Measuring Disparities In Health Concurrent Session III – 12 Monday, July 15 th 3:30 – 5:00 PM

What Do We Mean By Disparity Jeffrey N. Pearcy, MS Kenneth G. Keppel, PhD … Monitoring the Nation’s Health National Center for Health Statistics

Disparity Public Health context

Disparity Composed of Inequality and Inequity

Disparity Public Health context Composed of Inequality and Inequity “..Inequality – A factual matter Inequity – An ethical judgement..” (Roy Carr-Hill, U.K. Health Equity Network)

Components of Disparity Inequality – How different are we? (measurement issues) Inequity – Who should we be like? (another group) – What should we be like? (some target)

Perspective Inequality – How different are we? Are different outcomes unavoidable? ……or, Are different outcomes avoidable?

Perspective Inequity – Outcomes are avoidable Are differences acceptable? ….or, Are they unfair and unjust?

Disparity Evaluation Adapted from Evans, Whitehead, Diderichsen, et al. 2001

Determinants of Disparity Unavoidable Genetics Unhealthy behavior – freely chosen Temporary health advantage Adapted from Margaret Whitehead, 1992

Determinants of Disparity Unavoidable Genetics Unhealthy behavior – freely chosen Temporary health advantage Adapted from Margaret Whitehead, 1992

Determinants of Disparity Unavoidable Genetics Unhealthy behavior – freely chosen Temporary health advantage Adapted from Margaret Whitehead, 1992

Determinants of Disparity Avoidable Restricted lifestyle choices Damaging environment Access to care Natural selection Adapted from Margaret Whitehead, 1992

Determinants of Disparity Avoidable Restricted lifestyle choices Damaging environment Access to care Natural selection Adapted from Margaret Whitehead, 1992

Determinants of Disparity Avoidable Restricted lifestyle choices Damaging environment Access to care Natural selection Adapted from Margaret Whitehead, 1992

Determinants of Disparity Avoidable Restricted lifestyle choices Damaging environment Access to care Natural selection Adapted from Margaret Whitehead, 1992

Applications of Disparity Model Inequality – Descriptive or Monitoring Inequity – Goal or Target Oriented

Conclusions Disparity…not so simple after all !! Inequality == Inequity Complex interactions of … Genetics Environment (physical, social, economic) Behavior

Conclusions Incomplete knowledge == Inaction ! Purposes of measurement – Monitoring and Assessment – Intervention and Improvement Programs P.D.G. affects choice of statistics

Handbook on Measuring Disparity Timeline – complete in 2002 ? Stakeholder engagement continues – Handbook work group State, Federal, Academic – Meetings NCVHS, DUC, HP Steering Committee, APHA