This measure is an aggregate of three 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 six 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 four 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 four indicators, including 1) recent poor mental health; 2) adolescent suicide ideation; 3) suicide deaths; and 4) overdose and poisoning deaths. Percentages or rates for each indicator will be reported for each of the five 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 June 2024 will be counted as an improvement. The denominator will be 70 (14 indicators, each with percentages or rates for five HII groups.) The data sources for these indicators are BRFSS, ESSENCE, 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.

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, 6.67% of mental and behavioral health indicators by geography showed statistically significant improvements. Very low HII areas showed improvement in recent poor mental health (2020-2021). There were no statistically significant improvements in suicide ideation (2020-2021) and suicide death rates (2019-2020).

During the second period of data collection, 13.3% of mental and behavioral health indicators by geography showed statistically significant improvements. Average HII areas showed improvements in both recent poor mental health (2021-2022) and suicide death rates (2020-2022). High HII areas showed an improvement in suicide death rates. While having a significantly better health status in recent poor mental health and suicide death rates in the first period of data collection, very low HII areas experienced a decline in both of these measures during the second period of data collection. Very high HII areas experienced worser recent poor mental health and suicide ideation (2021-2022) during the first period of data collection and maintained that status during the second period of data collection.

During the third period of data collection, 20% of mental and behavioral health indicators by geography showed statistically significant improvements. Low HII areas showed an improvement in suicide ideation (2022-2023). In addition, Very Low HII and Very High HII areas showed improvements in suicide death rates (2021-2023). During this period, Average HII areas experienced worser suicide death rates, going from significantly better than the state average to having no significant difference from the state average. There were no significant improvements observed for poor mental health (2022-2023) during this period of data collection.

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), 6.67% 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 health 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.

During the third period of data collection (2022-2023 for all indicators; dental checkups are not present during this period of data collection), 16% of mental and behavioral health indicators by geography showed statistically significant improvements. Average and Very High HII areas showed improvements in routine checkups. In addition, Low and Very High HII areas showed improvements in influenza immunizations. There were no significant improvements observed in access to health insurance, cost as a barrier to healthcare, and accessing a health care provider. There is no data available for dental checkups during this period.

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.

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. High HII areas showed higher infant mortality rates during this period. Additionally, both low and high 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 showed a significant improvement in infant mortality. There were no improvements observed for first trimester prenatal care and births to adolescents, respectively.