This Tool Measures How Far States And The US Are From Meeting Health and Well-Being Goals
By Brian D. Smedley, Dennis P. Andrulis, Steven H. Woolf
Opportunity is a core US value. All who reside in this country should have a fair chance to achieve their full potential, regardless of who they are or where they were born or live. While many think of opportunity in the context of education, occupation, and income, these resources are also a key pathway to health. But many millions of Americans are unable to realize their full potential, including optimal health, due to circumstances frequently beyond their personal control in the communities where they work, live, study, and play.
Ensuring that everyone can be as healthy, prosperous, and successful as possible is not only consistent with US values of fairness and inclusiveness, but is also good for the nation’s economic growth and vitality. To better understand, assess, and accelerate the nation’s progress toward improving the opportunity for health and well-being for all, the National Collaborative for Health Equity, the Texas Health Institute, and Virginia Commonwealth University’s Center on Society and Health launched the Health Opportunity and Equity (HOPE) Initiative in July. The HOPE Initiative measures include 28 indicators of opportunity, including not only population health status, but also the social, economic, and environmental factors that shape health and well-being.
Too often, inequity is couched in the language of “deficits” and “disparities” The HOPE Initiative instead is asset-oriented. For instance, we measure income, not poverty, and track employment, not unemployment. Our goal is to reframe conversations, moving from descriptive data about health disparities to actionable strategies to improve opportunity and equity. We want to understand what produces health and well-being, and promote programs and policies that inspire positive action, particularly for individuals and communities that face systematic barriers that severely limit their ability to pursue and live the healthiest of lives.
The initiative sets aspirational, yet achievable “goals” or benchmarks for each of these indicators by examining outcomes already achieved in high-performing states. Specifically, for each indicator, we identify the five highest-performing states and then calculate the average for the healthiest populations in those states (typically those with higher education or income). We then assess how far each state, or the nation, must go to enjoy the outcomes the benchmark groups have achieved—referred to as the “Distance to Goal.” We also stratify the Distance to Goal by race, ethnicity, and socioeconomic status to give states a better sense of the progress that needs to be made for different populations.
The HOPE Initiative indicators fall into two broad categories: health outcomes, which include measures of health across the life cycle; and determinants of health, organized into four broad domains: socioeconomic factors (which include education, income, and employment); the social environment (which includes neighborhood poverty and safety); the physical environment (which includes food access, housing, and air quality); and access to health care. Importantly, these indicators focus on actionable conditions—those that are modifiable by policy and practice. Health behaviors (such as smoking or diet) are also important but are not our focus.
Initial results from the HOPE Initiative reveal that groups differ—sometimes by a wide margin—in the Distance to Goal. Some groups meet or exceed the benchmarks, while most fall short. But almost all populations can do better. Understanding the conditions and circumstances that are associated with progress toward meeting benchmarks can help us identify ways to improve health opportunities for all.
In the full report, results are organized into national and state findings. The national Distance to Goal estimates show how many US lives could be affected by achieving the benchmarks. For example, more than 17,000 additional infants would reach their first birthday if the infant mortality benchmark was met nationally. An additional 70 million Americans would live in economically prosperous (that is, low-poverty) neighborhoods if the HOPE benchmark was achieved on this measure. Currently, whites are most likely to live in prosperous neighborhoods (85.2 percent), followed by Asian Americans/Pacific Islanders (82.8 percent), multiple-race individuals (77.3 percent), Hispanics (60.5 percent), American Indians/Alaska Natives (54.2 percent), and African Americans (52.8 percent).
Some unexpected findings across the 28 indicators should inspire more research to understand why we’re seeing these outcomes. For example, the African American infant mortality rate in Washington State (7.1 per 1,000 live births) is lower than infant mortality rates among whites in Alabama (7.3), Hispanics in South Dakota (8.6), and Asian Americans/Pacific Islanders in Utah (7.6).
At present, the HOPE Initiative does not measure all factors that influence health, especially those for which we lack well-established and widely available measures, such as neighborhood social cohesion and trust. Nevertheless, it represents an important first step toward establishing benchmarks and metrics explicitly grounded in bringing the nation and states closer to achieving health equity.
As is often said, that which is measured gets changed. Many important measurement tools have been developed to measure inequity and disparity—which is important. But by tracking our progress in creating health opportunity, we introduce an important new set of goals that move us closer to shared US values.