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

Abstract

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.

FIGURE. Female Breast Cancer Deaths, 2001–2013^a

Abbreviation: ICD-10, International Classification of Diseases, Tenth Revision. ^aData are for ICD-10 code C50 reported as underlying cause of death and are age-adjusted using the year 2000 standard population. Prior to 2003, only 1 race category could be recorded; recording more than 1 race was not an option. Beginning in 2003, multiple-race data were reported by some states; multiple-race data were bridged to the single-race categories for comparability. From National Vital Statistics System–Mortality, National Center for Health Statistics, Centers for Disease Control and Prevention.