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A Flexible Urban Health Index for Small Area Disparities

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Abstract

Available urban health metrics focus primarily on large area rankings. Less has been done to develop an index that provides information about level of health and health disparities for small geographic areas. Adopting a method used by the Human Development Index, we standardized indicators for small area units on a (0, 1) interval and combined them using their geometric mean to form an Urban Health Index (UHI). Disparities were assessed using the ratio of the highest to lowest decile and measurement of the slope of the eight middle deciles (middle; 80 %) of the data. We examined the sensitivity of the measure to weighting, to changes in the method, to correlation among indicators, and to substitution of indicators. Using seven health determinants and applying these methods to the 128 census tracts in the city of Atlanta, USA, we found a disparity ratio of 5.92 and a disparity slope of 0.54, suggesting substantial inequality and heterogeneity of risk. The component indicators were highly correlated; their systematic removal had a small effect on the results. Except in extreme cases, weighting had a little effect on the rankings. A map of Atlanta census tracts exposed a swath of high disparity. UHI rankings, ratio, and slope were resistant to alteration in composition and to non-extreme weighting schemes. This empirical evaluation was limited to a single realization, but suggests that a flexible tool, whose method rather than content is standardized, may be of use for local evaluation, for decision making, and for area comparison.

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Acknowledgment

This study was supported by a grant from the WHO Center for Health Development (the WHO Kobe Center). Research support was also provided by the National Institute of Minority Health and Health Disparities of the National Institutes of Health under award number 1P20MD004806. The content is solely the responsibility of the authors and does not necessarily represent the official views of the World Health Organization or of the National Institutes of Health.

The authors would like to acknowledge the advice and encouragement of Dr. Michael Eriksen, Founding Dean of the School of Public Health, GSU; and Byungwoo Cho, Prasanth Kambhatla, and Kumiko Miyake, who provided technical assistance in translation, data management, and analysis.

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Authors and Affiliations

  1. School of Public Health, Georgia State University, Atlanta, GA, USA

    Richard Rothenberg, Scott R. Weaver & Christine Stauber

  2. Department of Geosciences, College of Arts and Sciences, Georgia State University, Atlanta, GA, USA

    Dajun Dai

  3. The World Health Organization Center for Health Development (The WHO Kobe Center), Kobe, Japan

    Amit Prasad & Megumi Kano

Authors
  1. Richard Rothenberg
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  2. Scott R. Weaver
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  3. Dajun Dai
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  4. Christine Stauber
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  5. Amit Prasad
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  6. Megumi Kano
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Correspondence to Richard Rothenberg.

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Rothenberg, R., Weaver, S.R., Dai, D. et al. A Flexible Urban Health Index for Small Area Disparities. J Urban Health 91, 823–835 (2014). https://doi.org/10.1007/s11524-014-9867-6

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  • DOI: https://doi.org/10.1007/s11524-014-9867-6

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