Measuring Disparities In Health

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Measuring DisparitiesIn Health

• Concurrent Session 3212.0
• Monday, Nov. 11th 1230 200 PM

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What Do We Mean By Disparity

• Jeffrey N. Pearcy, MS
• Kenneth G. Keppel, PhD

Centers for Disease Control and
Prevention National Center for Health Statistics
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Disparity

• Semantics
• Components
• Framework
• Determinants
• Limitations
• Conclusions

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Semantics

• Disparity
• inequality or difference as in rank, amount,
  quality, etc.
• Inequality
• a difference or variation in size, amount, rank,
  quality, social position, etc.
• Inequity
• lack of justice unfairness

Websters New World Dictionary 2nd Edition, 1994
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Semantics (usage)

• Outside United States
• Inequality or Inequity used
• In United States
• Disparity, Inequality and Inequity used
• Interchangeably
• Public Health Context
• Disparity is now Value-Loaded
• Alternative definition required ???

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Disparity

• In the context of public health and social
  science, has become value-loaded, and so can be
  distinguished from inequality.
• As something different in meaning as applied
  here

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Disparity

• should be viewed as a train of events leading
  to a difference in
• Access to, utilization of, or quality of care
• Health status, or
• Health outcome
• .that deserves scrutiny.

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Disparity

• such a difference should be evaluated in terms
  of inequality and inequity, since what is unequal
  is not necessarily inequitable.
• In short, the term disparity in the context of
  public health embodies both inequality and
  inequity.

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Components of Disparity

• Inequality
• How different are we?
• (measurement issues)
• Inequity
• Who should we be like?
• (another group)
• What should we be like?
• (some target)

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Conceptual Frameworkof Disparity
Inequality
Inequity
Adapted from Evans, Whitehead, Diderichsen, et
al. 2001
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Health Determinants(Health Canada)
Avoidable
Unavoidable

• Income and Social Status
• Social Support Networks
• Education
• Employment and Working Conditions
• Social Environments
• Physical Environments
• Healthy Child Development
• Health Services

• Personal Health Practices / Coping Skills
• Biology and Genetic Endowment
• Gender
• Culture

http//www.hc-sc.gc.ca/hppb/phdd/determinants/inde
x.html
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Health Determinants(Whitehead)

• Unavoidable
• Natural biological variation
• Behavior that is restricted
• Transient health advantage

• Avoidable
• Home work environment
• Behavior freely chosen
• Access to care
• Health-related social mobility

http//www.who.dk/eprise/main/WHO/Progs/HPA/Equity
/20020319_1
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Effect of Determinants on Diseases (Hypothetical
Example !!)
Unavoidable
Avoidable
Disease A
Disease B
Disease C
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Effect of Determinants by Population (Hypothetical
Example !!)
Unavoidable
Avoidable
Population A
Population B
Population C
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Limitations

• Idea of unavoidable determinants disputed
• Identification of all / or important determinants
  ??
• Avoidability / unavoidability may be continuous
  rather than categorical
• Measuring determinants is inexactat best.
• Ethical Inequity judgement is subjective

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Limitations

• Therefore.
• No way to distinguish (accurately)
• Inequality from Inequity
• So, were not reducing Disparity, but rather
  Inequality

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Conclusions

• Disparitynot so simple after all !!
• Inequality Inequity
• Complex interactions of
• Genetics
• Environment (physical, social, economic)
• Behavior

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Conclusions

• Incomplete knowledge Inaction !
• Purposes of measurement
• Monitoring and Assessment
• Intervention and Improvement Programs
• P.D.G. affects choice of statistics