Page 519 Cite

Suggested Citation:"Appendix B: Community-Level Indicators and Interactive Tools for Health Equity." National Academies of Sciences, Engineering, and Medicine. 2017. Communities in Action: Pathways to Health Equity. Washington, DC: The National Academies Press. doi: 10.17226/24624.

×

Appendix B

Community-Level Indicators and Interactive Tools for Health Equity

Chapter 8 summarizes the current state of indicators and interactive tools available to communities. This appendix contains two resources relevant to that discussion. Table B-1 contains publicly accessible indicators related to health equity. This includes measures of demographics, the social determinants of health, and four aspects of the conceptual model for this report: (1) making health equity a shared vision and value, (2) building community capacity to shape outcomes, (3) fostering multisector collaboration, and (4) creating healthier more equitable communities in which members and families live, learn, work, and play. Table B-2 describes interactive tools that communities can use to examine health equity indicators by geographic region as the foundation for community-based solutions and to monitor progress over time.

Page 520 Cite

Suggested Citation:"Appendix B: Community-Level Indicators and Interactive Tools for Health Equity." National Academies of Sciences, Engineering, and Medicine. 2017. Communities in Action: Pathways to Health Equity. Washington, DC: The National Academies Press. doi: 10.17226/24624.

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TABLE B-1 Examples of Indicators Relevant to Health Equity in Publicly Available Data Sources

	HP2020^a	CoH^b	AHR^c	CHR^d	CHSI^e	NEA^f	VHOI^g	DDK^h	AARPⁱ
Demographics
Age	•		•	•	•	•
Race	•		•	•	•	•	•	•
Ethnicity	•		•	•	•	•	•	•
Immigrant status						•
Social Determinants of Health
Education
Early childhood education		•						•
Education levels and job requirements						•
Grade school achievement								•
High school graduation			•	•				•	•
High school graduation 4 years after starting 9th grade	•		•	•	•
Public school enrollment and racial/ethnic composition								•
School poverty						•	•
Years of schooling of adults							•
Employment
Annual unemployment rate			•	•	•	•	•	•

Page 521 Cite

Suggested Citation:"Appendix B: Community-Level Indicators and Interactive Tools for Health Equity." National Academies of Sciences, Engineering, and Medicine. 2017. Communities in Action: Pathways to Health Equity. Washington, DC: The National Academies Press. doi: 10.17226/24624.

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	HP2020^a	CoH^b	AHR^c	CHR^d	CHSI^e	NEA^f	VHOI^g	DDK^h	AARPⁱ
Social Determinants of Health
Eligibility for Family Medical Leave Act								•
Job quality								•
Jobs per worker									•
Underemployment rate			•
Working poor						•
Health Systems and Services
Access to care							•
Access to mental health services		•
Access to stable health insurance	•	•		•	•
Cost barrier to care					•
Hospice use				•
Primary care physicians			•		•
Primary care provider rate	•			•
Preventable hospitalizations			•	•
Preventable hospitalizations: Older adults					•
Public health funding			•
Unmet care need

Page 522 Cite

Suggested Citation:"Appendix B: Community-Level Indicators and Interactive Tools for Health Equity." National Academies of Sciences, Engineering, and Medicine. 2017. Communities in Action: Pathways to Health Equity. Washington, DC: The National Academies Press. doi: 10.17226/24624.

×

	CoH^b	AHR^c	CHR^d	CHSI^e	NEA^f	VHOI^g	DDK^h	AARPⁱ
Social Determinants of Health
Housing
Home ownership					•
Housing affordability	•			•
Income spent on housing and transportation (i.e., Affordability Index)							•
Renters							•
Income and Wealth
Children in poverty		•	•				•
Gross domestic product (GDP) gains with racial equity					•
Income disparity/inequality		•	•		•	•		•
Income disparity ratio		•
Income gains with racial equity					•
Income growth					•
Job and GDP growth					•
Job and wage growth					•
Median household income		•
Median wage					•
Minimum wage							•

Page 523 Cite

Suggested Citation:"Appendix B: Community-Level Indicators and Interactive Tools for Health Equity." National Academies of Sciences, Engineering, and Medicine. 2017. Communities in Action: Pathways to Health Equity. Washington, DC: The National Academies Press. doi: 10.17226/24624.

×

	HP2020^a	CoH^b	AHR^c	CHR^d	CHSI^e	NEA^f	VHOI^g	DDK^h	AARPⁱ
Social Determinants of Health
Per capita personal income			•
Poverty					•	•		•
Wages $15/hour						•
Physical Environment
Access to healthy food		•	•		•		•		•
Access to jobs via auto									•
Access to jobs via transit									•
Access to libraries		•							•
Access to parks					•				•
Air pollution	•	•	•	•	•	•	•
Children exposed to secondhand smoke	•
Housing accessibility									•
Housing burden						•
Housing costs									•
Housing options									•
Housing stress					•
Liquor-store density			•
Living near highways					•

Page 524 Cite

Suggested Citation:"Appendix B: Community-Level Indicators and Interactive Tools for Health Equity." National Academies of Sciences, Engineering, and Medicine. 2017. Communities in Action: Pathways to Health Equity. Washington, DC: The National Academies Press. doi: 10.17226/24624.

×

	HP2020^a	CoH^b	AHR^c	CHR^d	CHSI^e	NEA^f	VHOI^g	DDK^h	AARPⁱ
Social Determinants of Health
Neighborhood: Activity density									•
Neighborhood: Mixed use									•
Neighborhood: Poverty						•
Neighborhood: Vacancy rate									•
Population churning/turnover							•
Population density							•
Population growth rates						•
Walkability							•
Public Safety
Crime rate									•
Homicides	•
Violent crime			•	•	•
Youth safety		•
Social Environment
Disconnected youth						•
Home language								•
Inadequate social support				•	•
Linguistic isolation								•

Page 525 Cite

Suggested Citation:"Appendix B: Community-Level Indicators and Interactive Tools for Health Equity." National Academies of Sciences, Engineering, and Medicine. 2017. Communities in Action: Pathways to Health Equity. Washington, DC: The National Academies Press. doi: 10.17226/24624.

×

	CoH^b	CHR^d	CHSI^e	NEA^f	VHOI^g	DDK^h	AARPⁱ
Social Determinants of Health
Residential segregation	•
Single-parent households		•	•
Transportation
Car/vehicle access				•	•
Commute time				•
Safe and convenient options							•
Making Health Equity a Shared Vision and Value
Community diversity/Diversity index				•	•
Distances between communities with different racial or ethnic profiles					•
Public school racial/ethnic composition						•
Racial generation gap				•
Increasing Community Capacity to Shape Outcomes
Sense of community	•
Social support	•

Page 526 Cite

Suggested Citation:"Appendix B: Community-Level Indicators and Interactive Tools for Health Equity." National Academies of Sciences, Engineering, and Medicine. 2017. Communities in Action: Pathways to Health Equity. Washington, DC: The National Academies Press. doi: 10.17226/24624.

×

	CoH^b	AARPⁱ
Increasing Community Capacity to Shape Outcomes
Volunteer engagement	•	•
Voter participation	•	•
Fostering Multi-Sector Collaboration
Business support for workplace health promotion and culture of health	•
Climate adaptation and mitigation	•
Community relations and policing	•
Health in all policies	•
Local health department collaboration	•
Opportunities to improve health for youth at schools	•
Youth exposure to advertising for health and unhealthy food and beverage products	•
Healthier More Equitable Communities in Which Members and Families Live, Learn, Work, and Play
Caregiving
Caregiving burden	•

Page 527 Cite

Suggested Citation:"Appendix B: Community-Level Indicators and Interactive Tools for Health Equity." National Academies of Sciences, Engineering, and Medicine. 2017. Communities in Action: Pathways to Health Equity. Washington, DC: The National Academies Press. doi: 10.17226/24624.

