete information
Targets set for objectives are applicable to each standard subpopulation group suggesting that progress for each group should be measured separately

The two goals are listed separately; each dimension is of interest on its own
Measuring the two dimensions allows each of the goals to be tracked separately

Combining progress towards a target with disparity confounds the measuring of both goals; is an observed change due to improvement in the overall trend, or are all the groups getting worse but less disparate.  Added to the confounding is the issue that targets for objectives were set using different criteria, this obstructs comparisons between objectives of disparity based on progress towards a target.

## A three part approach to measuring progress in Healthy People 2010 is suggested

- Measure progress toward targets
- Overall
- Particular groups
- Measure progress toward elimination of disparity
- Overall
- Particular groups
- Magnitude of underserved individuals or excess events

## 1.

**1.**

**2.**

**3.**

## Persons with health insurance

- 1997

- 1998

- 1999

- 2000

- 50

- 60

- 70

- 80

- 90

- Percent

-  Total

-  White non-Hispanic

-  Black non-Hispanic

-  Hispanic

-  Am. Indian/Alaska Native

-  Asian/Pacific Islander

## 1.

**1.**

## Percent of target achieved (Progress Quotient)

- 	=  (r most recent – r baseline)
- 		  (r 2010 target – r baseline)   * 100

## 2.

**2.**

## Change required to achieve target

- Number of persons
- 	= Expected (target) – Observed (most recent)
- Percent of population
- 	=    Number of persons
- 		 Total persons in group

## Persons with health insurance (without)

- 1997

- 1998

- 1999

- 2000

- 5

- 10

- 15

- 20

- 25

- 30

- 35

- 40

- 45

- 50

- Percent

-  Total

-  White non-Hispanic

-  Black non-Hispanic

-  Hispanic

-  Am. Indian/Alaska Native

-  Asian/Pacific Islander

## 3.

**3.**

## Percent Difference

- 		= (ri-T / T) * 100
- Index of Disparity
- 		= (i |ri-T| / n / T) * 100
- Percentage point change
- 	= Most recent - baseline

## Slide 20

## Slide 21

## Slide 22

## Resources

**NCHS Healthy People: **_[www.cdc.gov/nchs/healthypeople](http://interdev2.nchs.cdc.gov/nchs/)_
**DATA2010: **_[www.wonder.cdc.gov/data2010](http://interdev2.nchs.cdc.gov/nchs/)_
**DHHS Healthy People: **_[www.health.](http://www.health.gov/healthypeople)__[gov](http://www.health.gov/healthypeople)__[/](http://www.health.gov/healthypeople)__[healthypeople](http://www.health.gov/healthypeople)_