Understanding Health Disparities among People with Disabilities: Core Health Indicators

1. Understanding Health Disparities among People with Disabilities: Core Health Indicators Michael H. Fox, Sc.D. Kimberly G. Phillips, MA Knowledge for Equity November 13-14, 2012 Silver Spring, Maryland The findings and conclusions in this presentation have not been formally disseminated by the Centers for Disease Control and Prevention and should not be construed to represent any agency determination or policy.

2. Session outline • Define & describe health disparities & health indicators • Consider their relation to health status • Find & frame disparity data for stakeholders, partners & policymakers • Engage in community concerns exercise

3. Key Points • Major health gaps exist between people with and without disabilities on leading indicators of health, illustrating poorer health among people with disabilities • Finding and framing the data on health disparities is an important step in addressing the issue • Creating an inventory of community concerns offers a strategy to prioritize and set an agenda for dealing with health disparities at a local level

4. What are health disparities?

5. Health Disparities • Health differences closely linked with social, economic, and/or environmental disadvantage • Health disparities adversely affect groups of people who have systematically experienced greater obstacles to health based on their: • Racial or ethnic group; religion; socioeconomic status; gender; age; mental health; cognitive, sensory, or physical disability; sexual orientation or gender identity; geographic location; or other characteristics historically linked to discrimination or exclusion. U.S. Department of Health and Human Services. The Secretary’s Advisory Committee on National Health Promotion and Disease Prevention Objectives for 2020. Phase I report: Recommendations for the framework and format of Healthy People 2020. Section IV. Advisory Committee findings and recommendations. Available at: http://www.healthypeople.gov/hp2020/advisory/PhaseI/sec4.htm#_Toc211942917

6. How do we know about health disparities? Key health indicators

7. Health indicators • Health indicators contribute to a person's current state of health, defined as a state of complete physical, mental, and social well-being and not just the absence of sickness or frailty. They may be biological, socioeconomic, psychosocial, behavioral, or social in nature.  Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, N.Y., 19-22 June, 1946; signed on 22 July 1946 by the representatives of 61 States (Official Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April 1948.

8. What do we mean by key health indicators?The HP2020 Leading Health Indicators http://healthypeople.gov/2020/LHI/default.aspx

9. National sources of data • Behavioral Risk Factor Surveillance System (BRFSS) • ww.cdc.gov/brfss • American Community Survey (ACS) • www.census.gov/acs • National Health Interview Survey (NHIS) • www.cdc.gov/nchs/nhis.htm • National Health and Nutrition Examination Survey (NHANES) www.cdc.gov/nchs/nhanes.htm • Children with Special Health Care Needs (NS-CSHCN) • http://childhealthdata.org/learn/NS-CSHCN • Youth Risk and Behavior Surveillance System (YRBS) • www.cdc.gov/yrbs

10. DHDS screenshot http://dhds.cdc.gov/

11. Caveat: disability identifiers • They aren’t on everything • They aren’t always the same (apples / oranges) • CDC funding allowing us in NH to address this issue of surveillance & monitoring

12. What do we know about health disparities? What can I do with all of this data?

13. Where things stand currently Statewide (NH) (BRFSS, 2010)

14. Where things stand currently National (BRFSS, 2009)

15. How things have changed over time National obesity rates by age (BRFSS, 2006 - 2010)

16. How things have changed over time National rates of inactivity by education level (BRFSS, 2005 - 2009)

17. Compare to other groups • People with disabilities / People without disabilities • Refer back to disparity groups defined by WHO Racial or ethnic group; religion; socioeconomic status; gender; age; mental health; cognitive, sensory, or physical disability; sexual orientation or gender identity; geographic location; or other characteristics historically linked to discrimination or exclusion.

