Measures to Advance Health and Opportunity

The Health Opportunity and Equity (HOPE) Initiative was launched in 2018 to start a new conversation about health because we believe that every person in the U.S. should have a fair and just opportunity for the best possible health and well-being.  The initiative, which is funded by the Robert Wood Johnson Foundation (RWJF), is led by the National Collaborative for Health Equity and Texas Health Institute in partnership with Virginia Commonwealth University's Center on Society and Health. We believe that every person in the U.S., regardless of their race, ethnicity, socioeconomics or ZIP code, should have the best possible health outcomes. For the country, 50 states, and D.C., HOPE sets benchmarks and tracks 27 indicators by race, ethnicity, and socioeconomic status. The indicators measure Social and Economic Factors, Community & Safety, Physical Environment, Access to Healthcare, and Health Outcomes. The data demonstrates how well D.C., states, and the country are providing equitable opportunities to thrive and achieve good health.

In commissioning our work, RWJF recognized that measuring the gaps in health and well-being is an important step toward documenting progress and motivating action to achieve greater equity. With this data, we can better understand the factors contributing to poor health and determine what resources, practices and policies are needed to address them. With its vision, unique design, and data, HOPE offers an aspirational approach by identifying gaps in health and well-being, while charting a path for all to benefit and flourish.

What is Unique About HOPE?

HOPE complements notable data resources such as County Health Rankings & Roadmaps, America's Health Rankings, National Equity Atlas, Opportunity Index, Health of the States, and others. What makes HOPE unique are the following four features:

Opportunity framing which provides an asset- based orientation to replace measures that typically call attention to deficits rather than highlighting achievements or opportunities for improvement.
We measure income, not poverty; employment, not unemployment; housing quality, not housing problems.

Aspirational, yet attainable goals for achieving equity across health and broader well-being indicators. We use benchmarks that we know are feasible.

National and state data by race, ethnicity, and socioeconomic status, allowing for a deeper understanding of health equity and opportunity for specific population groups.

Measures of progress, also referred to as Distance to Goal, for specific population groups. This tells states, and the nation, how far they must go to achieve the goal of greater equity in health outcomes and the determinants of health for their populations.

Who Will Find HOPE's Tools Most Useful? 

HOPE is intended for use by a wide range of national, state, and local audiences, including but not limited to:

Individuals and professionals, such as policymakers, advocates, community members, practitioners, researchers, and thought leaders.

Health sector organizations, such as state and local health departments, health centers, hospital systems, think tanks, and foundations.

Non-health organizations, such as faith- and community-based organizations, and those in social service, education, housing, environment, and community development sectors.

What is Not in HOPE?

While HOPE breaks new ground in providing practical tools to identify and measure national and state baseline progress toward achieving equity in health and in the opportunity for health, the data and scope are limited. 

  • Not all key factors that influence health and the opportunity for optimal health are included. In some cases, the field lacks well-established metrics that we know are responsible for inequities such as racism, other forms of discrimination, and social exclusion. In other cases, we have good metrics but the data are not uniformly collected for every state. 
  • In some instances, data are not available for all racial, ethnic, education, or income groups due to limited sample sizes or data source constraints. 
  • Other key populations—characterized by sexual orientation, gender identity, immigration status, religion and functional status—are not included.
  • Local variation at the substate level—such as county, city, neighborhood or census tract—are also not included.
  • Disaggregated race and ethnic group data are also not captured as these data are often statistically limited when available and inconsistently reported across states. 

Notwithstanding these data constraints, HOPE provides an important first step and reference point for tracking state and national health equity status and progress. Most importantly, it offers new ways to identify and promote opportunity to advance health and well-being for everyone across the U.S.

National Advisory Committee

David R. Williams, PhD, MPH
Harvard University, Committee Chair

Dolores Acevedo Garcia, PhD, MPA-URP
Brandeis University

Jeanne Ayers, MPH
Wisconsin Department of Health (formerly)

Rajiv Bhatia, MD, MPH
US Department of Veterans Affairs

Paula Braveman, MD, MPH
University of California - San Francisco

Renee Canady, PhD, MPA
Michigan Public Health Institute

Janet Corrigan, PhD, MBA

Rachel Davis, MSW
Prevention Institute

Tom Eckstein, MBA
Arundel Metrics

Ed Ehlinger, MD, MSPH
HHS Secretary’s Advisory Committee on Infant Mortality

Glenn Flores, MD
Connecticut Children’s Medical Center

Marjory Givens, PhD
University of Wisconsin, Population Health Institute

Doug Jutte, MD, PhD
University of California - Berkeley & Build Healthy Places Network

Ernest Moy, MD, MPH
Centers for Disease Control and Prevention (CDC), National Center for Health Statistics

Ana Penman-Aguilar, PhD, MPH
CDC, Office of Minority Health and Health Equity

Malia Villegas, EdD
Afognak Native Corporation

The HOPE Initiative Team

National Collaborative for Health Equity

Gail C. Christopher, DN, Principal Investigator

Naima Wong Croal, PhD, MPH, Consulting Director

Michael Frisby, Communications Consultant

Texas Health Institute

Dennis P. Andrulis, PhD, Co-Principal Investigator

Nadia Siddiqui, MPH, Data Director

Kim Wilson, DrPH, Lead Data Consultant

Afrida Faria, MPH, Data Analyst

Kimberly Cooper, Health Equity Intern

Virginia Commonwealth University, Center on Society and Health

Derek A. Chapman, PhD, Co-Principal Investigator

Sarah Blackburn, MS, Communications

Latoya Hill, MPH, Data Analyst

Special Acknowledgments

Brian Smedley, PhD, American Psychological Association

Steven Woolf, MD, MPH, Virginia Commonwealth University

Tracy Orleans, PhD, Robert Wood Johnson Foundation (retired)

Dwayne Proctor, PhD, Robert Wood Johnson Foundation

Elaine Arkin, special adviser to Robert Wood Johnson Foundation

Maryam Khojasteh, PhD, Robert Wood Johnson Foundation