Using Data to Move Toward Health Equity in Michigan

Michigan Department of Community HealthHealth Disparities Reduction/Minority Health SectionDivision of Health Wellness & Disease Control

Terminology

• Health Disparities: Measured health differences.

• Health Inequities: Measured health differences between populations that are systemic, unnecessary, and avoidable, and are therefore considered to be unfair and unjust.

• Health equity: Fair, just distribution of social resources and opportunities needed to achieve well-being.

MI Health Equity Roadmap

Health Disparities Reduction and Minority Health Section

• Established as the Office of Minority Health in 1988 to serve as the coordinating body for minority health issues in the state of Michigan.

• Mission: To provide a persistent and continuing focus on eliminating health disparities among racial and ethnic minorities in Michigan.

• Minority Health legislation (PA 653) passed in 2006.

Michigan Population (2010)

African American (13.9%)

American Indian (0.6%)

Asian American (2.4%)

Hispanic/Latino (4.4%)

Native Hawaiian/OPI (0.1%)

White (76.5%)

Two or more races (2.1%)

American Indian

African American

Hispanic/Latino

Asian American

Native Hawaiian/

OPITwo or

more races

White

Arab American (1.6%)

Other (98.4%)

Arab American

Other

U.S. Census Bureau, 2010 American Community Survey

Race and Ethnicity Data Challenges

• Availability of Data– Small Sample Sizes– Differently Defined Populations

• Quality of Data– Misclassification of Race/Ethnicity– Missing Data

• Consistency in Methods– Sampling Methods– Measuring Equity

Michigan Health Equity Data Project

Objective: Monitor racial/ethnic health equity in Michigan. Make data about racial/ethnic populations

easily accessible. Feature social determinants along with priority

health outcomes. Provide standardization. Measure health disparities. Monitor health disparities over time.

Health Equity Data

Multiple Health Indicators 3 Major Categories

Social Determinants Health Status, Health Behaviors,

Healthcare Diseases and Deaths

6 Major Populations Standard Time Periods Standard Data Sources

Key Indicators• Social Determinants

– Median household income– % Children living at or below poverty– Unemployment Rate– High school dropout rate– % Persons not registered to vote

• Health Status, Behaviors, Healthcare– Self-reported fair/poor health– Poor physical health– Poor mental health– Obesity prevalence– Current smoker– % Uninsured

• Morbidity and Mortality– Heart disease mortality rate– Diabetes prevalence– All-cancer mortality rate– Gonorrhea incidence– HIV infection rate– Infant mortality rate– Unintentional injury mortality rate

Data Sources

• Michigan Behavioral Risk Factor Survey (2001-2003, 2007-2009)

• US Census (2000)• American Community Survey (2006-2008)• Michigan Resident Birth and Death Files (2000-02,

2006-08)• HIV/AIDS Epidemiology Profiles and Quarterly

Reports (Jan. 2001, Jan. 2009)• Local Area Unemployment Statistics (2000, 2009)• State of Michigan Cohort Dropout Rate Report,

Center for Educational Performance and Information (2007, 2009)

• Current Population Survey (2000, 2008)• Michigan Disease Surveillance System (2003, 2009)

Data Template

Time 1 Time 2

Indicator African American

Hispanic

Asian

AI/AN

Arab

White

Total

African American

Hispanic

Asian

AI/AN

Arab

White

Total

Household Income

Infant Mortality

Etc.

What Total Equity Would Look Like (Fictional Data)

0%

10%

20%

30%

40%

AfricanAmerican

AmericanIndian

ArabAmerican

AsianAmerican

Latino Other White

Hea

lth O

utco

me

Subgroup Average

Michigan Average

Conceptual Clarification (Fictional Data)

30%

36%

15%

28%

0%

20%

40%

Time 1 Time 2

ReferenceMinorityD

isea

se P

reva

lenc

e

DISPARITY

HEALTH

Poor Mental Health

0

5

10

15

20

25

AfricanAmerican

AmericanIndian /AlaskaNative

Arab Asian / PI Hispanic /Latino

White

>1

4 D

ays

in P

ast

Mo

nth

(%

)

