Methodology

The HOPE Initiative provides an interactive data tool designed to help our nation and states move beyond measuring disparities to spur action toward achieving health equity. HOPE tracks social determinants of health and health outcomes by race, ethnicity, and socioeconomic status. A full report on our methods can be accessed here: HOPE Initiative Technical Methods Report.

HOPE Indicator Definitions

HEALTH OUTCOMES

Adult Health Status - Portion of adults who say their health is very good or excellent

Child Health Status - Portion of children whose parents rate their health as very good or excellent

Infant Mortality - Number of infants who die before their first birthday annually per 1,000 live births

Low Birthweight - Portion of infants weighing less than 2,500 grams at birth

Premature Mortality - Number of annual deaths due to any cause per 100,000 people age 25-64

SOCIAL & ECONOMIC FACTORS

Affordable Housing - Portion of households spending no more than 30% of monthly household income on housing and related expenses

Employment - Portion of people age 16 years and older in the U.S. labor force who are employed

Livable Income - Portion of adults living in households with income greater than 250% of the Federal Poverty Level

Post-secondary Education - Portion of adults age 25 and older who have attained at least some college education after graduating from high school

Youth in School or Working - Portion of people age 16-24 enrolled in school or working, including military enlistment

COMMUNITY & SAFETY FACTORS

Low Homicide - Portion of people living in counties with fewer than 6.02 murders per 100,000 population annually

Low Physical Assault - Portion of people living in counties with fewer than 308.8 reported cases of physical assault per 100,000 people annually

Low Poverty Concentration - Portion of people in neighborhoods with fewer than 20% of residents living in poverty

Low Robbery - Portion of people living in counties with fewer than 51.07 reported cases of robbery per 100,000 people annually

Low Sexual Assault - Portion of people living in counties with fewer than 56.26 reported cases of rape per 100,000 people annually

PHYSICAL ENVIRONMENT

Food Security - Portion of people living in census tracts that are not food deserts (i.e., census tracts not designated low income and low food access)

Home Ownership - Portion of households living in a home they own

Housing Quality - Households with no severe housing problems are defined as having good housing quality. Specifically, they have complete kitchens, functioning plumbing, and are not overcrowded or severely cost-burdened (monthly housing costs exceeding 50% of monthly income)

Low Liquor Store Density - Counties with low liquor store density are defined as those with fewer than 1.77 liquor stores per 10,000 population

ACCESS TO HEALTH CARE

Access to Primary Care - Portion of people living in counties with a population-to-primary care physician ratio of less than 2,000:1

Access to Psychiatric Care - Proportion of people living in counties with a population-to-psychiatrist ratio of less than 30,000: 1 

Affordable Health Care - Portion of adults who did not delay or forego any necessary medical care due to cost in the past year

Dedicated Health Care Provider - The portion of adults age 25 and older who have someone they consider their personal health care provider

Health Insurance Coverage - Portion of people under age 65 who have any kind of health insurance

How Were HOPE Goals Created?

The process for setting goals for each indicator was to identify the top-performing socioeconomic group in each state, identify the five states with the best outcomes for the top-performing group, and take the average of their scores, rates, or outcomes. In the vast majority of cases, the top performers were college graduates or those with household incomes 400% FPL or greater.

How Was Distance to Goal Calculated?

Distance to Goal is the absolute magnitude of difference between the HOPE goal and the baseline rate of an indicator for a particular population, nationally or within a state. Distance to Goal is provided broadly for the general population and specifically by race and ethnicity, at the national and state levels on the web site (and by socioeconomic status at the state level, as well as by socioeconomic status and race / ethnicity at the national level in the downloadable resources).

How Were Indicator and Domain Summary Scores Calculated?

To measure equity, we created Indicator summary scores based on the Distance to Goal for states and the degree of inequity by race and ethnicity within a state. Z-scores were created for both Distance to Goal and inequity. After averaging both z-scores, the results were rescaled from 0-100 for comparability. Domain summary scores were created by averaging the state indicator summary scores for all indicators within the domain. 

How Were Population Groups Defined?

The HOPE Initiative identifies health equity progress by race and ethnicity and socioeconomic status. The results by race and ethnicity are presented on the web site; results for socioeconomic groups are available in the downloadable resources. Following is a summary of how groups are defined.

RACE AND ETHNICITY

HOPE provides data for six mutually exclusive racial and ethnic groups:

  • White;

  • Black or African American (Black);

  • Asian and Pacific Islander (Asian/PI);

  • American Indian or Alaska Native (AI/AN);

  • Multiracial; and

  • Hispanic or Latino (Hispanic).

Populations not captured within these groups and often attributed to an “Other” category were excluded from analyses.

HOPE offers a deeper dive into providing health and opportunity data consistently by six race and ethnic groups. Most current, and especially historic, data initiatives have typically focused on four or fewer groups—White, Black, Hispanic, and Other. At the same time, we recognize that these six groups are not homogeneous and that life experiences of group members may vary depending on ethnicity, country of origin, and immigration status. However, given the practical considerations of data availability and need to assure reliability of estimates, creating more granular racial and ethnic groups was not feasible in this phase of work.

SOCIOECONOMIC STATUS

Depending upon the data source, socioeconomic status was either defined by education or by household income. Where education attainment was used, the groups were:

  • Less than high school graduation
  • High school graduation
  • Some college (includes associate degrees and vocational / technical training)
  • College graduate (includes those with advanced degrees).

Where household income was used as the indicator of socioeconomic status, it was defined based on percentage of the federal poverty level (% FPL) as follows:

  • Less than 100% FPL
  • 100-199% FPL
  • 200-299% FPL
  • 300-399% FPL
  • Greater than or equal to 400% FPL.

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