Using Data to Promote Health Equity in Maine 2016 Maine Health Equity Surveillance Plan 0 1 6 : Recommendations for Using Data to Promote Health Equity Sheryl Peavey Christopher Pezzullo, MD Chief Operating Officer State Health Officer Debra Wigand, Med, MCHES Director, Division of Disease revention Maine Center for Disease Control and P revention Maine Department of Health and Human Services Preparation Erika Lichter, ScD Finn Teach, MPPM Barbara Poirier, MPPM Associate Research rofessor Research Assistant P olicy Associate Alison Green-Parsons Caitlin Pizzonia, MPH Research Analyst Research Associate P opulation Health and Health olicy Cutler Institute for Health and Social P olicy Muskie School of ublic Service U niversity of Southern Maine Emily Morian-Lozano, MPH, MSW Council of State and Territorial Epidemiology/Centers for Disease Control and revention Copyright information: All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated. Suggested Citation: ichter EL , Morian-L oz ano E, Teach , oirier , reen-P arsons A, iz z onia C. U sing Data to P romote Health Equity: Maine 2016. Augusta, ME: Maine Center for Disease Control and P revention; 2016. Using Data to Promote Health Equity in Maine 2016 Acknowledgements The authors would like to acknowledge the following individuals who contributed their knowledge to this report L isa Sockabasin Debra Halm rrDirector rrAssociate Director, Community iving, Office of Health Equity L ong-Term Services and Supports Maine Center for Disease Control and revention Office of Aging and Disability Services Shannon K ing J ayson Hunt P rogram Manager HIV revention rogram Manager W r Maine Center for Disease Control and revention Maine Center for Disease Control and revention Connie ones N ancy irkhimer Director of Community Services P rogram Manager SeniorsP lus Quality Assurance and P erformance Improvement Maine Center for Disease Control and revention Holly asagna Health romotion Manager, Racial and Ethnic Approaches to Community Health (REACH) Tarlan Ahmadov Healthy Androscoggin P rogram Director Refugee and Immigration Services J essica Maurer, Esq Catholic Charities of Maine Executive Director Association of Area Agencies on Aging Alan Cobo-L ewis and Susan Russell Director and Associate Director K risti Ricker Center for Community Inclusion and Disability Studies Tribal District iaison U niversity of Maine Maine Center for Disease Control and revention J ennifer Crittenden Toho Soma Assistant Director Director U niversity of Maine Center on Aging P ortland City Department of Health N ancy Cronin Holly Stover Executive Director rrDirector Maine Developmental Disabilities Council P revention of Domestic Violence and Sexual Assault Maine Department of Health and Human Services G ia Drew P resident, MaineTransnet L isa Tapert P rogram Director, Equality Maine Executive Director Maine Migrant Health rogram Using Data to Promote Health Equity in Maine 2016 L aurie Trenholm B ethany oods Executive Director Migrant Education Advocate and Community The Alz heimer' s Association, Maine Chapter Relations Coordinator Mano En Mano J ulia Truj illo uengo Director Sandra Yarmul Office of Multicultural Affairs rrTribal District iaison Maine Department of Health and Human Services Maine Center for Disease Control and revention Meryl Troop Deaf Services Director Disability Rights Maine Toni all Quality Management Manager crc This publication was supported by therr2B01OT009026-15, Centers for Disease Control and rcontents are solely the responsibility of the authors and do not necessarily represent the official view of the .S. 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Image Sources: Equal vs equity http: //www.maine.gov/dhhs/mecdc/health-equity/ G roup by evin from the oun roj ect L eader by ilson oseph from the oun roj ect Mountain orest andscape by Cez ary opacinski from the N oun ro ect Racial equality by Romualdas urgaitis from the oun roj ect G raph by icholas Menghini from the oun roj ect Using Data to Promote Health Equity in Maine 2016 Table of Contents 2 T 5 Introduction: Using Data to Promote Health Equity Healthy Equity Surveillance ramework 9 Chapter : Using Public Health Surveillance Systems to Advance Health 1 0 Equity Health Equity Data System Summaries 1 6 Chapter : Presenting Data on Health Disparities 2 5 Chapter : Measuring Social Determinants of Health 3 6 Social Determinants of Health Report Outline 3 8 Social Determinants of Health Indicators with Definitions 4 1 Chapter : Populations Experiencing Health Disparities 6 1 N ative American Tribal P opulations 6 2 P eople of Color 6 8 Refugees and Immigrants 7 2 Hispanic/L atino opulation 7 7 Migrant and Seasonal armworkers 8 1 G