3 Ways to Tell Stories of Health Disparities
Health equity focuses on the fair distribution of health determinants, outcomes and resources across communities.1 National data has shown that systemic racism, poverty and gender discrimination have led to poorer health outcomes for groups such as Black, Indigenous, or People of Color, individuals living below the poverty level and LGBTQIA+ communities.
Community health practitioners working to advance health equity often dig into their work by understanding and addressing health disparities or “a difference in health that is closely linked with social, economic, and/or environmental disadvantage.” 2
Given the diverse makeup of many communities throughout the U.S., how can groups most likely to experience health disparities be identified at the local level? A great place to start is with reliable data from credible sources that can provide data about groups within a community.
With reliable data, we can use tools to help visualize and tell each community’s unique stories.
1. Compare group values
One way to show disparities is by comparing health outcomes between groups or between a specific group and the overall population. For instance, comparing the health outcomes in one racial/ethnic group with the overall value of a county or state.
When data sources provide confidence intervals, one can determine if a statistically significant difference exists, meaning that a difference between groups is likely caused by something other than chance. This is achieved by looking at groups whose confidence intervals don’t overlap with the overall value’s confidence intervals.
In the example below, the percent of the population living below poverty level in Dallas County is shown by race/ethnicity. Groups in red have values significantly higher than the overall value, while those in green are significantly lower. Those in blue are not significantly different from the overall. This helps tell the story of communities at greater risk of living below poverty. Coupled with our understanding of the impact of poverty on health, visualizations such as this can be a simple and effective way to help communities understand disparities and inform work toward health equity.
2. Explore correlations
Another way to tell stories around disparities is to explore the relationship between two indicators. Since health equity work centers on the fair distribution of health outcomes regardless of social or economic circumstances, investigating the correlations between the two may reveal important information.
Scatter plots can be a helpful tool to understand these relationships. They use dots to represent values for two different numeric variables, one shown on the horizontal axis and one on the vertical axis.
In the example below, each dot represents a county — plotted on the vertical axis based on the percent of population experiencing frequent mental distress,3 and on the horizontal axis based on median household income.4 The plot shows a strong negative relationship between the two variables.
Counties with lower median household income had higher rates of frequent mental distress. For instance, in Marion County, with a median household income of $37,662, 16.8% of the population is estimated to experience frequent mental distress. By contrast, Collin County, with a median household income of $96,913, 10.6% of the population is estimated to experience frequent mental distress.
The scatter plot helps underscore the relationship between health and social determinants of health. It’s important to note however that the scatter plot does not prove causation between these two variables — only that they are related.
3. Show trends over time
Looking at data over time can help demonstrate whether disparities are widening or narrowing. These insights can provide valuable information around progress toward health equity and potential intervention strategies.
As an example, reducing pregnancies among adolescent females is a Healthy People 2030 goal as teen mothers and their babies are more likely to experience negative health and socioeconomic impacts compared to older mothers.5 The chart below shows Teen Birth Rates for 15-19-year-olds by race/ethnicity for each year between 2013 and 2019. The overall trend, shown in orange, indicates the teen birth rate decreased from 24 to 16 live births per 1,000 females, with teen birth rates for all groups showing a decline.6
But looking more closely reveals that the fastest decrease was for Black/African American teens. This group saw a 34.3% decrease in rate compared with a 29.8% decrease for White teens over the same time frame. This sharper decrease in Black/African American teen birth rate reflects promising success in public health intervention strategies in this community.
Connecting with community leaders, faith-based organizations, schools, and other community groups can help bring to light community assets and resources that can contribute to building resilience and driving positive outcomes related to health equity.
Visualizations like those shared here tell an important story around health disparities and can help inspire action toward equity. Shared technology platforms that can track and provide visualizations on a range of health, education, and income indicators can be an essential tool to move communities toward shared action.
About Healthy Communities Institute
Conduent Healthy Communities Institute provides an end-to-end solution for community health that links health and social determinants of health with technology and expertise. The HCI platform brings stakeholders together with a centralized dashboard of more than 150 health, social, and economic indicators, high value analytics, tools for storytelling, and evidence-based practices at the user’s fingertips. HCI’s Consulting Services team provides expert guidance for assessing community needs, developing strategies, and implementing evaluation and monitoring processes. Contact Conduent Healthy Communities Institute at communityhealth@conduent.com.
Sources
1. Klein R, Huang D., National Center for Health Statistics, Center for Disease Control and Prevention – Defining and measuring disparities, inequities, and inequalities in the Healthy People initiative.
2. U.S. Dept. of Health and Human Services, the Secretary’s Advisory Committee on National Health Promotion and Disease Prevention Objectives for 2020, Phase I report…Section IV
3. Frequent Mental Distress, County Health Rankings, 2018
4. Median Household Income, American Community Survey 2015-2019
5. U.S. Dept. of Health and Human Services, Office of Disease Prevention and Health Promotion. (n.d.). Reduce pregnancies in Adolescents. Healthy People 2030.
6. Florida Department of Health, Bureau of Vital Statistics, 2013 - 2019
About the Authors
Margaret Mysz, MPH, is a Public Health Research Associate with Conduent Healthy Communities Institute (HCI). As a public health professional, she strives to make public health research more easily accessible to the general population through effective communication and data visualization.
Jane Chai, MPH is a community health expert with Conduent Healthy Communities Institute. She has been a leader in the field of public health and community health planning for more than 20 years at various organizations in Southern California.