among People with Disabilities Core Health Indicators Knowledge for Equity November 1314 2012 Silver Spring Maryland The findings and conclusions in this presentation have not been formally disseminated by the Centers for Disease Control and Prevention and should not be construed to repr ID: 526390
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Slide1
Understanding Health Disparities among People with Disabilities: Core Health Indicators
Knowledge for Equity November 13-14, 2012Silver Spring, Maryland
The findings and conclusions in this presentation have not been formally disseminated by the Centers for Disease Control and Prevention and should not be construed to represent any agency determination or policy.
Michael H. Fox, Sc.D.
Kimberly G.
Phillips, MASlide2
Session outlineDefine & describe health disparities & health indicatorsConsider their relation to health status
Find & frame disparity data for stakeholders, partners & policymakersEngage in community concerns exerciseSlide3
Key PointsMajor health gaps exist between people with and without disabilities on leading indicators of health, illustrating poorer health among people with disabilities
Finding and framing the data on health disparities is an important step in addressing the issueCreating an inventory of community concerns offers a strategy to prioritize and set an agenda for dealing with health disparities at a local levelSlide4
What are
health disparities?Slide5
Health DisparitiesHealth differences closely linked with social, economic, and/or environmental disadvantage
Health disparities adversely affect groups of people who have systematically experienced greater obstacles to health based on their:Racial or ethnic group; religion; socioeconomic status; gender; age; mental health; cognitive, sensory, or physical disability; sexual orientation or gender identity; geographic location; or other characteristics historically linked to discrimination or exclusion.
U.S. Department of Health and Human Services. The Secretary’s Advisory Committee on National Health Promotion and Disease Prevention Objectives for 2020. Phase I report: Recommendations for the framework and format of Healthy People 2020. Section IV. Advisory Committee findings and recommendations. Available at: http://www.healthypeople.gov/hp2020/advisory/PhaseI/sec4.htm#_
Toc211942917Slide6
How
do we know about health disparities?
Key health indicatorsSlide7
Health indicatorsHealth indicators contribute to a person's current state of health, defined as a state of complete physical, mental, and social well-being and not just the absence of sickness or frailty. They may be biological, socioeconomic, psychosocial, behavioral, or social in nature.
Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, N.Y., 19-22 June, 1946; signed on 22 July 1946 by the representatives of 61 States (Official Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April 1948.Slide8
What do we mean by key health indicators?The HP2020 Leading Health Indicatorshttp://healthypeople.gov/2020/LHI/default.aspxSlide9
National sources of dataBehavioral Risk Factor Surveillance System (BRFSS)
ww.cdc.gov/brfssAmerican Community Survey (ACS)www.census.gov/acs
National Health Interview Survey (NHIS)www.cdc.gov/nchs/nhis
.htmNational Health and Nutrition Examination Survey (NHANES) www.cdc.gov/nchs/nhanes.htmChildren with Special Health Care Needs (NS-CSHCN)http://childhealthdata.org/learn/NS-CSHCNYouth Risk and Behavior Surveillance System (YRBS)
www.cdc.gov/yrbsSlide10
DHDS screenshot
http://dhds.cdc.gov/Slide11
Caveat: disability identifiersThey aren’t on everythingThey aren’t always the same (apples / oranges)
CDC funding allowing us in NH to address this issue of surveillance & monitoringSlide12
What do we know about health disparities?
What can I do with all of this data?Slide13
Where things stand currently
(BRFSS, 2010)
NH residents
with disabilitiesNH residents without disabilitiesSmoker28%15%No exercise last 30 days
35%
16%Obese40%21%
Statewide (NH)Slide14
Where things stand currently(BRFSS, 2009)
NationalSlide15
How things have changed over time
(BRFSS, 2006 - 2010)
National obesity rates by ageSlide16
How things have changed over time
National rates of inactivity by education level
(BRFSS, 2005 - 2009)Slide17
Compare to other groupsPeople with disabilities / People without disabilities
Refer back to disparity groups defined by WHO Racial or ethnic group; religion; socioeconomic status; gender; age; mental health; cognitive, sensory, or physical disability; sexual orientation or gender identity; geographic location; or other characteristics historically linked to discrimination or exclusion.Slide18
Disability & Health Chart BookHow do the health disparities experienced by people with disabilities compare with those experienced by other recognized minority groups in the US?