ay, esbian, isexual and Transgender Mainers 8 5 P ersons with Disabilities 9 1 Children and Youth with Special Health N eeds 9 6 W omen 1 0 4 Older Adults iving in Rural Areas 1 0 8 Key Findings and Recommendations 1 1 3 4 Using Data to Promote Health Equity in Maine 2016 List of Tables and Figures Chapter Table 1. Health Equity Data Set Overview 1 3 Table 2. Missing data analyses of selected indicators within ma or public health surveillance systems 1 3 F igure 1. Maine’s hospital discharge data by race and year, 2008-2012 1 4 Chapter Sample Table Shell: Indicators of health and social determinants of health by education level, Maine, 2015 2 6 Sample Table Shell: Indicators of health and social determinants of health by 2 7 income level, Maine, 2015 Sample Table Shell: Indicators of health and social determinants of health by ethnicity, Maine, 2015 2 8 Sample Table Shell: Indicators of health and social determinants of health by 2 9 racial group, Maine, 2015 Sample Table Shell: Indicators of health and social determinants of health by 3 0 rurality, Maine, 2015 Sample Table Shell: Indicators of health and social determinants of health by 3 1 sexual orientation, Maine, 2015 Sample Table Shell: Indicators of health and social determinants of health by sex, Maine, 2015 3 2 Sample Maps: Indicators of health and social determinants of health by county, Maine, 2015 3 3 Chapter F igure 1. Determinants of population health 3 5 Table 1. Examples of social determinants of health 3 6 Chapter Table 1. Selected data elements related to immigration 7 2 Table 2. RF SS Questions related to health problems or impairments 9 2 5 Using Data to Promote Health Equity in Maine 2016 Table 3. American Community Survey disability concepts 9 6 Table 4. Maine Integrated Youth Health Survey questions on special health needs by module 9 7 Table 5. Summary of available data sources with information on children with special health care needs 9 9 Table 6. Selected data sources for women 1 0 4 6 Using Data to Promote Health Equity in Maine 2016 Using Data to Promote Health Equity: Introduction What is Health Equity? Health Equity is the attainment of the highest level of health for all people.” 1 Health Inequities are differences in health that are avoidable, unfair, and un ust.2 Health Disparities are differences in health outcomes among groups of people linked with social, economic and/or environmental 1 disadvantage. Health disparities are avoidable Why Measure Health Inequity? and unequitable.3 Healthy inequities can be caused by: In order to apply evidence-based practices and policies to health inequity, valid and informative • Social conditions: hen a person or group is data are needed to understand the scope of the treated differently because of their race, sex, problem and the factors contributing to health class, sexual orientation, or immigration status. disparities. It is also critical to continue to monitor • Economic conditions: U nequal opportunities inequities to ensure progress towards can lead to less access to educational and comprehensive, long-term reductions. employment opportunities. To increase health equity, it is critical to: • Environmental conditions: W here you live can 1. Identify inequalities in health. affect your health due to neighborhood conditions, economic opportunities, school 2. Identify the inequalities that can be reduced quality, access to healthy food, opportunities through changes in social and health policy and 4 for physical activity, exposure to violence, practices. cleanliness of the environment, and social Traditionally public health surveillance is conducted support. to assess the health of a population. It generally includes identifying population health status and trends. From a health equity perspective, it is important to identify differences in health that are associated with the historical and current socio- economic advantages or disadvantages of a particular group. 7 Using Data to Promote Health Equity in Maine 2016 An Overview of This Report C. Populations with disparities One of the challenges of using traditional public health data systems to address health equity is the This report is based on a framework designed to lack of data on populations at risk for health summari e the current status of data analyses, data disparities, such as refugees, migrants, G B TQ and systems, and data availability on health equity. The tribal members. Data on these groups in many data three lenses of this framework include: systems are simply not collected. W hen data are A. Public health data: systems, analysis, and collected, the data collection methods are often not presentation adequate to reliably capture their experiences. Chapters 1 and 2