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Zip code more predictive of health and well-being than genetic code
Taking the pulse of Rhode Island lifeBy Richard Asinof, ConvergenceRI.com
A new survey, the Rhode Island Life
Index, creates a qualitative survey measuring how Rhode Islanders perceive the
social disparities of health in their communities
There is much to recommend in the
findings from the first Rhode Island Life Index, conducted as a partnership
between Blue Cross and Blue Shield of Rhode Island and the Brown University
School of Public Health, which sought to capture and measure the “perceptions”
by Rhode Island residents about their own communities’ health and well-being.
The Index, which was based on surveys of 2,209 Rhode Island residents in April
and May, created yet another dataset, reaffirming and reinforcing the importance
of the need to address the social determinants of health in a comprehensive
fashion in future health policy.
Translated, the concept of health equity has entered the vernacular
around future health policy, confirmed by the Rhode Island Health Index.
As Kim Keck, president and CEO of Blue Cross and Blue Shield of Rhode Island
put it, in introducing the findings at the public release of the Index, held on
Wednesday morning, Oct. 23, on the fourth floor of South Street Landing, “Zip
code is more important than genetic code” in determining health outcomes.
The need for affordable housing
As described in the Index, the surveys attempted to capture a summary of how
residents rated the social and economic aspects of their own community,
including questions about access to transportation, health care, employment,
food, and housing.
What rose to the top [or actually the bottom] of the findings, based upon the
results of the 15-minute survey, with 902 conducted by landline, 900 by cell
phone, and 407 through a web survey tool, with responses segmented by income
– respondents who earned more or less than $50,000 a year; age –
respondents who were under age 55 or older than 55, with a built-in
over-sampling of older adults; and location – whether respondents lived
in the four “core” cities of Rhode Island, Providence, Pawtucket, Central Falls
and Woonsocket [defined by having 25 percent of the population which lived
below the poverty level], or not, was housing.
[For the record, the calls were conducted by the Siena College Research
Institute, employing 124 of their most experienced interviewers, utilizing 46
computer assisted interview stations.]
Coupled with the release of 2019 Housing Fact Book by HousingWorks RI Works,
which quantified the dire need for safe, healthy, affordable housing in Rhode
Island, the Index and the Housing Fact Book, taken together, served as a
one-two punch that identified housing as a critical need, tying it to health
outcomes. [Whether or not the news media were able to grasp the interconnected
nature of health outcomes and housing is open to question.]
A first step in a continuing saga
Melissa Clark, Ph.D., the principal investigator of the project, readily talked
about what she saw as the potential places in room for improvement in the next
iteration of the survey. They included: the need to consider conducting an
over-sample for racial and ethnic minorities; the need to ask questions about
insurance coverage, whether the respondents were uninsured, had commercial
insurance, Medicare or Medicaid; and the need to ask more questions about
access to behavioral health care treatment.
The most important takeaway for Clark was the imperative to use the data. “Use
the data,” Clark said. “Don’t just talk about the data. Do something about it.”
Panel discussion highlights
As part of the pubic release event on Oct. 23, Clark was joined by four others
on a panel discussion to discuss the findings, with Dr. Matt Collins, the chief
medical officer at Blue Cross and Blue Shield of Rhode Island, serving as
Matthew Johnson, the executive director of the Howard R. Swearer Center for
Public Service at Brown University, questioned the low number regarding
responses to questions about the opioid epidemic, saying that the question
asked about actual experiences, as differentiated from a questions about
perception. And, when asked that way, the responses would be mitigated by
stigma, he said.
Carrie Bridges Feliz from Lifespan also questioned the way that the opioid
question was worded, which asked: “Have you, an immediate family member,
extended family member, or friend, abused opioids?” The results from the
community health needs assessment conducted by the Lifespan health system, as
well as in follow-up focus groups, identified that simply asking about
“opioids” missed the reality that there were other sources of substance abuse,
including alcohol and cocaine, that needed to be addressed.
Dr. Ada Amobi, the director of the Health Equity Institute at the R.I.
Department of Health, questioned the relative high positive numbers around the
perceptions of access to food, saying that every health equity zone in Rhode
Island, as part of their community needs assessment, had identified food
insecurity as a major problem.
Angela Ankoma, executive vice president at United Way of Rhode Island, felt
there was a need to ask different questions about the problems of social
isolation, as reflected in the kinds of calls received by United Way as part of
its 2-1-1 program. Ankoma also thought that there needed to be better questions
around economic insecurity as part of the questionnaire.
[Given that the initial survey did not over-sample for ethnic and minority
populations, and the question regarding discrimination in the past 12 months,
which asked: “How often have you been concerned about treated unfairly in a
health care setting because of your race, ethnicity or some other personal
characteristics?” received only a total of 7 percent saying respondents had
experienced discrimination, it did occur to ConvergenceRI that the make-up of
the panel, which include three women of color, appeared to overcompensate for
the gap in the survey.]
For a link to the story, with
sidebar commentary, in ConvergenceRI, go to: