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

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

3. Disparity Public Health context

4. Disparity Composed of Inequality and Inequity

5. 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)

6. 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)

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

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

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

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

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

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

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

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

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

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

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

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

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

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