×

	CoH^b	AHR^c	CHR^d	CHSI^e
Healthier More Equitable Communities in Which Members and Families Live, Learn, Work, and Play
Consumer/Patient Satisfaction
Consumer experience	•
Patient–clinician communication satisfaction	•
Costs
Annual end-of-life care expenditures	•
Family health care cost	•
Potentially preventable hospitalization rates	•
Social spending relative to health expenditure	•
Health Status: Self-rated
Poor physical health days		•	•
Self-rated overall health status		•	•	•
Unhealthy days				•
Well-being rating	•

Page 528 Cite

Suggested Citation:"Appendix B: Community-Level Indicators and Interactive Tools for Health Equity." National Academies of Sciences, Engineering, and Medicine. 2017. Communities in Action: Pathways to Health Equity. Washington, DC: The National Academies Press. doi: 10.17226/24624.

×

	HP2020^a	CoH^b	AHR^c	CHR^d	CHSI^e	DDK^h
Healthier More Equitable Communities in Which Members and Families Live, Learn, Work, and Play
Injury and Violence
Fatal injuries	•		•
Motor vehicle crash deaths				•	•
Occupational fatalities			•
Unintentional injury (including motor vehicle)					•
Maternal, Infant, and Child Health
Adolescent health issues						•
Adverse child experiences (ACEs)		•
Birth rate						•
Infant mortality	•		•			•
Low birth weight			•	•
Teen birth rates			•	•	•
Total preterm live births	•		•		•
Mental Health
Depression: Adolescents	•
Depression: Older adults					•

Page 529 Cite

Suggested Citation:"Appendix B: Community-Level Indicators and Interactive Tools for Health Equity." National Academies of Sciences, Engineering, and Medicine. 2017. Communities in Action: Pathways to Health Equity. Washington, DC: The National Academies Press. doi: 10.17226/24624.

×

	HP2020^a	CoH^b	AHR^c	CHR^d	CHSI^e	NEA^f
Healthier More Equitable Communities in Which Members and Families Live, Learn, Work, and Play
Poor mental health days	•		•	•
Suicides	•		•
Morbidity
Alzheimer’s diseases/dementia					•
Asthma					•	•
Cancer
Diabetes			•		•	•
Diabetes: Adult					•
Disability associated with chronic conditions		•
Heart attack			•
Heart disease			•
High blood pressure			•
High cholesterol			•

Page 530 Cite

Suggested Citation:"Appendix B: Community-Level Indicators and Interactive Tools for Health Equity." National Academies of Sciences, Engineering, and Medicine. 2017. Communities in Action: Pathways to Health Equity. Washington, DC: The National Academies Press. doi: 10.17226/24624.

×

	AHR^c	CHR^d	CHSI^e	NEA^f
Healthier More Equitable Communities in Which Members and Families Live, Learn, Work, and Play
Infectious disease	•
Stroke	•
Mortality
Deaths: All causes	•		•
Deaths: Alzheimer’s disease			•
Deaths: Cancer	•		•
Deaths: Cardiovascular disease	•
Deaths: Chronic kidney disease			•
Deaths: Chronic lower respiratory disease			•
Deaths: Coronary heart disease			•
Deaths: Diabetes			•
Deaths: Premature	•	•
Deaths: Stroke			•
Life expectancy			•	•

Page 531 Cite

Suggested Citation:"Appendix B: Community-Level Indicators and Interactive Tools for Health Equity." National Academies of Sciences, Engineering, and Medicine. 2017. Communities in Action: Pathways to Health Equity. Washington, DC: The National Academies Press. doi: 10.17226/24624.

×

	HP2020^a	CoH^b	AHR^c	CHR^d	CHSI^e	NEA^f
Healthier More Equitable Communities in Which Members and Families Live, Learn, Work, and Play
Nutrition, Physical Activity, and Obesity
Adult obesity	•		•	•
Body mass index						•
Child and adolescent obesity	•		•
Fruit consumption			•
Physical activity			•
Physical inactivity			•		•
Vegetable consumption	•		•
Oral Health
Annual dental visit	•		•
Dental care		•	•
Teeth extractions			•
Reproductive and Sexual Health
Adult female routine Pap test					•

Page 532 Cite

Suggested Citation:"Appendix B: Community-Level Indicators and Interactive Tools for Health Equity." National Academies of Sciences, Engineering, and Medicine. 2017. Communities in Action: Pathways to Health Equity. Washington, DC: The National Academies Press. doi: 10.17226/24624.

×

	HP2020^a	AHR^c	CHR^d	CHSI^e	NEA^f
Healthier More Equitable Communities in Which Members and Families Live, Learn, Work, and Play
Chlamydia screening		•	•
Gonorrhea				•
HIV				•
Knowledge of serostatus among HIV-positive persons	•
Sexually active females ages 15 to 44 years who received reproductive health services in the past 12 months	•
Syphilis				•
Sleep
Insufficient sleep		•
Substance Abuse
Addiction death rate					•
Adolescents using alcohol or any illicit drugs during the past 30 days	•
Binge drinking	•	•	•	•

Page 533 Cite

Suggested Citation:"Appendix B: Community-Level Indicators and Interactive Tools for Health Equity." National Academies of Sciences, Engineering, and Medicine. 2017. Communities in Action: Pathways to Health Equity. Washington, DC: The National Academies Press. doi: 10.17226/24624.

×

	HP2020^a	AHR^c	CHR^d
Healthier More Equitable Communities in Which Members and Families Live, Learn, Work, and Play
Chronic drinking		•
Drug deaths		•
Excessive drinking		•
Tobacco Use
Adolescent smoking	•	•
Adult smoking	•	•	•

^a Healthy People 2020, https://www.healthypeople.gov/2020/leading-health-indicators/2020-lhi-topics (accessed December 22, 2016).

^b Culture of Health Metrics, http://hero-health.org/wp-content/uploads/2016/04/HERO-Final-Report-Developing-Culture-of-Health-MetricsThat-Really-Matter-to-Companies-and-Communities.pdf (accessed December 22, 2016).

^c America’s Health Rankings, http://www.americashealthrankings.org (accessed December 22, 2016).

^d County Health Rankings, http://www.countyhealthrankings.org/our-approach (accessed December 22, 2016).

^e Community Health Status Indicators, http://wwwn.cdc.gov/CommunityHealth/info/AboutProject (accessed December 22, 2016).

^f National Equity Atlas, http://nationalequityatlas.org (accessed December 22, 2016).

^g Virginia Health Opportunity Index, https://www.vdh.virginia.gov/OMHHE/policyanalysis/virginiahoi.htm (accessed December 22, 2016).

^h Diversity Data Kids Data Set, http://www.diversitydatakids.org (accessed December 22, 2016).

ⁱ AARP Livability Index, https://livabilityindex.aarp.org/categories/neighborhood (accessed December 22, 2016).

Page 534 Cite

Suggested Citation:"Appendix B: Community-Level Indicators and Interactive Tools for Health Equity." National Academies of Sciences, Engineering, and Medicine. 2017. Communities in Action: Pathways to Health Equity. Washington, DC: The National Academies Press. doi: 10.17226/24624.

×

TABLE B-2 Interactive Tools for Examining Health Equity Indicators by Geographical Region

Name/How to Access	Components
AARP Livability Index https://livabilityindex.aarp.org/categories/neighborhood (accessed December 22, 2016). City, zip code, address	Housing (affordability and access), Neighborhood (access to life, work, and play), Transportation (safe and convenient options); Environment (clean air and water); Health (prevention, access, quality); Engagement (civil and social involvement); Opportunity (inclusion and possibilities)
Children’s Health and Education Mapping Tool http://www.sbh4all.org/resources/mapping-tool (accessed December 22, 2016).	Health Insurance and Coverage (under 18 percent on Medicaid or CHIP, under 18 percent uninsured), Health (teen birth rate, percent adult obesity, percent food insecure, chlamydia rate), Education (percent adults over 25 without high school diploma), Demographic and Socioeconomic Indicators (percent free lunch, percent kids in poverty, percent kids in single-parent households, percent households with severe housing problems, violent crime rate)
	School and School-Based Health Center (SBHC) Characteristics (Title I eligibility, lowest grade offered, highest grade offered, total school enrollment, free and reduced lunch eligibility; SBHC location, sponsor, staffing models [primary care only, primary care and mental health, primary care and mental health plus], hours of operation, populations served)
Community Health Status Indicators http://wwwn.cdc.gov/CommunityHealth/info/AboutProject (accessed December 22, 2016). County level	Physical (access to parks, annual average particulate matter concentration, housing stress, limited access to healthy food, living near highways), Social Factors (children in single-parent households, high housing costs, inadequate social support, on-time high school graduation, poverty, unemployment, violent crime), Health Behaviors (adult binge drinking, adult female routine pap tests, adult physical inactivity, adult smoking, teen births), Health Care Access and Quality (cost barrier to care, older adult preventable hospitalizations, primary care provider access, uninsured), Morbidity (adult diabetes, adult obesity, adult overall health status, Alzheimer’s disease/dementia, cancer, gonorrhea, HIV, older adult asthma, older adult depression, preterm births, syphilis), Mortality (Alzheimer’s disease deaths, cancer deaths, chronic kidney disease deaths, chronic lower respiratory disease deaths, coronary heart disease deaths, diabetes deaths, female life expectancy, male life expectancy, motor vehicle deaths, stroke deaths, unintentional injury, including motor vehicle)

Page 535 Cite

Suggested Citation:"Appendix B: Community-Level Indicators and Interactive Tools for Health Equity." National Academies of Sciences, Engineering, and Medicine. 2017. Communities in Action: Pathways to Health Equity. Washington, DC: The National Academies Press. doi: 10.17226/24624.

×

Name/How to Access	Components
Diversity Data Kids dataset http://www.diversitydatakids.org (accessed December 22, 2016).	Rankings and child opportunities by race and ethnicity by states, counties, large cities, large school districts including Population Demographics and Diversity (population and racial/ethnic composition), Household Composition and Family Structure (home language and linguistic isolation); Early Childhood Care and Education (Head Start); Education (public school enrollment and racial/ethnic composition, student achievement [Grade 4 reading, Grade 8 reading, Grade 4 math, Grade 8 math, graduation rates]); Health (infant mortality, natality, adolescent health issues); Parental Employment (employment and labor force participation, employment characteristics, job quality, eligibility for Family Medical Leave Act [FMLA]); Policy (Head Start, FMLA); Income and Poverty (minimum wage, child poverty, parental poverty)
EJSCREEN: Environmental Justice Screening and Mapping Tool https://www.epa.gov/ejscreen (accessed December 22, 2016).	Environmental Indexes (National-Scale Air Toxics Assessment [NATA] Air Toxics Cancer Risk, NATA Respiratory Hazard Index, NATA Diesel Particulate Matter, particulate matter 2.5, ozone, traffic proximity and volume; lead paint, proximity to risk management plan sites, proximity to treatment, storage, and disposal facilities, proximity to National Priorities List sites, proximity to major direct water dischargers; Demographic Indexes (Demographic Index [average of percent low-income and percent minority] and Supplemental Demographic Index [average of percent low-income, percent minority, percent less than high school education, percent linguistic isolation, percent under 5, percent over 64])
Food Access Research Atlas http://www.ers.usda.gov/data-products/food-access-research-atlas.aspx (accessed December 22, 2016).	General Census Tract Characteristics (population, low-income tract, urban/rural status, housing units), Low-Access and Distance Measures (1 and 10 mile access), Low-Income and Low-Access (0.5, 1, 10, 20, or more mile access), Vehicle Availability (no vehicle and 0.5, 1, 10, 20, or more mile access), Group Quarters (census tract with 67 percent or more living in group quarters), Low Access by Population Subgroups (measures above by seniors and children)
Health Equity Index Connecticut	Community-Specific Scores on Seven Social Determinants of Health (civic involvement, community safety, economic security, education, employment, environmental quality, housing) and 13 Health Outcomes (accidents/violence, cancer, cardiovascular, childhood illness, diabetes, health care access, infectious disease, life expectancy, liver disease, mental health, perinatal care, renal disease, respiratory illness)

Page 536 Cite

Suggested Citation:"Appendix B: Community-Level Indicators and Interactive Tools for Health Equity." National Academies of Sciences, Engineering, and Medicine. 2017. Communities in Action: Pathways to Health Equity. Washington, DC: The National Academies Press. doi: 10.17226/24624.

×

Name/How to Access	Components
JustSouth Index http://www.loyno.edu/jsri/news/inauguraljustsouth-index-2016 (accessed December 22, 2016)	Demographics, nine social justice indicators in three categories: Poverty (average income per household, health insurance coverage for the poor white-minority, housing affordability white-minority), Racial Disparity (public school segregation, wage equity, employment equity); Immigrant Exclusion (immigrant youth outcomes, immigrant English proficiency, health insurance coverage for immigrants)
National Equity Atlas http://nationalequityatlas.org (accessed December 22, 2016).	Demographics (detailed race/ethnicity, people of color, race/ethnicity, population growth rates, contribution to growth: immigrants, contribution to growth: people of color, racial generation gap, diversity index, median age); Economic Vitality (poverty, working poor, unemployment, wages: median, wages: $15/hour, income growth, job and wage growth, job and gross domestic product growth, income inequality: Gini, income inequality: 95/20 ratio, homeownership); Readiness (school poverty, air pollution: exposure index, air pollution: unequal burden, education levels and job requirements, disconnected youth, overweight and obese, asthma, diabetes); Connectedness (neighborhood poverty, housing burden, car access, commute time); Economic Benefits (GDP gains with racial equity, income gains with racial equity)
Opportunity Index http://opportunityindex.org/#4.00/40.00/-97.00 (accessed December 22, 2016).	Jobs and Local Economy (jobs, wages, poverty, inequality, access to banking, affordable housing, Internet access); Education (preschool enrollment, high school graduating, postsecondary completion); and Community Health and Civic Life (group membership, volunteerism, youth economic and academic inclusion, community safety, access to health care, access to healthy food)
The Housing and Transportation (H+T®) Affordability Index http://www.htaindex.org (accessed December 22, 2016).	Provides a comprehensive view of affordability that includes both the cost of housing and the cost of transportation at the neighborhood level for more than 200,000 neighborhoods. Neighborhood Characteristics (gross density, regional household intensity, fraction of single-family detached housing, block density, Employment Access Index, Employment Mix Index, Transit Connectivity Index, transit access shed, transit access shed jobs, average available transit trips per week; Household Characteristics (median household income, average commuters per household, average household size), Transit (auto ownership, auto usage, public transit usage)

Page 537 Cite

Suggested Citation:"Appendix B: Community-Level Indicators and Interactive Tools for Health Equity." National Academies of Sciences, Engineering, and Medicine. 2017. Communities in Action: Pathways to Health Equity. Washington, DC: The National Academies Press. doi: 10.17226/24624.

×

Name/How to Access	Components
Virginia Health Opportunity Index https://www.vdh.virginia.gov/OMHHE/policyanalysis/virginiahoi.htm (December 22, 2016).	Index consists of 13 indicators organized into 4 profiles: Community Environmental (air quality, population churning, population density, walkability); Consumer Opportunity (affordability, education, food accessibility, material deprivation); Economic Opportunity (employment accessibility, income inequality, job participation); Wellness Disparity (access to care, segregation [community diversity and distances between communities with different racial or ethnic profiles])

Name/How to Access

Components

Virginia Health Opportunity Index https://www.vdh.virginia.gov/OMHHE/policyanalysis/virginiahoi.htm (December 22, 2016).

Index consists of 13 indicators organized into 4 profiles: Community Environmental (air quality, population churning, population density, walkability); Consumer Opportunity (affordability, education, food accessibility, material deprivation); Economic Opportunity (employment accessibility, income inequality, job participation); Wellness Disparity (access to care, segregation [community diversity and distances between communities with different racial or ethnic profiles])

Page 538 Cite

Suggested Citation:"Appendix B: Community-Level Indicators and Interactive Tools for Health Equity." National Academies of Sciences, Engineering, and Medicine. 2017. Communities in Action: Pathways to Health Equity. Washington, DC: The National Academies Press. doi: 10.17226/24624.

×