For example, underserved racial and ethnic groups(Drum, McClain, Horner-Johnson, & Taitano, 2011)Slide19
Disability compared to other minority groups
(BRFSS, 2010)
Social determinants of healthSlide20
Disability compared to other minority groups
(BRFSS, 2010)
Prevalence of obesity, diabetes, asthmaSlide21
Disability compared to other minority groups
(BRFSS, 2010)
Rates of stroke, CHD, heart attackSlide22
How do we strategize
addressing health disparities locally
?Slide23
How to Best Assess Community Concerns Related to Health Equity for People with Disabilities?Developing a Concerns Inventoryhttp://ctb.ku.edu/en/tablecontents/section_1045.htm
Concerns inventories are a form of community assessment in which people are asked to identify the most important issues facing their community in a given area and
how satisfied they are with how the issues are being dealt withResults can be used to help form strategies to deal with the community's problems and help set an agenda that reflects people's concernsSlide24
Developing a Concerns InventoryIdentify broad areas (“domains”) related to the topic (in our case, health equity for people with disabilities) in which your community might have important issuesIdentify issues within these domains
Rank issues based on importance and satisfaction with the community’s efforts in dealing with this issuePriorities are then identified as issues with the greatest difference between importance and satisfaction among issues of greatest
importanceSlide25
Conducting a the Concerns InventoryAn Example:Identifying priority issues among CDC partners working with the Division of Human Development and Disability (12/2009)Slide26
Implementing the Concerns InventoryPartners (n=7) and DHDD leadership staff (n=6, excluding the Director)
completed a concerns inventory36 items within four domains were ranked on importance and satisfaction using a scale of 0 (least) to 4 (most)
Domains included Science,
Health Promotion & Education, Public Health Content, and Health PolicyAverage importance and satisfaction scores were then calculated for both sets of respondents Slide27
Implementing the Concerns Inventory Summary of Technique
Issues of Interest to
Division’s
PartnersPlease circle one:
Please circle one:
How important is this issue to you?
How satisfied are you with the CDC’s efforts in this area for your population of greatest interest?
Not
Very
Not
Very
0
1
2
3
4
0
1
2
3
4
A.
Science
1. Finding a cure
2. Improving quality of life
3. Improving quality of health care
4. Effective surveillance; Prevalence (how many people have the condition)
5. Effective surveillance; Incidence (how many new cases occur each year)
6. Participatory involvement of persons with disabilities
7. Facilitating best practices and ensuring that current research influences practice
8. Evaluating program effectiveness
Other—please specifySlide28
Implementing the Concerns InventorySummary of Technique
How
to average responses to questions
Question from concerns survey:
How important is this issue to you?
How satisfied are you with the CDC’s efforts in this area for your population of greatest interest?
Not
.
Very
Not
.
Very
Effective surveillance
0
1
2
3
4
0
1
2
3
4
8 partners answered this question. Possible responses for each rating (e.g., in the first column, 1 person answered with a rating of 0, 2 people answered with a rating of 1, etc.)
1
2
0
3
2
0
0
2
5
1
Multiply number of people who responded with each rating by value of that rating (e.g., in the first column 1 person answered 0, so that would be 1 x 0; 2 people answered 1, so that would be 2 x 1, etc.)
1 x 0 = 0
2 x 1 = 2
0 x 2 = 0
3 x 3 = 9
2 x 4 = 8
0 x 0 = 0
0 x 1 = 0
2 x 2 = 4
5 x 3 = 15
1 x 4 = 4
Add these figures up for each question. As you see, the numbers are 19 and 23. The overall possible score for each question is 32 (8 people responding x the total highest possible value of each question, which is 4)
0+2+0+9+8 =19
(out of 32 possible )
0+0+4+15+4 =23
(out of 32 possible)
Divide the total for each question by the total possible for each question, and this gives you your percentages.
19/32 =.5938,
or 59.38%
23/32 =.7188,
or 71.88%Slide29
Implementing the Concerns InventorySummary of TechniqueRank by importance and satisfaction
Compare difference between importance and satisfactionStrengths are items that have high ratings in both importance and satisfaction, while problems are rated high in importance but low in terms of satisfactionPriorities
may be identified as highest ranked importance areas that have lowest ranked satisfaction among items with high overall importance i.e.
Issue Importance Satisfaction Physical vs Cog 59.38% 71.88% Etc. xx.xx% xx.xx%Slide30
Summary of DHDD Partners’ and Staff Importance Public Health Content Areas
In parenthesis (DHDD staff)
Issues of Interest to Partners
Average Importance Score
Issues of Interest to Staff
Average Importance Score
Public Health Content Areas
Public Health Content Areas
Health Disparities for this condition (differences between people with this condition vs. the general population)
96%
Access
to health, social, education services
(96%)
Emotional well-being (including mental health)
96%
Health Disparities for this condition (differences between people with this condition vs. the general population)
(92%)
Health disparities for race/ethnic groups
82%
Emotional
well-being (including mental health)
(83%)
Social participation
79%
Injuries (intentional and unintentional)
(83%)
Access to health, social, education services
75%
Obesity
/ Nutrition/ Physical Activity
(71%)
Care giving (including parenting support, respite care, adult personal assistance)
71%
Physical
access in homes and communities
; Homes** Community**
** DHDD staff question
(71
%)
(75%)
Obesity/ Nutrition/ Physical Activity
61%
9. Care giving (including parenting support, respite
