Tuesday, June 24, 2008

Root Causes of Health Inequities

"What we choose to measure, how we choose to measure it and the significdance we attach to the results have more to do with philosophy, values, and politics, than science."

Trevor Hancock, Indicators that Count: Measuring Population Health at the Community Level"

A colleague shared a copy of the latest work on a Health Equity Index (HEI) developed by the Connecticut Association of Directors of Health, Inc. It is the latest product of a long-term project to understand the social and economic determinants of health inequities or disparities. This effort is supported by the Connecticut Health Foundation, Joint Center for Political and Economic Studies, and the Universal Health Care Foundation

The basic model looks at a set of nine "social determinants linked to health status" like economic security, education, or environmental quality. Each social determinant has multiple components which in turn have various indicatorsand data sources. Economic security's components, for example, include income, wealth/assets, poverty, public assistance, and access to capital. The art of the Health Equity Index is to create composite scores for each component and determinant -- and an overall score. Scores can be created at the neighborhood level and then statistically correlated with a variety of demographic and health status/outcome variables. Not surprisingly, higher HEI scores are correlated to incidence of cancer.

The purpose of the HEI is to facilitate community dialogue about "healthy cities" and the "root causes" of health disparities. It shows why community building is so complicated -- there are so many fronts tfor work.

Within the Economic Security social determinant the components of wealth/assets and access to capital used home mortgages and home purchases as the major indicators. I wonder whether measures of the unbanked, foreclosures, EITC receipt, and other predatory financial services would have been helpful. I guess if home mortgages are low, one would expect these alternative and frequently predatory financial services. But not always. Ifdifferent component indicators were tested,what differences, if any, were found?

Indicator models are always illuminating. How could we better use models like the HEI in the field of community economic development?

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