Social Determinants of Health Disparities: The CT Health Index

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Social Determinants of Health Disparities The
CT Health Index

• Connecticut Association of Directors of Health
• October 2006

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Health Equity Index

• A systematic, identification, quantification and
  measurement of social determinants that lead to
  health disparities
• Social Determinants
• Components
• Indicators
• Core
• Complementary
• Data Sources

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Economic Security/ Financial Resources
Income
Wealth/ Assets
Poverty
Public Assistance
Access to Capital
Households Below Poverty Individuals
with Income lt50 Poverty Children lt18
in Poverty Concentration of Poverty

• Media Value- Owner
• Occupied Homes
• Land/Building
• Assessed Value
• Sales Prices
• Average of Vehicles

• Approval Rates- Home
• Purchase Mortgages
• of Home Purchase
• Mortgages

Median Household Income

• Rate per Household-
• TFA
• Food stamps
• SAGA

US Census/ Claritas

• US Census/Claritas
• Local Tax Assessor

US Census/ Claritas
Department of Social Services
Home Mortgage Disclosure Act
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Social Determinants

• Set of Ten Social Determinants
• Economic Security Financial Resources
• Livelihood Security Employment Opportunity
• School Readiness Educational Attainment
• Environmental Quality
• Civic Involvement Political Access
• Availability Utilization of Quality Health Care
• Health
• Adequate, Affordable Safe Housing
• Community Safety Security
• Transportation

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Components

• A set of elements that comprise the respective
  Social Determinants
• Examples
• Economic Security Financial Resources
• Income
• Wealth/ Assets
• Poverty
• Public Assistance
• Access to Capital

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Indicators

• A measurement used to describe the condition of a
  population group on a specific characteristic or
  event.
• Indicator Selection Criteria
• Core Indicators
• Proxy Measures
• Complementary Indicators

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Types of IndicatorsCore Indicators

• The set of indicators used in the SDHEI for which
  reference points and measurement scales have been
  developed and scoring will be applied

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Types of IndicatorsCore Indicators

• Social Determinant Economic Security Financial
  Resources
• Component Wealth/ Assets
• Indicators
• Median Value for Specified Owner-occupied Housing
• Land/ Building Assessed Values
• Sales Prices of Existing Homes
• Average Number of Automobiles Available by
  Household

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Types of IndicatorsCore Indicators

• Social Determinant Economic Security Financial
  Resources
• Component Access to Capital
• Indicators
• Approval Rate of Home Purchase Mortgage Loan
  Applications
• Number of Home Purchase Mortgage Loan
  Applications
• Median Dollar Amount of Home Purchase Mortgage
  Loans Originated Over Two Years

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Types of Indicators Proxy Measures

• A stand-in measure used to approximate an actual
  condition, outcome or event when a direct measure
  is not feasible to data collection, time or
  resource constraints.

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Types of Indicators Proxy Measures

• Examples
• Access to Quality Health Care
• Insurance Coverage- Self pay code as primary
  payor source- CHIME
• Rates of Ambulatory Care Sensitive
  Hospitalizations- CHIME
• Access to Capital
• Approval rate home purchase mortgage loan
  applications- HMDA
• Area Business Capacity/Economic Development
• Percent of all businesses over four years old

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Indicator Construct
Indicator
Data Source
Data Source
Reference Point
Rate Percentage Mean Median
Six Point Measurement Scale
Numerator Denominator
Indicator Score
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Indicator Construct Example
Median Household Income
US Census-Claritas
Hartford 24,820 Meriden
43,237 Wethersfield 53,289 Farmington
67,073 Fairfield 83,512 Darien
146,755
CT Median HH Income 60,538

1. 0-20,000
2. 20,001- 40,000
3. 40,001-60,000
4. 60,001- 80,000
5. 80,001-100,000
6. 100,001

Hartford-2 Meriden-3 Wethersfield-3 Farmington-4 F
airfield-5 Darien-6
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Framework of Analysis

• Demographic and health outcome measures against
  which SDHEI findings will be analyzed
• Health Outcomes incidence or prevalence rates
  for mortality and specified diseases
• Demographic race/ethnicity gender age place
  of residence class (educational attainment,
  income

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Summary Accomplishments to DateSDHEI Methodology

• Common Meanings for Critical Concepts
• Systematic Methodology
• Identification of Measures of Disparities
• Method of Tying SDHEI Findings to Health Outcomes
  and Demographics
• Method of Pre-testing the SDHEI Instrument
• 16 Neighborhoods- Hartford
• 4 Zip Codes- West Hartford

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Summary Accomplishments to DateInstrument
Development

• Identified Core Indicators
• Acquired Datasets
• Computed Formulas
• Developed Reference Points and Measurement Scales

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Summary Accomplishments to DateInstrument
Pre-Testing

• Acquired Municipal Data from Target Cities
• Calculated Indicator Scores for Neighborhoods

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Next Steps Instrument Development Using SPSS

• Exploratory Statistical Analysis of SDHEI as a
  Measurement Tool
• Descriptive Statistics means, median, mode,
  variability, percentages
• Inferential Statistics t-tests, pearson
  correlations, ANOVAs
• Multivariate Statistics regression, DFA

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Next Steps SDHEI Relationship to Health Outcomes

• Work with DPH to Identify Availability of Health
  Outcome Data
• Compile Health Outcome Data by Neighborhood
• Test Strength and Direction of the Correlations
  Between SDHEI and the Measures of Health Outcomes

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Next Steps SDHEI Relationship to Demographics

• Test Strength and Direction of the Correlations
  Between SDHEI and Demographic Variables

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Types of IndicatorsComplementary Indicators

• Measures used to support further, in-depth
  analysis of issues raised by the HEI
• Based on systematic observation, and survey and
  qualitative research
• Observations, perceptions, descriptions

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Complementary Indicators

• Urban Environment/ Sanitation
• Nutrition/ Life Style
• Natural Environment
• Political Access Power
• Social Cohesion
• Stress
• Community Organization
• Work Environment
• Public Transit

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Examples of Complementary Indicators

• Urban Environment Physical Aspects of the
  Neighborhood
• Amount of municipal expenditures for
  infrastructure
• Parks and amount of open space available for
  recreational use
• Nutrition/ Life Style
• Supermarkets per capita
• Billboards advertising liquor or cigarettes
• Transportation
• Availability of public transportation
• Political Access and Power
• Racial/ gender representation in elected office
• Social Cohesion
• Quality of social relationships/ support network
• Social control