1 Public Health Alliance of Southern California, Public Health Institute, San Diego, CA, USA.
2 Center on Society and Health, Virginia Commonwealth University, Richmond, VA, USA.
Public Health Rep. 2019 Jul/Aug;134(4):354-362. doi: 10.1177/0033354919849882. Epub 2019 May 16.
We describe the California Healthy Places Index (HPI) and its performance relative to other indexes for measuring community well-being at the census-tract level. The HPI arose from a need identified by health departments and community organizations for an index rooted in the social determinants of health for place-based policy making and program targeting. The index was geographically granular, validated against life expectancy at birth, and linked to policy actions.
Guided by literature, public health experts, and a positive asset frame, we developed a composite index of community well-being for California from publicly available census-tract data on place-based factors linked to health. The 25 HPI indicators spanned 8 domains; weights were derived from their empirical association with tract-level life expectancy using weighted quantile sums methods.
The HPI's domains were aligned with the social determinants of health and policy action areas of economic resources, education, housing, transportation, clean environment, neighborhood conditions, social resources, and health care access. The overall HPI score was the sum of weighted domain scores, of which economy and education were highly influential (50% of total weights). The HPI was strongly associated with life expectancy at birth ( = 0.58). Compared with the HPI, a pollution-oriented index did not capture one-third of the most disadvantaged quartile of census tracts (representing 3 million Californians). Overlap of the HPI's most disadvantaged quartile of census tracts was greater for indexes of economic deprivation. We visualized the HPI percentile ranking as a web-based mapping tool that presented the HPI at multiple geographies and that linked indicators to an action-oriented policy guide.
The framing of indexes and specifications such as domain weighting have substantial consequences for prioritizing disadvantaged populations. The HPI provides a model for tools and new methods that help prioritize investments and identify multisectoral opportunities for policy action.
我们描述了加利福尼亚健康场所指数（HPI）及其在衡量社区幸福感方面相对于其他指数的表现，该指数是在卫生部门和社区组织提出需要的基础上产生的，他们希望有一种基于健康的社会决定因素的指数，用于制定基于地点的政策和目标计划。该指数具有地理粒度，通过出生时的预期寿命进行验证，并与政策行动相关联。
根据文献、公共卫生专家和积极的资产框架，我们从与健康相关的基于地点的因素的公开可获得的普查区数据中为加利福尼亚开发了一个社区幸福感综合指数。HPI 的 25 个指标涵盖了 8 个领域；权重是通过使用加权分位数总和方法从它们与 tract 级预期寿命的经验相关性中得出的。
HPI 的领域与健康的社会决定因素和政策行动领域（经济资源、教育、住房、交通、清洁环境、邻里条件、社会资源和医疗保健获取）相吻合。总体 HPI 得分是加权域得分的总和，其中经济和教育具有重要影响（占总权重的 50%）。HPI 与出生时的预期寿命密切相关（ = 0.58）。与 HPI 相比，以污染为导向的指数无法捕获三分之一最贫困的普查区（代表 300 万加利福尼亚人）。HPI 的最贫困四分之一的普查区的重叠程度对于经济贫困指数更高。我们将 HPI 的百分位排名可视化作为一个基于网络的映射工具，该工具在多个地理位置呈现 HPI，并将指标链接到面向行动的政策指南。
指数的框架和规范（例如领域加权）对确定弱势群体具有重大影响。HPI 为工具和新方法提供了一个模型，这些工具和方法有助于确定投资重点和确定政策行动的多部门机会。
