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About the Health Equity Index

What is the Heath Equity Index?

The Health Equity Index is a community-based assessment that can be used to identify social, political, economic, and environmental conditions that are most strongly correlated with specific health outcomes. The Health Equity Index is implemented in conjunction with public health workforce development and community engagement strategies as an overall approach to address health inequities.

Who Developed the Health Equity Index?

The Connecticut Association of Directors of Health (CADH), a state affiliate of the National Association of County and City Health Officials, representing local directors of health departments and districts in Connecticut.

Why was the Health Equity Index Developed?

Unlike approaches that describe differences in health status among certain populations, the Health Equity Index was developed to focus on the root causes of differences in health status.

What can the Health Equity Index Do?

  • Illuminate conditions in neighborhoods and communities that are the root cause of poorer health.
  • Encourage collaboration between public health personnel, community leaders, municipal department heads, neighborhood residents, and community-based organizations to address health inequities.
  • Provide an opportunity to focus policymakers’ efforts and investments in prevention, improving conditions that promote good health rather than waiting for people to become sick.

Have any Local Health Departments Implemented the Health Equity Index?

In May of 2009, a review panel selected the Hartford Health and Human Services Department, the New Haven Health Department, and the Ledge Light Health District to pilot the Health Equity Index in the cities of Hartford and New Haven and the town/city of Groton, based on funding from W. K. Kellogg Foundation.

How can I learn more about the Health Equity Index?

To learn more about the Health Equity Index please contact Sharon Mierzwa, Health Equity Project Director, at smierzwa@cadh.org or (860) 727-9874.


How does the Health Equity Index Work?

The Health Equity Index is based on a seven social factors (determinants) that are linked to health status:

  • Civic Involvement/Political Access
  • Community Safety and Security
  • Economic Security
  • Education
  • Employment
  • Environmental Quality
  • Housing

Each determinant is comprised of a number of components; within each component are a number of Indicators or measures that have been identified, and when combined, form the core index. A methodology is employed to standardize scoring among the determinants and to adjust for the varying number of Indicators for each Determinant.

Based on the data collected, a reference is determined (statewide mean and median) and a ten point measurement scale developed. Each neighborhood receives a score for each Indicator, Component, Determinant, and an overall Index Score. These scores are then tested for significance and strength of correlation with demographic variables and health status/outcomes, all also measured at the neighborhood level. Health outcomes such as incidence/prevalence of illness, disease and injury, mortality, and years of potential life lost are examined. Each indicator has an explicit definition, reference, data source, and rationale.

About MRGS

The need for additional stratification became apparent as soon as local health departments in Connecticut began to use the Index. The largest urban districts particularly expressed the need for geographic stratification. Scores in their districts were consistently low, and demonstrated limited variation across the municipal region. Health departments wanted the ability to visualize intra-city variation in scores in addition to the inter-city variation currently shown.

In response, we explored various methodologies for clustering SDOH and health outcomes by geography, in order to see if there was a good criterion for partitioning the geographic locations. Several approaches were explored, including arranging towns by population or population density and searching for cutoffs, as well as a k-means cluster analysis with various numbers of clusters. In each case, 20 social determinant and health outcome scores were treated as geometric coordinates, giving a “social/health” distance between two cities as the sum of the squares of their score differences. Good clusters were taken to be those with small distance variance sums. All of these methods gave roughly the same sorts of clusters: big cities on one end, and smaller ones on the other, as anticipated.

Our analysis found no compelling argument for any particular number of clusters, and we selected eight MRGs based on the objective of grouping the most affluent towns into one MRG, and the poorest towns, including the biggest cities, into one MRG.

The MRG was comprised of the following social determinant and demographic variables:

Demographic Indicators:
  • The diversity index (demogr51) - The Shannon-Wiener index for racial and ethnic diversity
  • Percent of female headed households (demogr11)
Social Determinants:
  • Median household income (estinc01)
  • Percent of adults with at least a bachelor's degree (edupop07)
  • Professional positions as a percentage of total employment (occupa03)
  • Percentage of children age 18 and under living in poverty (povert03)
  • Owner-occupied housing as a percentage of total housing units (housng05

Methodology

Registered users can download the full documentation here:

HEI_Methodology_v1a.pdf
Below is an example of one determinant, its five components, and fourteen Indicators:
tree view of determinant and its descendents

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