Assessment of State Capacity to Identify and Track Disparities in the Leading Health Indicators

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Our analysis sought to characterize the capacity of states to identify and track disparities in health across subgroups of the population (like race/ethnicity), using the leading health indicators (LHIs) from Healthy People 2010 (HP2010) as the basis for our work. Assessing health status is one of the three core functions of public health (along with formulating public policies and assuring that all populations have access to appropriate and cost-effective care). HP2010 lays out important goals and objectives for improving the health of the public, which are particularly relevant because they were developed through a collaborative process involving stakeholders at all levels—federal, state and the local community. HP2010 also makes the attainment of these goals and objectives, and the reduction of disparities among subgroups of the population, as key overall goals.

Our intent in carrying out this study was to identify whether states, which play a vital role in efforts to achieve public health goals, have the data they need for assessment, a first step in action. We focused on the LHIs cited in HP2010 both because they are important and because they provided a way to focus the study. The 10 LHIs cover a range of broad public health issues (physical fitness and activity, overweight and obesity, tobacco use, substance abuse, responsible sexual behavior, mental health, injury and violence, environmental quality, immunization, and access to health care). By searching the websites of the Centers for Disease Control and Prevention (CDC), federally standardized data sources, and state governments, we identified data sources that collect the data specified in the LHI objectives.

This project is the first phase of a two-phase study. The information presented in this paper describes what we learned about the availability of leading indicators in states, both overall and by population subgroup, including a review of findings for every state as of September 2007. The second phase, now underway, will involve case studies that seek to identify whether efforts to improve performance on leading indicators consider the issue of disparities, and what analytical, political, organizational or other factors enhance or impede such efforts. This effort also will provide an opportunity to learn more about how potential users at the state and local level view the value and adequacy data of disparities data of the type we examined for and within states and also how important they view data in driving the design of disparities initiatives.

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