Mariel Harding on Measuring What Works to Achieve Health Equity

Hi all, I’m Mariel Harding, a Program Coordinator with Prevention Institute (PI). PI is a national non-profit dedicated to improving community health and well-being by building momentum for effective primary prevention. PI has 18 years’ experience advancing policy and supporting communities in improving environments for health and health equity.

When gathering data on health, we often simply measure individual conditions and fail to count the elements at the community level that shape health. Yet we know that access to quality education and housing, clean air, safe places to play, strong social networks, and more, are essential for health and well-being. For example, when identifying key metrics regarding diabetes, it’s not enough to measure blood sugar levels—we need to also look at walkability, the existence of safe parks and open spaces nearby, and food access.

Prevention Institute’s (PI) recent report, Measuring What Works to Achieve Health Equity: Metrics for the Determinants of Health, represents a paradigm shift in thinking about helping communities count what matters when it comes to health, safety and equity. The report lays out the determinants of health – including structural drivers, community determinants, and healthcare – that must be improved to achieve health equity. It also describes the methods and criteria we applied to identify health equity metrics.

We identify 35 recommended metrics for the determinants of health that could track progress toward achieving health equity. However, not all of the metrics presented in the report actually exist because many important determinants of health equity are not regularly measured. Or, if they are, they aren’t being compiled in meaningful ways. Where metrics didn’t exist, we suggest new metrics to fill the gap.

Lessons Learned

• What we count reflects what we think matters. If health equity is important, we must note it, count it, measure it, and track it.
• Good metrics foster an understanding of the problem and the solution. For example, measuring neighborhood access to healthy food vendors may prompt efforts to facilitate healthy eating that address the underlying causes of illness, going beyond education campaigns. Such efforts may include recruiting vendors, zoning changes, and/or community gardens.
• Metrics should gain the attention of the public, be designed not only as a measurement tool, but also as a communications tool to help inform the public about health inequity and what will reduce it. Composite measures, which include multiple indicators, do this well because they express the complexity of the environments which produce health inequity.

Metrics can help clarify and measure the sources of inequity and fostering understanding of solutions and actions that can lower the cost of healthcare, keep all people healthy, and ensure equal opportunities to thrive.

Do you have questions, concerns, kudos, or content to extend this aea365 contribution? Please add them in the comments section for this post on the aea365 webpage so that we may enrich our community of practice. Would you like to submit an aea365 Tip? Please send a note of interest to aea365@eval.org . aea365 is sponsored by the American Evaluation Association and provides a Tip-a-Day by and for evaluators.