18. Disability & Health Chart Book • How do the health disparities experienced by people with disabilities compare with those experienced by other recognized minority groups in the US? • For example, underserved racial and ethnic groups (Drum, McClain, Horner-Johnson, & Taitano, 2011)

19. Disability compared to other minority groups Social determinants of health (BRFSS, 2010)

20. Disability compared to other minority groups Prevalence of obesity, diabetes, asthma (BRFSS, 2010)

21. Disability compared to other minority groups Rates of stroke, CHD, heart attack (BRFSS, 2010)

22. How do we strategize addressing health disparities locally?

23. How to Best Assess Community Concerns Related to Health Equity for People with Disabilities?Developing a Concerns Inventoryhttp://ctb.ku.edu/en/tablecontents/section_1045.htm • Concerns inventories are a form of community assessment in which people are asked to identify the most important issues facing their community in a given area and how satisfied they are with how the issues are being dealt with • Results can be used to help form strategies to deal with the community's problems and help set an agenda that reflects people's concerns

24. Developing a Concerns Inventory • Identify broad areas (“domains”) related to the topic (in our case, health equity for people with disabilities) in which your community might have important issues • Identify issues within these domains • Rank issues based on importance and satisfaction with the community’s efforts in dealing with this issue • Priorities are then identified as issues with the greatest difference between importance and satisfaction among issues of greatest importance

25. Conducting a the Concerns Inventory An Example: Identifying priority issues among CDC partners working with the Division of Human Development and Disability (12/2009)

26. Implementing the Concerns Inventory • Partners (n=7) and DHDD leadership staff (n=6, excluding the Director) completed a concerns inventory • 36 items within four domains were ranked on importance and satisfaction using a scale of 0 (least) to 4 (most) • Domains included Science, Health Promotion & Education, Public Health Content, and Health Policy • Average importance and satisfaction scores were then calculated for both sets of respondents

27. Implementing the Concerns Inventory Summary of Technique

28. Implementing the Concerns InventorySummary of Technique

29. Implementing the Concerns InventorySummary of Technique • Rank by importance and satisfaction • Compare difference between importance and satisfaction • Strengthsare items that have high ratings in both importance and satisfaction, while problems are rated high in importance but low in terms of satisfaction • Priorities may be identified as highest ranked importance areas that have lowest ranked satisfaction among items with high overall importance i.e. IssueImportanceSatisfaction Physical vs Cog 59.38% 71.88% Etc. xx.xx% xx.xx%

30. Summary of DHDD Partners’ and Staff Importance Public Health Content AreasIn parenthesis (DHDD staff)

31. Summary of DHDD Partners’ and Staff SatisfactionPublic Health Content AreasIn parenthesis (DHDD staff)

32. Top Five Items of Importance and SatisfactionItems in italics are identified by both Partners and DHDD Leadership Staff

33. Top Five Perceived Strengths and ProblemsItems in italics are identified by both Partners and DHDD Leadership Staff

34. Example:SummaryTop Five Partner Priorities • Emotional well-being (including mental health) of population of greatest interest • NCBDDD leadership and management • Increasing policy makers’ awareness of condition • Communicating with policy makers • Investigating health disparities for respective condition

35. ExerciseYour Turn • What are issues associated with health equity or health disparities for people with disabilities in your community? • Kimberly and Mike have identified five broad topic areas (“domains”) to identify and score issues in: • Defining disability • Identifying health indicators • Finding people with disabilities (“surveillance”) • Implementing practices to reduce disparities • Evaluating effectiveness of the above issues • Your job will be to identify issues within each of these broad topic areas, score them on importance and satisfaction, and calculate their ranking as priorities.

36. *The 12 Healthy People 2020 Leading Health Indicator Topic Areas http://www.healthypeople.gov/2020/LHI/default.aspx • Access to Health Services • Clinical Preventive Services • Environmental Quality • Injury and Violence • Maternal, Infant, and Child Health • Mental Health • Nutrition, Physical Activity, and Obesity • Oral Health • Reproductive and Sexual Health • Social Determinants • Substance Abuse • Tobacco