Healthy People 2020: Building a Solid Data Foundation

Richard J. Klein, MPHNational Center for Health Statistics

Centers for Disease Control and Prevention

•• Maintains comprehensive database Maintains comprehensive database for all objectivesfor all objectives

NCHS Role in Healthy PeopleNCHS Role in Healthy People

•• Provides a large portion of Healthy Provides a large portion of Healthy People dataPeople data

•• Statistical advisor to HHS and the Statistical advisor to HHS and the interagency Focus Area workgroupsinteragency Focus Area workgroups

NCHS Role in Healthy PeopleNCHS Role in Healthy People

•• Develops publications/presentations Develops publications/presentations to assess progress towards reaching to assess progress towards reaching the targets/goalsthe targets/goals

•• Develops research on measuring the Develops research on measuring the overarching goalsoverarching goals

www.cdc.gov/nchs/hphome

wonder.cdc.gov/data2010

•• Transition to a fully relational databaseTransition to a fully relational database

•• Multiple groupingsMultiple groupings

•• Trends with HP2010 objectivesTrends with HP2010 objectives

•• Mapping capabilitiesMapping capabilities

•• UserUser--defined graphs/chartsdefined graphs/charts

Future plans for Data2020Future plans for Data2020

http://www.cdc.gov/nchs/about/otheract/hpdata2010/thp.htm

Healthy People 2020:Healthy People 2020: Data/Measurement IssuesData/Measurement Issues

•• Summary/Global measures of healthSummary/Global measures of health–– Methodology: HALE, QALY, DALYMethodology: HALE, QALY, DALY–– International comparabilityInternational comparability

Expected years of life Free of activity limitation

In good or better health Free of selected chronic diseases

Years from birth

Note: The categories white and black do not include persons of Hispanic origin

0102030405060708090

Total Women Men White Black

Life Expectancy and Expected Years of Life Expectancy and Expected Years of Healthy Life from Birth, 2001Healthy Life from Birth, 2001--0202

Healthy People 2020:Healthy People 2020: Data/Measurement IssuesData/Measurement Issues

•• DisparityDisparityInequityInequity: : Different kinds of Different kinds of ““differencesdifferences””

Concept Research question Application to policy or program planning

Disparity Is there a difference in health status rates between population groups?

Is the difference too large?

Inequity

Inequality

Burden How many people are affected in specific groups and in the total population?

How many people would benefitfrom interventions?

Is the disparity in rates due to differences in social, economic,environmental or healthcare resources?

How do rates vary with the amount of the resource, and how is the population distributed among resource groups?

Is the distribution of resources fair?

Can the distribution of the population among resource groups and/or the rateswithin resource groups be influenced?

Distinctions Among the Concepts

Defining Health EquityDefining Health Equity

“Health equity is attainment of the highest level of health for all people. Achieving health equity requires valuing everyone equally with focused and ongoing societal efforts to address avoidable inequalities, historical and contemporary injustices, and the elimination of health disparities.”

Source: Draft definition: National Partnership for Action to End Health Disparities

OperationalizingOperationalizing Health Health InInequity equity

“Health inequity could be defined as a difference in health status between population groups that is associated with an unfair

distribution of a determinant of health between the populations”

Source: Keppel K, Klein R. Working paper on Measuring Disparities and Inequities in Healthy People 2020.

HP2010 “Minimum” Population Template

Race:Race: Socioeconomic Status:Socioeconomic Status:American Indian or Alaska Native only Family Income LevelAsian or Pacific Islander only

Asian only PoorNative Hawaiian or Other Pacific Islander only Near poor

Black or African American only Middle/high incomeWhite only2 or more races

American Indian or Alaska Native; White ororBlack or African American; White

Hispanic origin and race:Hispanic origin and race: Education LevelHispanic or LatinoNot Hispanic or Latino Less than high school

Black or African American High school graduateWhite At least some college

Gender:Gender:Female Male

Proposed HP2020 Proposed HP2020 Standard Population TemplateStandard Population Template

•• Standard categoriesStandard categories–– GenderGender–– Race/ethnicityRace/ethnicity–– AgeAge–– Educational attainmentEducational attainment–– Family incomeFamily income–– Family typeFamily type–– Country of birthCountry of birth–– Disability statusDisability status–– Geographic locationGeographic location–– Health insurance statusHealth insurance status

•• Optional categoriesOptional categories–– Sexual orientationSexual orientation–– Selected chronic Selected chronic

conditionsconditions–– Nursing homesNursing homes–– Active military serviceActive military service–– Marital statusMarital status–– Veterans statusVeterans status

Healthy People 2020:Healthy People 2020: Data/Measurement IssuesData/Measurement Issues•• HRQoLHRQoL/Well/Well--beingbeing

–– Health status Health status vsvs HRQoLHRQoL–– Functioning Functioning vsvs participationparticipation–– Defining wellDefining well--being w/in scope of healthbeing w/in scope of health

•• Social determinants of healthSocial determinants of health–– Which are most important?Which are most important?–– High degree of correlationHigh degree of correlation–– Data sourcesData sources

•• GenomicsGenomics

Healthy People 2020:Healthy People 2020: Data/Measurement IssuesData/Measurement Issues

•• Consistency with other indicator Consistency with other indicator projects (e.g. SUSA, MATCH, CHSI)projects (e.g. SUSA, MATCH, CHSI)

•• State and local dataState and local data•• TargetTarget--settingsetting methodologymethodology

–– Continue BTTB?Continue BTTB?–– Consistency across objectivesConsistency across objectives–– Use of modeling/projectionsUse of modeling/projections–– Consistency with other initiativesConsistency with other initiatives

Data ResourcesData Resources

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www.cdc.gov/nchs/hphomewww.cdc.gov/nchs/hphome

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wonder.cdc.gov/data2010wonder.cdc.gov/data2010

Slide Number 1Slide Number 2NCHS Role in Healthy PeopleNCHS Role in Healthy PeopleSlide Number 5Slide Number 6Future plans for Data2020Slide Number 8Healthy People 2020:�Data/Measurement IssuesSlide Number 10Healthy People 2020:�Data/Measurement IssuesSlide Number 12Defining Health Equity Operationalizing �Health Inequity Slide Number 15Proposed HP2020 �Standard Population TemplateHealthy People 2020:�Data/Measurement IssuesHealthy People 2020:�Data/Measurement IssuesData ResourcesSlide Number 20