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Keeping Track of the Health of the State: Social Index – A Proposal Michael Landen, MD, MPH Corazon Halasan, MPH Tom Scharmen, MPH New Mexico Department of Health NM Public Health Assn 2003 Annual Meeting

A Proposal - New Mexico Public Health Association...Proposal: try out the Connecticut Social Index Indicators for NM using the NM rate ratio based method A Social Index for City Neighborhoods

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Page 1: A Proposal - New Mexico Public Health Association...Proposal: try out the Connecticut Social Index Indicators for NM using the NM rate ratio based method A Social Index for City Neighborhoods

Keeping Track of the Health of the State: Social Index – A Proposal

Michael Landen, MD, MPH Corazon Halasan, MPHTom Scharmen, MPH

New Mexico Department of Health

NM Public Health Assn 2003 Annual Meeting

Page 2: A Proposal - New Mexico Public Health Association...Proposal: try out the Connecticut Social Index Indicators for NM using the NM rate ratio based method A Social Index for City Neighborhoods

Social Index --- Today’s OutlineWhat and why?

What’s gone before

An index for New Mexico

Neighborhood Applications

Discussion

Page 3: A Proposal - New Mexico Public Health Association...Proposal: try out the Connecticut Social Index Indicators for NM using the NM rate ratio based method A Social Index for City Neighborhoods

What IS a social index?

From a height, an overlookA composite of single indicators of issues of societal concernMany particulars global condition

Page 4: A Proposal - New Mexico Public Health Association...Proposal: try out the Connecticut Social Index Indicators for NM using the NM rate ratio based method A Social Index for City Neighborhoods

Why have a Social Index?Why do we have daily/ weekly reports of:

Dow-Jones AverageGross Domestic ProductConsumer Confidence IndexConsumer Price Index . . . etcetera, etcetera

Page 5: A Proposal - New Mexico Public Health Association...Proposal: try out the Connecticut Social Index Indicators for NM using the NM rate ratio based method A Social Index for City Neighborhoods

‘and now for the financial news’

The condition of our economy:Told in vivid precise termsThrough a highly developed monitoring system of economic indicators and indexesStory of dynamics & change regularly summarized

Fordham Institute for Innovation in Social Policy

Forms basis for debate, discussion, policy intervention throughout society

Page 6: A Proposal - New Mexico Public Health Association...Proposal: try out the Connecticut Social Index Indicators for NM using the NM rate ratio based method A Social Index for City Neighborhoods

Social / health monitoringWhere to go for regular summary of social health of nation, state, county

Social / health indicators infrequently released, assessed

No generally accepted index of agreed upon indicators re social conditions’ improvement & worsening

Page 7: A Proposal - New Mexico Public Health Association...Proposal: try out the Connecticut Social Index Indicators for NM using the NM rate ratio based method A Social Index for City Neighborhoods

Social / health monitoringContext typically missing or inadequate

many issues often seen as crisestoo often portrayed as individual’s problem or isolated eventsdifficult to place relative importance in larger picture

What becomes society’s basis for debate, dialogue & intervention?

Page 8: A Proposal - New Mexico Public Health Association...Proposal: try out the Connecticut Social Index Indicators for NM using the NM rate ratio based method A Social Index for City Neighborhoods

What has gone before …United Nations

UN Development Programme: addressing human development matters

Connecticut

Page 9: A Proposal - New Mexico Public Health Association...Proposal: try out the Connecticut Social Index Indicators for NM using the NM rate ratio based method A Social Index for City Neighborhoods

Human Development Indices Human Development Index Overall achievement in a country of longevity, knowledge, decent standard of living

Human Poverty Index-2 (for high income countries)

HDI plus social exclusion/ participation

Both indices include resource & outcome indicators

Page 10: A Proposal - New Mexico Public Health Association...Proposal: try out the Connecticut Social Index Indicators for NM using the NM rate ratio based method A Social Index for City Neighborhoods

Current Applications

No automatic link between human development and human poverty

0

0.2

0.4

0.6

0.8

1

1.2

HDI HPI (1 & 2)

Uganda ~41

Tanzania ~32

United States ~16

Norway ~8

Similar HDI, different HPI (1999)

Page 11: A Proposal - New Mexico Public Health Association...Proposal: try out the Connecticut Social Index Indicators for NM using the NM rate ratio based method A Social Index for City Neighborhoods

Components of Indices Human Development Index

Life expectancy, adult literary rate, primary to tertiary school enrollment ratio, GDP per capitaData series since 1975 for countries, by regions; analysis of index & its components

Human Poverty Index-2Probability of not surviving to age 60; adult functional literacy rate, percent living below poverty, unemployment

Page 12: A Proposal - New Mexico Public Health Association...Proposal: try out the Connecticut Social Index Indicators for NM using the NM rate ratio based method A Social Index for City Neighborhoods

Index of Social Health of Connecticut

Index includes indicators about:Children (infant mortality, child abuse)Adults (unemployment, average weekly wages, health care costs)

Youth (suicide, high school completion, teen births)

All Ages (violent crime, affordable housing)

State, counties from 1970 onTrend of index & its components

Page 13: A Proposal - New Mexico Public Health Association...Proposal: try out the Connecticut Social Index Indicators for NM using the NM rate ratio based method A Social Index for City Neighborhoods

Index of Social Health of Connecticut

Indicators:Children (infant mortality, child abuse)Adults (unemployment, average weekly wages, health care costs)

Youth (suicide, high school completion, teen births)

All Ages (violent crime, affordable housing)

Page 14: A Proposal - New Mexico Public Health Association...Proposal: try out the Connecticut Social Index Indicators for NM using the NM rate ratio based method A Social Index for City Neighborhoods

Current Applications

Analyzed individual indicators & counties to understandPublished in The Social State of Connecticut

Index of Social Health of Connecticut

0

20

40

60

80

1970

1972

1974

1976

1978

1980

1982

1984

1986

1988

1990

1992

1994

1996

Page 15: A Proposal - New Mexico Public Health Association...Proposal: try out the Connecticut Social Index Indicators for NM using the NM rate ratio based method A Social Index for City Neighborhoods

A Proposed Social Index for New Mexico

First approach - determine if combining Vision of Health Indicators into a “Vision of Health Index” represents a Social Index for NM

Page 16: A Proposal - New Mexico Public Health Association...Proposal: try out the Connecticut Social Index Indicators for NM using the NM rate ratio based method A Social Index for City Neighborhoods

Vision of Health Indicators UsedTeen birth rateChild abuse rateHomicide rateAlcohol-related death rateDrug-related death rateAdult abuse rateSuicide rateHepatitis B rateMotor vehicle injury death rate

Page 17: A Proposal - New Mexico Public Health Association...Proposal: try out the Connecticut Social Index Indicators for NM using the NM rate ratio based method A Social Index for City Neighborhoods

Calculating a rate ratioCibola County drug-related death rate divided by the New Mexico drug-related death rate

• 10.9/15.6 = 0.7

Page 18: A Proposal - New Mexico Public Health Association...Proposal: try out the Connecticut Social Index Indicators for NM using the NM rate ratio based method A Social Index for City Neighborhoods

Calculating mean rate ratioPlugging rate ratios into the index formula

mean RR = [(RR1+RR2+RR3+RR4+RR5+RR6+RR7+R R8+RR9)]/9mean rate ratio = index

Page 19: A Proposal - New Mexico Public Health Association...Proposal: try out the Connecticut Social Index Indicators for NM using the NM rate ratio based method A Social Index for City Neighborhoods

Vision of Health Index County Values

Lowest (Best)Los Alamos 0.33Union 0.53DeBaca 0.63

Highest (Worst)Rio Arriba 1.91Sierra 1.63Quay 1.59

Page 20: A Proposal - New Mexico Public Health Association...Proposal: try out the Connecticut Social Index Indicators for NM using the NM rate ratio based method A Social Index for City Neighborhoods

Advantages to this Index MethodThe index number actually means something

Chavez County’s value of 1.51 means that on average Chavez County’s rates for these 9 indicators are 51% higher than average NM rates for the same indicatorsAllows for comparison to NM’s rates

Page 21: A Proposal - New Mexico Public Health Association...Proposal: try out the Connecticut Social Index Indicators for NM using the NM rate ratio based method A Social Index for City Neighborhoods

A Proposed Social Index for New Mexico

Comparison of Vision of Health Index to socioeconomic indicators

Indicators used included:• Child poverty• Income inequality (Gini coefficient)• High school dropout• Unemployment• Household vacancy

Page 22: A Proposal - New Mexico Public Health Association...Proposal: try out the Connecticut Social Index Indicators for NM using the NM rate ratio based method A Social Index for City Neighborhoods

Comparison of Vision of Health Index to Socioeconomic Indicators

Assessed the correlation of Vision of Health Index county values with those for rate ratios for each socioeconomic indicator

• Child poverty 0.14• Income inequality (Gini coefficient) 0.41• High school dropout 0.22• Unemployment 0.03• Household vacancy 0.17

Page 23: A Proposal - New Mexico Public Health Association...Proposal: try out the Connecticut Social Index Indicators for NM using the NM rate ratio based method A Social Index for City Neighborhoods

Comparison of Vision of Health Index to Socioeconomic Index

Combined first four indicators into “socioeconomic index”

Correlation with Vision of Health Index• 0.28

Page 24: A Proposal - New Mexico Public Health Association...Proposal: try out the Connecticut Social Index Indicators for NM using the NM rate ratio based method A Social Index for City Neighborhoods

Socioeconomic Index County Values

Lowest (Best)Los Alamos 0.28DeBaca 0.81Lea 0.83

Highest (Worst)Luna 2.32Taos 1.37Dona Ana 1.35

Page 25: A Proposal - New Mexico Public Health Association...Proposal: try out the Connecticut Social Index Indicators for NM using the NM rate ratio based method A Social Index for City Neighborhoods

A Proposed Social Index for New Mexico

What should we do now?

How about combining a health index with a socioeconomic index?

Proposal: try out the Connecticut Social Index Indicators for NM using the NM rate ratio based method

Page 26: A Proposal - New Mexico Public Health Association...Proposal: try out the Connecticut Social Index Indicators for NM using the NM rate ratio based method A Social Index for City Neighborhoods

A Social Index for City Neighborhoods INDICATOR MEAN FOR ALBUQUERQUE ZIP CODES

Unemployed 3.6% (Census)

Family Households in Poverty 6.3% (Census)

Children Not Enrolled in School 11.2% (Census)

Rental Occupancy 42.9% (Census)

Housing Vacancy (not used) 10.9% (Census)

Infant Mortality 5.92 per 1000 (VRHS)

Teen Birth Rate 61.2 per 1000 (VRHS)

Vice-Related Crime 13.1 per 1000 (APD)

SOCIAL INDEX = (mean of 7 indicators’ ratios to county rates)

Page 27: A Proposal - New Mexico Public Health Association...Proposal: try out the Connecticut Social Index Indicators for NM using the NM rate ratio based method A Social Index for City Neighborhoods

Zip Code Place Social Index87102 East Downtown &

South Broadway 2.0067

87108 SE Heights 1.818387105 South Valley (SW) 1.302387116 KAFB 1.154087104 Old Town 1.114287106 UNM & South (SE) 1.073187107 North Valley 1.055487121 West Mesa 1.052687123 SEH to 4 Hills 0.996687110 Near NEH 0.911387109 NE 0.895487113 Far North Valley 0.768287112 NE Heights 0.7491

87114 North Valley & Paradise Hills NW 0.6862

87111 NE Heights 0.680687120 West Side 0.673487118 KAFB 0.633287122 Sandia Foothills 0.2865

Ranking of Zip Codes

BEST

WORST

Page 28: A Proposal - New Mexico Public Health Association...Proposal: try out the Connecticut Social Index Indicators for NM using the NM rate ratio based method A Social Index for City Neighborhoods

SOCIAL INDEX

Page 29: A Proposal - New Mexico Public Health Association...Proposal: try out the Connecticut Social Index Indicators for NM using the NM rate ratio based method A Social Index for City Neighborhoods

CHILDREN NOT ENROLLED

VICE CRIME

FAMILY HOUSEHOLDS

BELOW POVERTY LINE

VACANT HOUSING(NOT INDEXED)

Page 30: A Proposal - New Mexico Public Health Association...Proposal: try out the Connecticut Social Index Indicators for NM using the NM rate ratio based method A Social Index for City Neighborhoods

INFANT MORTALITY

UNEMPLOYED

TEEN BIRTH RATE

RENTER OCCUPANCY

Page 31: A Proposal - New Mexico Public Health Association...Proposal: try out the Connecticut Social Index Indicators for NM using the NM rate ratio based method A Social Index for City Neighborhoods

SOCIAL INDEX

Page 32: A Proposal - New Mexico Public Health Association...Proposal: try out the Connecticut Social Index Indicators for NM using the NM rate ratio based method A Social Index for City Neighborhoods

Comments and Conclusions . . .• Social Indices invite comparison.

• The ‘mean rate ratio’ can highlight disparities.

• Neighborhoods may not agree on a definition of ‘neighborhood.’

• Neighborhoods may not agree on the mix of indicators.

• Indicators useful to neighborhoods; index useful to agencies.

• Trending will enhance meaning; comparison across time is more relevant than comparison across neighborhoods.

• How would you compose – and use – a social index?

Page 33: A Proposal - New Mexico Public Health Association...Proposal: try out the Connecticut Social Index Indicators for NM using the NM rate ratio based method A Social Index for City Neighborhoods

ReferencesHuman Development ReportUnited Nations Development Programme, Human Development

Report Office, various years. http://hdr.undp.org/

The Social State of ConnecticutFordham Institute for Innovation in Social Policy, various years.

http://www.cga.state.ct.us/coc/socindex/index.htm

http://hdr.undp.org/

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