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Overview
There is growing awareness across the health and community development sectors around the importance of simultaneously addressing social determinants of health—education, housing, employment, food access, neighborhood infrastructure—to improve population health and well-being. It is also well established that measurement is crucial to the development of partnerships and policies to holistically revitalize communities. And yet, despite growing recognition of the critical role of social determinants, the health and community development sectors currently lack a common framework for measuring their impacts. As a result, there are untapped opportunities for shared measurement strategies that can better align the work of both sectors, and ultimately scale their impacts.
The Build Healthy Places Network’s Common Indicators Project reviews measurement strategies spanning the community development, public health, and healthcare sectors and identify 23 that: 1) include metrics for assessing key social determinants of health as defined by the Centers for Disease Control and Prevention; 2) are either neighborhood-level in scope or are directly applicable to neighborhood contexts; and 3) have been validated through existing research and/or practice during the past 10 years. We then categorized and summarized the metrics utilized by each and evaluate for similarities and differences across approaches. Our presentation is available here.
Context and Implications
The National Committee on Vital and Health Statistics (NCVHS) Working Group is spearheading a larger effort to develop a multi-sector measurement framework reflective of the numerous initiatives underway, drawing attention to the opportunities and gaps in sub-county level data metrics.
While sub-county data is a boon to many communities seeking to measure improvements in health and well-being, more discussion is needed around how to engage cross-sector partners, and how other sectors might begin to see and understand their values in this common framework. How might we “frame the framework” to accelerate sector commonalities? While data can help sectors understand this, work still needs to be done “upstream” to shift attention beyond data to collective action, and beyond health outcomes to health equity and community well-being.
In evaluating similarities and differences across current measurement approaches, both sector-specific and across sectors, the Common Indicators Project provides an excellent starting place to start a dialogue on why public and private partners should collaborate and how they might begin to do this using a complementary framework. These conversations are important for demonstrating shared impact and the value of collaboration, informing resource allocation, and developing effective policies to achieve a national Culture of Health.
Project Goals
Note – This project is not a recommendation of the “best” indicators, but rather a snapshot and summary of those currently used in practice and research. Ideally, measurement strategies should be contextually-driven and participatory with involvement from local communities.
Research Methodology
The Network reviewed 23 measurement strategies spanning community development, public health, and healthcare sectors. To be included, tools must : 1) include metrics for assessing key social determinants of health as defined by the Centers for Disease Control and Prevention; 2) are either neighborhood-level in scope or are directly applicable to neighborhood contexts; and 3) have been validated through existing research and/or practice during the past 10 years. Measurement tools that met these criteria tended to cut across one or more sectors. A full list of tools and the primary sector for which it is intended is available here.
This project looks at the following types of measurement tools:
This scan does not include:
Because tools (particularly sector-specific) tend to define health and its social determinants differently, we used the World Health Organization’s definition of social determinants of health as a starting place to determine most frequently occurring domains (see slide 9 for examples of domains; a full list of determinants and domains is available here). These determinants were used to re-categorize indicators in a standardized fashion. We then analyzed across indicators and tallied to calculate frequency of use.
The network also conducted several informal interviews with members from the BHPN Measurement Working Group, a cadre of community development professionals working to improve equity of opportunity through incorporation of social determinants of health.
Findings
Results reveal that consensus is emerging around which domains are measured (e.g. education) but, while there is often a single most frequently used indicator for a domain (e.g. high school graduation as a measure of education), even the most common indicators are used in less than three quarters of measurement strategies examined. Rather, dozens of indicators are used to measure the more limited, somewhat shared set of domains. The indicators used show substantial variation both within and across sectors (e.g. public health vs. city planning), thus, dramatically limiting the ability to compare findings across measurement strategies. Further, demographic indicators are much less frequently incorporated, thus limiting direct evaluation of health equity. Full findings are available here.
In summarizing findings from interviews, participants echoed the need to develop a point of view for the framework that resonates with diverse partners at the “upstream” level. They also noted differences between indicators for comparison and evaluation and wondered how harmonious indicators might be created to serve these various purposes. Finally, participants voiced the need for indicators that capture inequity rather than just disparity.
Next Steps
This initial review provides a much-needed baseline of SDOH domains and indicators used within and across sectors. As part of the next phase of research, the Common Indicators Project will explore three areas: 1) data requirements; 2) policy landscape; and 3) a shared framework. The first, data requirements, will take a closer look at the challenges in data collection, sharing, and stewardship, including funding mechanisms for data collection and challenges with geographic scope. The second, policy landscape, will analyze policies affecting data sharing and collaborative measurement approaches. The third, a shared framework, will analyze what it will take to move beyond sector-based domains and indicators to a common framework. This measurement framework will be differentiated from the ongoing Health & Human Services NCVHS framework efforts in that our analysis will focus on upstream factors with implications for the work of other sectors. Our intent is to help various sectors “see themselves” as part of health measurement with clear goals and purpose that go beyond simply sharing indicators. Building upon the social determinants of health foundation, the shared framework will emphasize the value of cross-sector partnership in achieving greater impact, focus on equity of opportunity, and incorporate financial sustainability.
Common Indicators Project Slides available here.
Supplementary materials: