Response to Scanlan Concerning: Measurement of Health Disparities, Health Inequities, and Social Determinants of Health to Support the Advancement of Health Equity.

Abstract

In his commentary on our article, Scanlan raises important issues to consider in measurement of health disparities,2 specifically that when measured on the relative scale, disparities are affected by the prevalence of the outcome; that whether disparities are found to be increasing or decreasing depends on whether they are assessed in terms of a favorable outcome or its complementary adverse outcome; and that dependence on prevalence is not only limited to relative measures such as the rate ratio but that the absolute difference also varies with prevalence. These issues were discussed a decade ago in this journal. The goal of our article was to identify a handful of broad practices in monitoring health disparities, health inequities, and social determinants of health to support the pursuit of health equity in the United States; it was not to describe all of the implications of measurement choices. Furthermore, in our view, Scanlan’s commentary supports one of the 5 practices that we set forth: “Provide reasons for methodological choices and clarify their implications” and is not relevant to the other 4. The commentary’s attention to potential pitfalls of relying solely on particular measures (beyond the pitfalls we had space to highlight in an article of limited length) bolsters the urgency of our call for transparency and, relatedly, for “intensive and systematic training . . . for the workforce at the national, state, and local levels.” Although it presents a compelling case study, the commentary does not resolve measurement conundrums. The commentary proposes that disparities be measured using an “estimated effect size” (EES).2 This