Measuring progress on health disparities

Abstract

The struggle to eliminate disparities in health will be long and difficult. The gaps are often large and the causes many and intractable. Improving health services will help. But health services account for only about 10–15% of the variation in health outcomes among different groups. Socioeconomic factors play a far greater part.In the UK, access to health care is universal, but the life expectancy of a boy born into the lowest social class is more than 9 years less than that of a boy born into the most affluent class. Infant mortality rates for social class V, that of unskilled manual workers, are twice that for a boy born into the professional and management classes, social class I. In the USA, race and ethnicity are major factors. The life expectancy of an African–American man is 69·0 years, whereas that of a white man is 75·3. Infant mortality is 5·75 per 1000 livebirths for white infants, 14·01 for African–American infants. Race, class, and other socioeconomic factors are so complex and multifaceted that they will be far more difficult to change. Both nations have now initiated programmes to reduce health disparities. How likely are they to succeed?In a recent article in the journal Milbank Quarterly, Mark Exworthy and colleagues review the strategies being used by both countries to track progress. They find that neither nation has put in place systems that are likely to provide the information needed to tell which interventions work and which do not. They note that “despite the mounting evidence for health disparities, there is surprisingly little high-quality evidence for the effectiveness of policy interventions to address them”. To try to tackle such a complex problem without good evidence is inviting failure. Without such evidence, not only will time and resources be lost, but quite possibly political and public support as well.Efforts to address health disparities are laudable but steps need to be taken to develop accurate, relevant, and timely measures to assess these efforts. As Exworthy and colleagues note: “Central to all these efforts is the measurement of progress.” The struggle to eliminate disparities in health will be long and difficult. The gaps are often large and the causes many and intractable. Improving health services will help. But health services account for only about 10–15% of the variation in health outcomes among different groups. Socioeconomic factors play a far greater part. In the UK, access to health care is universal, but the life expectancy of a boy born into the lowest social class is more than 9 years less than that of a boy born into the most affluent class. Infant mortality rates for social class V, that of unskilled manual workers, are twice that for a boy born into the professional and management classes, social class I. In the USA, race and ethnicity are major factors. The life expectancy of an African–American man is 69·0 years, whereas that of a white man is 75·3. Infant mortality is 5·75 per 1000 livebirths for white infants, 14·01 for African–American infants. Race, class, and other socioeconomic factors are so complex and multifaceted that they will be far more difficult to change. Both nations have now initiated programmes to reduce health disparities. How likely are they to succeed? In a recent article in the journal Milbank Quarterly, Mark Exworthy and colleagues review the strategies being used by both countries to track progress. They find that neither nation has put in place systems that are likely to provide the information needed to tell which interventions work and which do not. They note that “despite the mounting evidence for health disparities, there is surprisingly little high-quality evidence for the effectiveness of policy interventions to address them”. To try to tackle such a complex problem without good evidence is inviting failure. Without such evidence, not only will time and resources be lost, but quite possibly political and public support as well. Efforts to address health disparities are laudable but steps need to be taken to develop accurate, relevant, and timely measures to assess these efforts. As Exworthy and colleagues note: “Central to all these efforts is the measurement of progress.”