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Measurement of Health Disparities, Health Inequities, and Social Determinants of Health to Support the Advancement of Health Equity

Penman-Aguilar, Ana PhD, MPH; Talih, Makram PhD; Huang, David PhD, MPH, CPH; Moonesinghe, Ramal PhD, MA, MS; Bouye, Karen PhD, MPH, MS; Beckles, Gloria MD, MSc

Journal of Public Health Management and Practice: January/February 2016 - Volume 22 - Issue - p S33–S42
doi: 10.1097/PHH.0000000000000373
Original Articles

Reduction of health disparities and advancement of health equity in the United States require high-quality data indicative of where the nation stands vis-à-vis health equity, as well as proper analytic tools to facilitate accurate interpretation of these data. This article opens with an overview of health equity and social determinants of health. It then proposes a set of recommended practices in measurement of health disparities, health inequities, and social determinants of health at the national level to support the advancement of health equity, highlighting that (1) differences in health and its determinants that are associated with social position are important to assess; (2) social and structural determinants of health should be assessed and multiple levels of measurement should be considered; (3) the rationale for methodological choices made and measures chosen should be made explicit; (4) groups to be compared should be simultaneously classified by multiple social statuses; and (5) stakeholders and their communication needs can often be considered in the selection of analytic methods. Although much is understood about the role of social determinants of health in shaping the health of populations, researchers should continue to advance understanding of the pathways through which they operate on particular health outcomes. There is still much to learn and implement about how to measure health disparities, health inequities, and social determinants of health at the national level, and the challenges of health equity persist. We anticipate that the present discussion will contribute to the laying of a foundation for standard practice in the monitoring of national progress toward achievement of health equity.

This article provides an overview of health equity and social determinants of health and proposes a set of recommended practices in measurement of health disparities, health inequities, and social determinants of health to support the advancement of health equity.

Office of Minority Health and Health Equity (Drs Penman-Aguilar, Moonesinghe, and Bouye) and National Center for Chronic Disease and Health Promotion (Dr Beckles), Centers for Disease Control and Prevention, Atlanta, Georgia; and National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland (Drs Talih and Huang).

Correspondence: Ana Penman-Aguilar, PhD, MPH, Office of Minority Health and Health Equity, Office of the Director, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, Mailstop K77, Atlanta, GA 30333 (bpv4@cdc.gov).

The authors acknowledge the contributions of Ms Monica Molina, who convened early discussions that led to the development of this report, as well as Dr Sonja Hutchins, who reviewed early versions of the material.

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

The authors have no conflicts of interest to report.

Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.