,
adult personal assistance)
(67%)
Physical access in homes and communities
54%
11. Reproductive health/Sexuality
(63%)
Infections
50%
6. Tobacco/Smoking
(63%)
Injuries
43%
7. Infections
(54%)
Reproductive health/Sexuality
43%
Tobacco/Smoking
39%Slide31
Summary of DHDD Partners’ and Staff Satisfaction Public Health Content Areas
In parenthesis (DHDD staff)
Issues of Interest to Partners
Average Satisfaction Score
Issues of Interest to Staff
Average Satisfaction Score
Public Health Content Areas
Public Health Content Areas
Obesity
/ Nutrition/ Physical Activity
75%
Health
Disparities for this condition (differences between people with this condition vs. the general population)
(63%)
Infections
75%
Injuries
(intentional and unintentional)
(58%)
Injuries
(intentional and unintentional)
75%
Obesity
/ Nutrition/ Physical Activity
(54%)
Reproductive
health/Sexuality
75%
Tobacco/Smoking
(54%)
Physical
access in homes and communities
65%
Access
to health, social, education services
(54%)
Health
disparities for race/ethnic groups
58%
Infections
(50%)
Tobacco/Smoking
55%
Care
giving (including parenting support, respite care, adult personal assistance)
(50%)
Health
Disparities for this
condition
54%
Physical
access in homes and communities
; Homes** ; Community**
**
DHDD staff question
(46
%) (
46%)
Access
to health, social, education services
50%
Reproductive
health/Sexuality
(42%)
Emotional
well-being (including mental health)
50%
Emotional
well-being (including mental health)
(42%)
Social
participation
46%
Care giving
46%Slide32
Top Five Items of Importance and Satisfaction
Items in italics are identified by both Partners and DHDD Leadership Staff
Top Five Items of Importance
PartnersItem ScoreCommunicating with policy makers 100%
Increasing policy makers awareness of
this condition 100%Policy changes to improve the rights of
people with this condition 100%
Emotional well-being (including mental
health) 96%
Health disparities for this condition
96%
Top Five Items of Importance
DHDD Staff
Item
Score
Access to health, social, and educational
services 96%
Health disparities for this condition
92%
NCBDD leadership and management 92%
Disseminating scientific information 92%
The following all at 88%
- Improving public knowledge and attitudes about
the condition
- Disseminating consumer-oriented information
- Co-occurring conditions
- Evaluating program effectiveness
Top Five Items of Satisfaction
Partners
Item
Score
The following all at 82%
- Communicating with health and education
partners
-
Disseminating scientific information
-
Disseminating consumer-oriented information
The following all at 79%
- Surveillance
- Evaluating program effectiveness
Top Five Items of Satisfaction
DHDD Staff
Item
Score
New knowledge about the condition 65%
The following all at 63%
-
HP2020 or other policy “blueprints”
- Improving public knowledge and attitudes about the
condition
- Health disparities for this condition
The following all at 58%
- Translating current research into policy
- Co-occurring conditions
-
Disseminating consumer-oriented information
- Injuries Slide33
Top Five Perceived Strengths and ProblemsItems in italics are identified by both Partners and DHDD Leadership Staff
Top Five Perceived Item Strengths
(Satisfaction Equals or Exceeds Importance)
PartnersItem Difference in Score
The following all at 32%
- Injuries
- Reproductive Health/Sexuality
Infections 25%
HP2020 or other policy “blueprints”
18%
The following all at 14%
- Earlier diagnosis of condition
- Obesity
Top Five Perceived Item Strengths
(Satisfaction Equals or Exceeds Importance)
DHDD Staff
Item
Difference
in Score
HP2020 or other policy “blueprints”
0%
Strategic planning by NCBDDD on policy 0%
No other items scored higher on satisfaction than importance
Top Five Perceived Problems/Priorities
(Importance Exceeds Satisfaction)
Partners
Item
Difference
in Score
The following all at 44%
- Emotional well-being (including mental health)
-
NCBDDD leadership and management
The following all at 42%
-
Increase policy makers awareness of condition
-
Communicating with policy makers
-
Health disparities for this condition
Top Five Perceived Problems/Priorities
(Importance Exceeds Satisfaction)
DHDD Staff
Item
Difference in Score
Communicating with policy makers
55%
Identifying state and federal policies that affect
the population of interest 50%
Increase policy makers awareness of the
condition
48%
Evaluating program effectiveness
46
%
NCBDD leadership
46%
management*
42%
* asked as separate items in DHDD inventory
Slide34
Example:SummaryTop Five Partner Priorities
Emotional well-being (including mental health
) of population of greatest interest
NCBDDD leadership and management Increasing policy makers’ awareness of condition
Communicating with policy
makers Investigating health disparities for respective conditionSlide35
ExerciseYour TurnWhat are issues associated with health equity or health disparities for people with disabilities in your community
?Kimberly and Mike have identified five broad topic areas (“domains”) to identify and score issues in:Defining disabilityIdentifying health indicators Finding people with disabilities (“surveillance”)Implementing practices to reduce disparitiesEvaluating effectiveness of the
above issuesYour job will be to identify issues within each of these broad topic areas, score them on importance and satisfaction, and calculate their ranking as priorities.
Slide36
* The 12 Healthy People 2020 Leading Health Indicator Topic Areas http://www.healthypeople.gov/2020/LHI/default.aspx
Access to Health Services Clinical Preventive Services Environmental Quality
Injury and Violence
Maternal, Infant, and Child Health Mental Health Nutrition, Physical Activity, and Obesity Oral Health Reproductive
and Sexual Health Social
Determinants Substance Abuse Tobacco