Methodological Decision

Reference Group = White Population

MiBRFS, 2007-09

Quantifying Equity: Pairwise

• Difference: Minority Estimate – Reference Estimate– E.g., 36% - 20% = 16%

• Ratio: Minority Estimate / Reference Estimate– E.g., 36% / 20% = 1.8

• Percent Change in Ratio Over Time– E.g., (1.8-1.5)/1.5 = 20% Change

Health Equity for Arab Americans in Michigan

Indicator2007-09 2008-10

Change Equity (%)Difference Ratio Difference Ratio

Obesity 1.1% 1.04 2.1% 1.07 2.9% 0

Infant Mortality Rate*

0.4 1.07 1.9 1.34 24.7% -

No Health Care Coverage

1.9% 1.14 3.8% 1.26 11.0% -

No Access Due to Cost

10.6% 1.95 13.3% 2.13 8.8% -

No Health Care Provider

1.4% 1.10 1.7% 1.14 3.4% 0

+ Improved Equity 0 No Change in Equity – Worsened Equity

*Infant Mortality comparisons are between 2004-06 and 2007-09

Change in Equity 2005-07 vs. 2008-10African

AmericanAmerican

IndianArab

American*Asian

AmericanLatino Other

Obesity 0 0 0 - 0 0

Infant Mortality Rate* + 0 - - + -

No Health Care Coverage - + - + - +

No Access Due to Cost - + - - 0 0

No Health Care Provider 0 + 0 + 0 -

+ Improved Equity 0 No Change in Equity – Worsened Equity

*Arab American comparisons are between 2007-09 and 2008-10*Infant Mortality comparisons are between 2004-06 and 2007-09

-Index of Disparity (ID)-Difference in ID Over Time

Arab

ID = 0%

Quantifying Equity: Population Level

Pearcy and Keppel, 2002

Population Equity (ID)

0.0%

8.0%

16.0%

A.A. Hisp. Asian AI/AN Arab White

% ≥

14 d

ays

in p

ast

mo

nth

Most Equity: Mental Health

Least Equity: Gonorrhea Incidence

0

300

600

A.A. Hisp. Asian AI/AN White

# n

ew c

ases

/100

,000

ID = 111.6% ID = 16.7%

-18.7%

-16.7%

-9.2%

-8.5%

-6.1%

-2.8%

-0.5%

2.2%

3.3%

3.3%

4.2%

5.7%

5.7%

9.8%

14.3%

14.8%

19.9%

37.6%

-25% -15% -5% 5% 15% 25% 35% 45%

Unhealthy physical days, % ?14 in past month

Self-reported fair/poor health, %

Median annual household income, $

Percent without health insurance, %

Children at or below poverty, %

High school drop-out rate, %

Heart disease mortality rate, per 100,000

All-cancer mortality rate, per 100,000

Prevalence obese, %

Tobacco use - current smoker, %

Infant mortality rate, per 1000 live births

Gonorrhea Incidence Rate, per 100,000

Unintentional injury mortality rate, per 100,000

Persons not registered to vote, %

Diabetes prevalence rate, %

HIV infection rate, per 100,000

Unhealthy mental days, % ?14 in past month

Unemployment rate, %

Better

Worse

Change in Equity Status (ID) Over Time

Better

Worse

Change in Equity Status (ID) Over Time

Change in Minority Health Equity, Michigan Overall Population (2000-09)

≥

≥

Health Equity Resources

Pearcy, JN and Keppel, KG. A summary measure of health disparity. Public Health Reports. 2002; 117(3): 273-280.

CDC MMWR on Health Disparities (Jan. 14, 2011) MDCH Health Disparities Website:

www.michigan.gov/minorityhealth Michigan Health Equity Roadmap Health Equity Data Tables

Health Equity Michigan Website: www.healthequitymi.com

Questions?

Sheryl Weir

weirs@michigan.gov

Rebecca Coughlin

coughlinr@michigan.gov

Michigan Health Equity Data Tables:

www.michigan.gov/minorityhealth