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4 Measurement and Health Equity
Pages 53-82

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From page 53...
... This panel featured three presentations; highlights are provided in Box 4-1. Session moderator Steven Woolf, Director of the Center on Society ­ and Health and Professor of Family Medicine and Population Health at Virginia Commonwealth University, provided a short introduction to BOX 4-1 Highlights from Presentations on Measurement and Health Equity 1.
From page 54...
... . From an analytic perspective, said Woolf, thinking about measuring the drivers of health inequity requires think 1 This section is based on remarks from Steven Woolf, Director of the Center on Society and Health and Professor of Family Medicine and Population Health at Virginia Commonwealth University, and the statements have not been endorsed or verified by the National Academies of Sciences, Engineering, and Medicine.
From page 55...
... MEASUREMENT AND HEALTH EQUITY 55 FIGURE 4-1  Impact of geography on life expectancy. SOURCE: Woolf presentation, July 30, 2015.
From page 56...
... Increasingly, said Woolf, the conversation about health disparities is turning to the role of place. "It is not just the classic social determinants of health that exist in people's households or in their personal lives, but
From page 57...
... MEASUREMENT AND HEALTH EQUITY 57 FIGURE 4-3  Income and disease burden. SOURCE: Woolf presentation, July 30, 2015.
From page 58...
... "Maybe the question is less about how we in the health field measure health inequity and more about how we as a society measure inequity in general." He advocated core measures of inequity in opportunity, along with metrics of the manifestations of inequity in various domains -- health among them. Another important factor, he said, is to remember the historical context when measuring inequity.
From page 59...
... A better understanding of adverse childhood experiences and their effects on health throughout life will require new metrics, he added. This is not just an inner city problem, as Woolf illustrated with data from the County Health Rankings showing worse health outcomes in eastern Kentucky (see Figure 4-6)
From page 60...
... Both are valuable and valid goals, but they are not the same goal." As an example, he discussed a study he conducted that identified racially integrated communities around the country that did not have disparities by race and socioeconomic status as measured by high school graduation rates and median income. One of those communities was in southwest Baltimore and there were, in fact, no disparities in health status by race because both African Americans and whites were experiencing the same high rates of adverse health events.
From page 61...
... reveals several patterns that LaVeist explained have implications for how interventions are planned and where resources are devoted. This analysis shows that smoking rates are much higher among whites compared to African Americans and Latinos during the teenage years, but that while the rate among whites declines over time, the rate among African Americans and Latinos, and particularly among the former, rises into adulthood.
From page 62...
... SOURCES: LaVeist presentation, July 30, 2015; U.S. National Center for Health Statistics, 2003.
From page 63...
... , with the exception being hypertension. White Americans, said LaVeist, show the typical pattern of increasing levels of income leading to decreased risk of hypertension, but African Americans show the opposite pattern (see Figure 4-13)
From page 64...
... NOTE: x-axis = income level; y-axis = percentage self-rating health as "very good" or "excellent." SOURCES: LaVeist presentation, July 30, 2015; original analysis of 2003-2008 Medical Expenditure Panel Survey.
From page 65...
... limitation and falling in one of three income categories shows that the odds ratio declines as income increases. The bivariate relationship between race and ADL limitation yields an odds ratio of 1.46, leading to the conclusion that African Americans have a 46 percent greater odds of having at least one ADL limitation compared to whites.
From page 66...
... TABLE 4-1  Cross-Tabulation of Race and Activities of Daily Living Within Income Groupings White Black Total P-Value <$20K 6.1% 7.6% 6.4% .031 e = 304 e = 97 e = 401 $20K-$75K 2.1% 2.1% 2.1% .50 e = 343 e = 45 e = 388 >$75K 1.0% 1.7% 1.0% .10 e = 56 e=8 e = 64 SOURCES: LaVeist presentation, July 30, 2015; analysis of data from 2005 National Health Interview Survey. One of the biggest issues with addressing race disparities, LaVeist explained, is racial residential segregation and the fact that races live in the country together, but experience the country differently because the risk environment is so different.
