1. Using Data to Move Toward Health Equity in Michigan Michigan Department of Community Health Health Disparities Reduction/Minority Health Section Division of Health Wellness & Disease Control

2. 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

3. 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.

4. 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/ OPI Two or more races White Arab American (1.6%) Other (98.4%) Arab American Other U.S. Census Bureau, 2010 American Community Survey

5. 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

6. 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.

7. 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

8. 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

9. 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)

10. Data Template Time 1Time 2 Indicator African AmericanHispanicAsianAI/ANArabWhiteTotalAfrican AmericanHispanicAsianAI/ANArabWhiteTotal Household Income Infant Mortality Etc.

11. What Total Equity Would Look Like (Fictional Data)

12. Conceptual Clarification (Fictional Data) Disease Prevalence DISPARITY HEALTH

13. Methodological Decision Reference Group = White Population MiBRFS, 2007-09

14. 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

15. Health Equity for Arab Americans in Michigan Indicator 2007-092008-10 Change Equity (%) DifferenceRatioDifferenceRatio Obesity1.1%1.042.1%1.072.9%0 Infant Mortality Rate* 0.41.071.91.3424.7%- No Health Care Coverage 1.9%1.143.8%1.2611.0%- No Access Due to Cost 10.6%1.9513.3%2.138.8%- No Health Care Provider 1.4%1.101.7%1.143.4%0 + Improved Equity 0 No Change in Equity – Worsened Equity *Infant Mortality comparisons are between 2004-06 and 2007-09

16. Change in Equity 2005-07 vs. 2008-10 African American American Indian Arab American* Asian American LatinoOther Obesity 000-00 Infant Mortality Rate* +0--+- No Health Care Coverage -+-+-+ No Access Due to Cost -+--00 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

17. -Index of Disparity (ID) -Difference in ID Over Time Arab ID = 0% Quantifying Equity: Population Level Pearcy and Keppel, 2002

18. Population Equity (ID) Most Equity: Mental Health Least Equity: Gonorrhea Incidence ID = 111.6%ID = 16.7%

19. 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) ≥ ≥

20. 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 www.michigan.gov/minorityhealth  Michigan Health Equity Roadmap  Health Equity Data Tables  Health Equity Michigan Website:  www.healthequitymi.com www.healthequitymi.com

21. Questions? Sheryl Weir weirs@michigan.gov Rebecca Coughlin coughlinr@michigan.gov Michigan Health Equity Data Tables: www.michigan.gov/minorityhealth