From politics to parity: using a health disparities index to guide legislative efforts for health equity

Abstract

Objectives: We created an index quantifying the longitudinal burden of racial health disparities by state and compared this index to variables to guide the construction of, and validate support for, legislative efforts aimed at eliminating health disparities.

Methods: We evaluated 5 focus areas of greatest racial disparities in health from 1999 to 2005 and compiled state health disparities index (HDI) scores. We compared these scores with variables representing the purported social determinants of health.

Results: Massachusetts (0.35), Oklahoma (0.35), and Washington (0.39) averaged the fewest disparities. Michigan (1.22), Wisconsin (1.32), and Illinois (1.50) averaged the greatest disparities. The statistical reference point for nationwide average racial disparities was 1.00. The longitudinal mixed model procedure yielded statistically significant correlations between HDI scores and Black state population percentage as well as with the racial gap in uninsured percentages. We noted a trend for HDI correlations with median household income ratios.

Conclusions: On the basis of the HDI-established trends in the extent and distribution of racial health disparities, and their correlated social determinants of health, policymakers should consider incorporating this tool to advise future efforts in minority health legislation.

FIGURE 1

Component disease processes of HDI for a) Massachusetts and b) Illinois. Y-axis values are HDI scores for each disease process or for state disparities as a whole. Note: CVD = cardiovascular disease; HDI = health disparities index. Value of 0.00 represents racial/ethnic parity in mortality rates, while a value of 1.00 represents the average Black–White mortality disparities across the United States.