This measure is an aggregate of 3 measures of improvements in indicators related to 1) access to healthcare and preventive services; 2) maternal and child health; 3) mental and behavioral health. Access to healthcare and preventive services is defined by 6 indicators, including 1) health insurance; 2) primary care provider; 3) cost as a barrier to healthcare; 4) influenza immunization; 5) routine medical check-up; and 6) routine dental visit. Maternal and child health is defined by 4 indicators, including 1) first trimester prenatal care; 2) preterm birth; 3) births to adolescents; and 4) infant mortality. Mental and behavioral health is defined by 3 indicators, including 1) recent poor mental health; 2) suicide ideation; and 3) suicide deaths. Percentages or rates for each indicator will be reported for each of the 5 Health Improvement Index (HII) groups (1) Very low HII; 2) Low HII; 3) Average HII; 4) High HII; and 5) Very high HII) in an appendix. Any improvement in percentages or rates from baseline to the current reporting period will be counted as an improvement. The denominator will be 65 (13 indicators, each with percentages or rates for 5 HII groups.) The data sources for these indicators are BRFSS, emergency department encounters, birth certificates, and death certificates.

The Utah Health Improvement Index (HII) is a health equity measure by geography. It includes 9 indicators that describe important determinants of health such as demographics, socio-economic deprivation, economic inequality, resource availability,and opportunity structure. The Utah HII gives a score to each Utah Small Area. Based on their score, Utah Small Areas are categorized into 5 groups: very low, low, average, high, and very high. The higher the group, the more improvements the area needs.

1.1 Percent of access to mental and behavioral health indicators by geography that show an improvement in disparity gap

During the first period of data collection (2020-2021 for recent poor mental health; 2019-2020 for suicide ideation; 2018-2021 for suicide death rates), 6.7% of mental and behavioral health indicators by geography showed statistically significant improvements. Very low HII areas showed improvement in recent poor mental health. There were no statistically significant improvements in suicide ideation or suicide death rates. Poor mental health significantly worsened among the Average and Very High HII areas.

During the second period of data collection (2021-2022 for recent poor mental health; 2020-2021 for suicide ideation; 2019-2022 for suicide death rates), 0% of mental and behavioral health indicators by geography showed statistically significant improvements. Poor mental health significantly worsened among the Low and Very High HII areas.

During the third period of data collection (2022-2023 for recent poor mental health; 2021-2022 for suicide ideation; 2020-2023 for suicide death rates), 0% of mental and behavioral health indicators by geography showed statistically significant improvements. Poor mental health remained worse in Low HII areas. Suicide ideation significantly worsened in Very High HII areas.

During the fourth period of data collection (2023-2024 for recent poor mental health; 2022-2023 for suicide ideation; 2021-2024 for suicide death rates), 6.7% of mental and behavioral health indicators by race and ethnicity showed statistically significant improvements. Very low HII areas showed improvement in recent poor mental health. There were no statistically significant improvements in suicide ideation or suicide death rates. Poor mental health was worse among Low and Average HII areas. Suicide ideation maintained worse rates in Very High HII areas.

1.2 Percent of access to health care and preventive services indicators by geography that show an improvement in disparity gap

During the first period of data collection (2020-2021 for all indicators except dental checkups, whose first period is 2018 & 2020), 6.7% of health care and preventive service indicators by geography showed statistically significant improvements. Low HII areas showed improvement in influenza immunization and High HII areas showed improvement in access to a primary care provider. There were no statistically significant improvements in routine checkups, routine dental care, access to health insurance, and cost as a barrier to healthcare.

During the second period of data collection (2021-2022 for all indicators except dental checkups, whose first period is 2020 & 2022), 10% of health care and preventive indicators by geography showed statistically significant improvements. Average HII areas showed an improvement in cost as a barrier to healthcare. Low HII areas maintained the improvement in influenza immunization achieved in the first period of data collection. Similarly, high HII areas maintained their improvement in accessing a health care provider. There were no statistically significant improvements in routine checkups, routine dental care, or access to health insurance. Average HII worsened with routine checkups.

During the third period of data collection (2022-2023 for all indicators; dental checkups did not have new data during this period of data collection), 13.3% of health care and preventive indicators by geography showed statistically significant improvements. Very High HII areas showed improvements in routine checkups. Low and Very High HII areas showed improvements in influenza immunizations. High HII areas maintained their improvement in accessing a health care provider. There were no significant improvements observed in access to health insurance or cost as a barrier to healthcare. Routine checkups worsened for High HII areas. There was no new data available for dental checkups during this period.

During the fourth period of data collection (2023-2024 for all indicators except dental checkups, whose fourth period is 2022 & 2024), 10% of health care and preventive indicators by geography showed statistically significant improvements. Low HII areas significantly improved for routine medical checkups. Low and Very High HII areas showed improvements in influenza immunizations. There were no statistically significant improvements in routine dental care, or access to health insurance, cost as a barrier to care, or access to a primary care provider. Routine checkups continued to be worse for High HII areas.

1.3 Percent of access to maternal and child health indicators by geography that show an improvement in disparity gap

During the first period of data collection (2020-2021 for prenatal care and pre-term births; 2019-2021 for births to adolescents and infant mortality), 20% of maternal and child health indicators by geography showed statistically significant improvements. Very Low HII areas showed improvement in both pre-term births and infant mortality, while Average and High HII areas also showed improvement in pre-term births. There were no statistically significant improvements in first trimester prenatal care and birth to adolescents. No areas worsened.

During the second period of data collection (2021-2022 for prenatal care and pre-term births; 2020-2022 for births to adolescents and infant mortality), 15% of maternal and child health indicators by geography showed statistically significant improvements. Very Low HII areas maintained their improvement in infant mortality, and both Very Low and Average HII areas maintained their improvement in pre-term births. There were no statistically significant improvements in first trimester prenatal care and birth to adolescents. High HII areas showed higher infant mortality rates during this period. Additionally, Low HII areas showed higher pre-term birth rates.

During the third period of data collection (2022-2023 for prenatal care and pre-term births; 2021-2023 for births to adolescents and infant mortality), 20% of the maternal and child health indicators by geography showed statistically significant improvements. Very Low, Average, and High HII areas all showed statistically significant improvements in pre-term births. In addition, Very Low HII areas maintained an improvement in infant mortality. There were no improvements observed for first trimester prenatal care and births to adolescents. High HII areas maintained higher infant mortality rates and Low HII areas maintained higher pre-term birth rates.

During the fourth period of data collection (2023-2024 for first trimester prenatal care and pre-term births; 2021-2024 for births to adolescents and infant mortality), 20% of maternal and child health indicators by geography showed statistically significant improvements in the disparity gap. Very Low and High HII areas maintained statistically significant improvements in pre-term births. Average HII areas showed a significant improvement in births to adolescents. Low HII areas showed a significant improvement in infant mortality. There was no improvement in first trimester prenatal care. High HII areas maintained higher infant mortality rates and Low HII areas maintained higher pre-term birth rates.