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Measuring Disparities In Health

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What Do We Mean By Disparity. Jeffrey N. Pearcy, MS. Kenneth G. Keppel, PhD ... Biology and Genetic Endowment. Gender. Culture. Avoidable. Unavoidable ... – PowerPoint PPT presentation

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Title: Measuring Disparities In Health


1
Measuring DisparitiesIn Health
  • Concurrent Session 3212.0
  • Monday, Nov. 11th 1230 200 PM

2
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
3
Disparity
  • Semantics
  • Components
  • Framework
  • Determinants
  • Limitations
  • Conclusions

4
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
5
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 ???

6
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

7
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.

8
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.

9
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)

10
Conceptual Frameworkof Disparity
Inequality
Inequity
Adapted from Evans, Whitehead, Diderichsen, et
al. 2001
11
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
12
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
13
Effect of Determinants on Diseases (Hypothetical
Example !!)
Unavoidable
Avoidable
Disease A
Disease B
Disease C
14
Effect of Determinants by Population (Hypothetical
Example !!)
Unavoidable
Avoidable
Population A
Population B
Population C
15
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

16
Limitations
  • Therefore.
  • No way to distinguish (accurately)
  • Inequality from Inequity
  • So, were not reducing Disparity, but rather
    Inequality

17
Conclusions
  • Disparitynot so simple after all !!
  • Inequality Inequity
  • Complex interactions of
  • Genetics
  • Environment (physical, social, economic)
  • Behavior

18
Conclusions
  • Incomplete knowledge Inaction !
  • Purposes of measurement
  • Monitoring and Assessment
  • Intervention and Improvement Programs
  • P.D.G. affects choice of statistics
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