Advancing Health Equity: An Approach to Systematically Identify and Evaluate Health Disparities

It has been more than 20 years since the National Academy of Medicine published their report, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, and despite decades of efforts, true health equity remains a distant goal. The COVID-19 pandemic laid bare the equity gaps that plague health and health care today, and it tragically demonstrated the devastating impacts these gaps have on individuals and communities.

One of the core challenges in addressing inequities in health and care is measurement. The old saying, “What gets measured gets improved” may well be wrong, but it is indisputable that sustained improvement requires measurement. Yet, in the health care industry, there is no standard or consensus on best practices to identify, quantify, track, and report health equity gaps among patient populations.

To help address this need, the Institute for Healthcare Improvement (IHI) Leadership Alliance convened the “Health Equity Accelerator” — a collaboration of 19 health care organizations working to advance improvements in the field by defining best practices for identifying and measuring health disparities. A product of the IHI Health Equity Accelerator, this document introduces a detailed, four-step measurement approach for identifying and quantifying health disparities.

Four-Step Approach to Systematically Evaluate Health Disparities:

STEP 1: Identify and Prioritize a Health Equity Initiative Focus Area, Population of Focus, and Metrics

STEP 2: Determine Stratification Attributes and Compute Metrics for all Attribute Values

STEP 3: Choose Reference Points

STEP 4: Quantify and Characterize Health Disparities

Based on the current, cumulative state of health equity measurement research and practice, the four-step approach represents the consensus of more than 35 subject-matter experts spanning a vast array of health care settings including clinical, quality, payor, academia, administration, and the relevant health care quality improvement and disparities reduction literature. 

The document is intended to be a practical guide to achieve a minimum set of agreed-upon practices for analyzing and reporting equity data – from which benchmarks can evolve. The goal is to provide guidance that is intentionally flexible to allow for local applicability.

We believe that health care organizations that are serious about reducing and eliminating equity gaps can use this guidance to understand where inequities exist, understand their magnitude, and chart a path toward meaningful and sustainable improvement.

How to Cite This Document: 
The IHI Health Equity Metrics Advisory Group. Advancing Health Equity: An Approach to Systematically Identify and Evaluate Health Disparities. Boston: Institute for Healthcare Improvement; 2025. (Available at ihi.org)