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Social Determinants of Health Disparities: The CT Health Index

Social Determinants of Health Disparities: The CT Health Index. Connecticut Association of Directors of Health October 2006. Health Equity Index. A systematic, identification, quantification and measurement of social determinants that lead to health disparities Social Determinants

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Social Determinants of Health Disparities: The CT Health Index

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  1. Social Determinants of Health Disparities: The CT Health Index Connecticut Association of Directors of Health October 2006

  2. 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

  3. Economic Security/ Financial Resources Income Wealth/ Assets Poverty Public Assistance Access to Capital • Media Value- Owner • Occupied Homes • Land/Building • Assessed Value • Sales Prices • Average # of Vehicles % Households Below Poverty % Individuals with Income <50% Poverty % Children <18 in Poverty Concentration of Poverty • 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

  4. 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

  5. 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

  6. 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

  7. Types of Indicators:Core Indicators • The set of indicators used in the SDHEI for which reference points and measurement scales have been developed and scoring will be applied

  8. Types of Indicators:Core 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

  9. Types of Indicators:Core 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

  10. 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.

  11. 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

  12. Indicator Construct Indicator Data Source Data Source Reference Point Rate Percentage Mean Median Six Point Measurement Scale Numerator Denominator Indicator Score

  13. Indicator Construct –Example US Census-Claritas Median Household Income Hartford: $24,820 Meriden: $43,237 Wethersfield: $53,289 Farmington: $67,073 Fairfield: $83,512 Darien: $146,755 CT Median HH Income $60,538 • 0-$20,000 • $20,001- 40,000 • $40,001-60,000 • $60,001- 80,000 • $80,001-100,000 • $100,001+ Hartford-2 Meriden-3 Wethersfield-3 Farmington-4 Fairfield-5 Darien-6

  14. 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

  15. 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

  16. Summary: Accomplishments to DateInstrument Development • Identified Core Indicators • Acquired Datasets • Computed Formulas • Developed Reference Points and Measurement Scales

  17. Summary: Accomplishments to DateInstrument Pre-Testing • Acquired Municipal Data from Target Cities • Calculated Indicator Scores for Neighborhoods

  18. 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]

  19. 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

  20. Next Steps: SDHEI Relationship to Demographics • Test Strength and Direction of the Correlations Between SDHEI and Demographic Variables

  21. Types of Indicators:Complementary 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

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

  23. 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

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