From page 67...
... SOURCES: LaVeist presentation, July 30, 2015; data from U.S. Census, 2000 and 2010.
From page 68...
... LaVeist concluded his presentation by describing the documentary film he is creating on African American health as part of a large community engagement program. "When you talk to people in communities, it is difficult to talk about these statistics in ways that they really understand," TABLE 4-2  A Hypothetical Example of Increasing Risk Ratios Year 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 Black 150 140 130 120 110 100 90 80 70 60 White 100 90 80 70 60 50 40 30 20 10 Diff 50 50 50 50 50 50 50 50 50 50 Ratio 1.5 1.55 1.65 1.71 1.83 2 2.25 2.67 3.5 6.0 NOTE: Diff = Difference.
From page 69...
... National Center for Health Statistics, 2011. 70 60 50 Figure 4-16 Revised 40 R02974 vector, editable 30 20 10 0 Non-Hispanic African American Hispanic/Latino White American Indian/Alaska Native FIGURE 4-17  Percentage of deaths that can be considered excess relative to Asian Americans, 2006.
From page 70...
... Her response was, "In 6 years there could be a cure." THE NATIONAL EQUITY ATLAS4 PolicyLink, explained Sarah Treuhaft, is a national research and action institute whose mission is to advance economic and social equity. That mission led PolicyLink to partner with the Program for Environmental and Regional Equity (PERE)
From page 71...
... The data, she said, illustrate the demographic change that the nation is undergoing, both in terms of the percentage of the population that people of color will represent (see Figures 4-19 and 4-20) and the share of population growth (see Figure 4-21)
From page 72...
... SOURCES: Treuhaft presentation, July 30, 2015; PolicyLink and PERE.
From page 73...
... Summed across the nation, they project that the increase in GDP from eliminating racial economic disparities would be $2.1 trillion annually. One focus of the National Equity Atlas is to help tailor PolicyLink's framing to regions.
From page 74...
... From the definition, Treuhaft and her colleagues developed a framework with three characteristics that is used to prepare regional equity profiles: • Economic vitality -- are all of a region's residents able to contribute to the region's economy? • Readiness -- is the region ready with the workforce and human capital needed for the future?
From page 75...
... Treuhaft noted that although the Atlas provides some unique data, one of its functions is to make disaggregated Census data more easily accessible because many advocates and policy makers do not find the Census Bureau's FactFinder tool easy to use. With funding from the HUD Sustainable Communities Initiative, she and her colleagues were able to work with 12 regions to develop detailed equity profiles.
From page 76...
... For example, in southeast Florida, it was necessary to disaggregate data to reflect the large black immigrant population there, while in Detroit, the large Middle Eastern population was not reflected in any of the normal census categories. The National Equity Atlas website, explained Treuhaft, embeds the central narrative and the indicator framework, and it attempts to democratize data and make them more broadly available and ready to use in policy contexts.
From page 77...
... FIGURE 4-24  A regional data profile from the National Equity Atlas. 77 SOURCE: Treuhaft presentation, July 30, 2015.
From page 78...
... 78 FIGURE 4-25  Indicators page of the National Equity Atlas. SOURCE: Treuhaft presentation, July 30, 2015.
From page 79...
... Treuhaft explained that while Dubuque's residents are predominantly white, IBM has a facility there that brings higher skilled immigrants into the community, and there is a growing population of African Americans moving from Chicago who are of lower income and living in Section 8 housing. "They are using this process of looking at the data to think about how to include everyone in the local economy," said Treuhaft.
From page 80...
... 80 FIGURE 4-26  Indicators and milestones in Multnomah County's Cradle-to-Career Effort. SOURCE: Treuhaft presentation, July 30, 2015.
From page 81...
... FIGURE 4-27  Cradle-to-Career indicators disaggregated by race. 81 SOURCE: Treuhaft presentation, July 30, 2015.


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