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 3 indicators, including 1) first trimester prenatal care; 2) preterm birth; and 3) births to adolescents. 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 6 racial and ethnic groups (1) American Indian/Alaska Native (AIAN); 2) Asian; 3) Black/African American (B/AA); 4) Hispanic/Latino (H/L); 5) Native Hawaiian/Pacific Islander (NHPI); and 6) White) in an appendix. Any improvement in percentages or rates from baseline to the current reporting year will be counted as an improvement. The denominator will be 72 (12 indicators, each with percentages or rates for 6 racial and ethnic groups.) The data sources for these indicators are BRFSS, Emergency Department encounters, birth certificates, and death certificates.

2.1 Percent of access to health care and preventive services indicators by race and ethnicity 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), 5.5% of access to health care and preventive services indicators by race and ethnicity showed statistically significant improvements in the disparity gap. Black/African Americans (B/AA) showed an improvement in having a primary care provider, moving from significantly worse at baseline to no significant difference. The other improvement was among the White population receiving influenza immunizations. There were no statistically significant improvements in accessing routine checkups, routine dental visits, access to health insurance, or cost as a barrier to healthcare. Influenza immunization rates significantly worsened for the American Indian/Alaska Native (AIAN) and Hispanic/Latino (H/L) populations. Routine dental check-ups also worsened among the B/AA and Native Hawaiian/Pacific Islander (NHPI) populations.

During the second period of data collection (2021-2022 for all indicators except dental checkups, whose second period is 2020 & 2022), 8.3% of access to health care and preventive services indicators by race ethnicity showed statistically significant improvements in the disparity gap. AIAN and H/L populations showed an improvement in having a primary care provider, moving from significantly worse at baseline to no significant difference. NHPI populations showed an improvement in reporting cost as a barrier to healthcare. There were no statistically significant improvements in accessing routine checkups, routine dental visits, access to health insurance, or influenza immunizations. Influenza immunization rates remained significantly worse for AIAN populations. Routine check-up rates were significantly worse for H/L and NHPI populations. Access to a primary care doctor was significantly worse for NHPI and White populations. Access to routine dental care was also significantly worse among NHPI populations.

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), 13.9% of access to health care and preventive services indicators by race and ethnicity showed statistically significant improvements in the disparity gap. NHPI populations maintained the improvement in reporting cost as a barrier to healthcare. AIAN and White populations showed an improvement in influenza immunization rates. AIAN and B/AApopulations showed an improvement in having a primary care provider. There were no statistically significant improvements in accessing routine checkups, routine dental visits, or access to health insurance. B/AA populations significantly worsened with access to health insurance. Influenza immunization rates were significantly worse among AIAN and H/L populations. H/L populations also showed a significant decline in having a routine medical checkup.

During the fourth period of data collection (2023-2024 for all indicators except dental checkups, whose fourth period is 2022 & 2024), 11.1% of access to health care and preventive services indicators by race ethnicity showed statistically significant improvements in the disparity gap. Asian populations had significant improvements in access to health insurance and cost as a barrier to healthcare. Asian and White populations showed improvement in influenza immunization rates. There were no statistically significant improvements in accessing routine checkups, routine dental visits, or having a primary care provider. Immunization influenza rates worsened for AIAN, H/L, and NHPI populations. Routine checkups worsened for H/L and NHPI populations. Routine dental checkups worsened for B/AA and NHPI populations.

2.2 Percent of access to maternal and child health indicators by race and ethnicity that show an improvement in disparity gap

During the first period of data collection (2020-2021 for first trimester prenatal care and pre-term births; 2018-2021 for births to adolescents), 11.11% of maternal and child health indicators by race and ethnicity showed statistically significant improvements in the disparity gap. Asian populations showed improvement in first trimester prenatal care and Hispanic/Latino (H/L) populations showed improvement in pre-term births. There were no statistically significant improvements in birth to adolescents. There were no groups that significantly worsened.

During the second period of data collection (2021-2022 for first trimester prenatal care and pre-term births; 2019-2022 for births to adolescents), 11.11% of maternal and child health indicators by race and ethnicity showed statistically significant improvements. Asians maintained their improvement in first trimester prenatal care during the second period of data collection. Similarly, H/L populations maintained their improvement in pre-term births. There were no statistically significant improvements in birth to adolescents. There were no groups that significantly worsened.

During the third period of data collection (2022-2023 for first trimester prenatal care and pre-term births; 2020-2023 for births to adolescents), 0% of maternal and child health indicators by race and ethnicity showed statistically significant improvements. The two observed improvements during the second period - first trimester prenatal care for Asians and pre-term births for H/L - both declined during the third period of data collection. There were no groups that significantly worsened.

During the fourth period of data collection (2023-2024 for first trimester prenatal care and pre-term births; 2021-2024 for births to adolescents), 5.6% of maternal and child health indicators by race and ethnicity showed statistically significant improvements in the disparity gap. The only significant improvement was pre-term births among the White population. There were no groups that significantly worsened.

2.3 Percent of access to mental and behavioral health indicators by race and ethnicity 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), 5.6% of mental and behavioral health indicators by race and ethnicity showed statistically significant improvements. Native Hawaiian/Pacific Islander (NHPI) populations showed improvement in poor mental health. There were no statistically significant improvements in suicide deaths or suicide ideation. NHPI populations worsened for suicide deaths. American Indian/Alaska Native (AIAN) and Hispanic/Latino (H/L) populations worsened for poor mental health.

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), 5.6% of mental and behavioral health indicators by race and ethnicity showed statistically significant improvements. The only improvement was for suicide deaths in the White population. There were no statistically significant improvements in poor mental health or suicide ideation. Poor mental health remained significantly worse among AIAN and H/L populations.

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 race and ethnicity showed statistically significant improvements. There were no significant changes in suicide deaths or suicide ideation. Poor mental health remained significantly worse among AIAN and H/L populations.

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), 0% of mental and behavioral health indicators by race and ethnicity showed statistically significant improvements. There were no significant changes in suicide deaths or suicide ideation. Poor mental health remained significantly worse among AIAN populations.