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Using Data to Move Toward Health Equity in Michigan
Michigan Department of Community HealthHealth Disparities Reduction/Minority Health SectionDivision of Health Wellness & Disease Control
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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
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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.
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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
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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
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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.
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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
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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
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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)
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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.
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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
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Conceptual Clarification (Fictional Data)
30%
36%
15%
28%
0%
20%
40%
Time 1 Time 2
ReferenceMinorityD
isea
se P
reva
lenc
e
DISPARITY
HEALTH
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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
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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
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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
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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
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-Index of Disparity (ID)-Difference in ID Over Time
Arab
ID = 0%
Quantifying Equity: Population Level
Pearcy and Keppel, 2002
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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%
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-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)
≥
≥
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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
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Questions?
Sheryl Weir
Rebecca Coughlin
Michigan Health Equity Data Tables:
www.michigan.gov/minorityhealth