Social Determinants of Health: Creating Indicators to Assess Disparities in Health and Environmental Exposure in Small Areas for Environmental Public Health Tracking

BACKGROUND:  Health burdens and exposures to environmental factors cannot be fully understood or addressed without first understanding the socio-demographic characteristics of a community.  The risks associated with living in an unhealthy community are not uniformly distributed across all races, incomes and education levels.  The association of socio-demographic factors with health outcomes is widely recognized by health professionals. However, little work has been done to develop a standardized process to use available social determinants of health data to delineate vulnerability to environmental hazards.  While Local Health Departments (LHDs) and others are expected to address health disparities at the community level, only about half of LHDs respondents to the 2008 NACCHO National Profile of LHDs Survey reported having data available to support their actions. 

METHODS:  In 2013 the national Environmental Public Health Tracking Program formed a team of public health professionals from state health departments to determine which socio-demographic indicators from widely available data sources are most meaningful to examine in describing vulnerable populations for a spectrum of environmental hazards and/or health outcomes. Team members reviewed data from a number of sources including: the American Community Survey, the USEPA National Air Toxics Assessment, birth certificates, body mass index scores created from driver licenses, myocardial infarction hospital reports, and childhood lead reports. The New York State Department of Health’s Geographic Aggregation Tool was used to create small area health indicators. Once the data were aggregated, we used geographic analysis methods and tools including spatial regression to explore the associations between socio-demographic and environmental factors and health.

RESULTS:  Building upon the work of CDC’s Geographic Research and Analysis Services Program, we compiled a nationwide geodatabase of socio-demographic factors at the census tract level to share between health departments.  Sub-county level health indicator maps were produced through the aggregation of census tracts.  Team members successfully linked selected health, environmental, and socio-demographic data together to explore the associations between the various indicators using regression analyses.  The next step will be to demonstrate how the results of these analyses,  detailing community-level variation in socio-demographic influences, can be presented on health department web sites as charts, tables and maps along with the appropriate messaging for the public and public health professionals.

CONCLUSIONS:  The project provides an analysis framework for using socio-demographic data in conjunction with health and environmental indicators, for planning intervention strategies and delineating vulnerable populations at the local level.