State Efforts to Address the Healthy People 2010 Goal to Eliminate Health Disparities: Two Case Studies

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Under a public health services research grant from the Robert Wood Johnson Foundation’s Changes in Health Care Financing and Organization (HCFO) program, Mathematica Policy Research, Inc. (MPR) assessed the availability of state-level disparities data and investigated how states use these data to prioritize health issues and shape interventions. In the first phase of the project, we assessed the availability of state-level data related to the LHIs and health disparities based on the population characteristics identified by Healthy People 2010: race and ethnicity, sex, income, education, geographic location, disability status, and sexual orientation (Dodd et al. 2007). We found that the state-level data could identify and track state-level disparities for most of the LHIs. However, some state indicators use sources or definitions differing from those used nationally. Furthermore, because indicator data often are aggregated at the state level, users have limited ability to differentiate among diverse population groups and produce local estimates.

In the next phase, we attempted to identify states that have emerged as leaders in leveraging data to document, and to develop strategies to eliminate, health disparities. Our goal was to learn not only how leading health indicators and disparities are viewed as states develop initiatives to improve the public’s health, but also the role-played by disparities data in developing initiatives. A brief environmental scan of existing state initiatives indicated that most state efforts to eliminate disparities are in their infancy.

Using feedback from key informants, we chose to examine North Carolina and Washington for our case studies, two states mentioned for their notable use of data to address disparities. Washington ’s initiative is in the planning stages, while North Carolina ’s has been around since the early 1990s. Our case studies illustrate how data—to the extent possible—are used to identify health disparities and to develop initiatives to eliminate them.

These two states we examined—the 11th and 15th most populous—are fairly different demographically, as seen in Table I.1. North Carolina’s population has a larger share of nonwhites than average in the U.S. Washington has a smaller but more heterogeneous nonwhite population, with sizable Hispanic and Asian populations. Compared to the general U.S. population, North Carolina has a higher rate of uninsured individuals and those living in poverty, as well as a lower median household income. In contrast, Washington’s rate of uninsured individuals and those living in poverty is lower and median household income is higher than the general U.S. population.

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