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Health is more than healthcare

Health is so much more than what happens within the healthcare system. We know health outcomes do not rest solely on medical interventions, but also greatly depend on meeting basic human needs.

Blue Cross & Blue Shield of Rhode Island (BCBSRI) and the Brown University School of Public Health are proud to present the fourth annual RI Life Index, which captures Rhode Islanders’ perceptions of social determinants of health and well-being. For BCBSRI, the Index serves as a driver of our mission to create access to high quality care for all Rhode Islanders. We believe the Index will help us to build healthier communities throughout Rhode Island. This is our long-term commitment. We must continue to listen, learn and act.

View our 2022 Launch Event

Key Findings

In 2022 we can report on trends based on four years of collected data. In keeping with the goal of measuring certain social determinants of health year over year, we annually ask the same core group of questions that speak to quality of life and quality of community. Below you’ll see the complete list of questions that comprise the “index” of quality of life and quality of community. We use these questions to measure progress.

In 2022, perceptions trended down in several areas. For example, the RI Life Index, which is comprised of topics including access to affordable housing, childcare and activities for youth, quality education, affordable and nutritious food, good jobs, medical care, programs for seniors, transportation services, feeling safe at home, and cost of living, trended down for most Rhode Islanders. The same held true for access to nutritious food and food security as well as cost of living and economic situation, which is not surprising given recent inflationary concerns. On a more positive note, perceptions of the availability of programs and services for children held steady from 2021 and improved from 2020.

About the RI Life Index

The slides below offer a brief overview of the methods used for the RI Life Index, along with tips to enhance your viewing experience. Use the red arrows on the right and left to move through the slides.

  • Viewing the Index: To explore the data found in the Index, simply scroll through the site. By selecting or clicking on the dark blue panel under each core topic, you can see questions and variable related to that topic. In cases where trend data and/or Community Sample data are available, you will find it with its RDD and/or Community Sample data.
  • The Methods: From April through June 2022, we randomly selected adult residents by landline telephone, cell phone, or web with geographic representation across the state of Rhode Island. Interviews lasted approximately 15 minutes and were conducted in English or Spanish. In total, 2093 surveys were completed with an oversample of Black and Latinx Rhode Islanders. Of the total surveys completed, 465 were conducted by landline, 1140 by cell phone, and 488 through a web survey tool. Community-based organizations conducted an additional 493 interviews in person or by telephone in 14 different languages. The data collected from these interviews are presented separately from the data collected from randomly selected residents.
  • The Survey: The survey featured three sets of questions about respondents' perceptions of their communities. One set of questions asked respondents to rate statements about their communities in terms of whether the statement was completely descriptive, somewhat descriptive, not very descriptive, or not descriptive at all. A second set of questions asked respondents to rate how likely each aspect of life was for a typical person living in their community--very likely, somewhat likely, somewhat unlikely, or very unlikely. The third set of questions asked respondents about housing availability and affordability.
  • The Survey (continued): We also included questions about programs and services for children and older Rhode Islanders as well as questions about respondents' actual experiences around food security, economic situation, confidence in managing health problems, and confidence in using technology.
  • Timeline: The launch of the RI Life Index in 2019 was just the first step in a journey towards catalyzing change in our state. Below are highlights of that journey to date. 2019: RI Life Index launched, Oversample of older Rhode Islanders, RI Life Index Coalition created, BCBSRI shifts focus of BlueAngel Community Health Grants to safe and affordable housing, 2020: Survey timing affected by pandemic and Presidential election, Oversample of Black and Latinx Rhode Islanders, BCBSRI grants for safe and affordable housing near $1 million, Data from Index cited by community partners, 2021: Continue to oversample Black and Latinx Rhode Islanders, BCBSRI grants for safe and affordable housing near $3 million, Partnership with four community-based organizations, interviews in 11 languages, First trends data reported, 2022: Continue to oversample Black and Latinx Rhode Islanders, BBSRI Gants for safe and affordable housing near $5 million, Partnership with four community-based organizations, interviews in 14 languages, Additional trends able to be reported
  • The Analytic Approach: First, we weighted the data to be representative of the state of Rhode Island with regard to age, gender, and race/ethnicity. Next, we created scores for various aspects of health and well-being in a community. We refer to these scores as POP (percent of the possible) scores. The POP score for each component represents how close respondents believe their community is to an ideal or healthy community in these areas. We used this approach to combine multiple indicators into one score, allowing for easier observation of targets for improvement, as well as community strengths.
  • POP Scores: A POP score of 100 is the highest possible score for each component. A score of 100 is reached when every single respondent rates each of the individual indicators of a component at the highest (best possible) value. Scores ranging from 0 to 100 show how close the community is to the ideal. For creation of the POP scores, negative outcomes were reversed so that a higher POP score indicates moving towards a healthier community. The darkest red colors represent the lowest (worst) POP scores while the darkest blue colors represent the highest (best) POP scores (see below). This allows for easy visualization of how close to the ideal survey participants viewed each component of health and well-being.
  • Variables: We also used ordinary least squares (OLS) regression modeling with each POP score individually treated as the dependent measure to examine the individual characteristics associated with each health and well-being component. Variables included in the models were: age, race/ethnicity, income. education, disability, gender, and geography. In the report, blue upward facing triangle means that a variable is associate with higher (better) perceptions of that component, red downward facing triangle means that the variable is associate with lower (worse) perceptions, and -- means that the variable was not meaningfully associated with that component.
  • Core Cities: Throughout the report, we show POP scores overall and stratified by geography (Core Cities vs. Non-Core Areas), race/ethnicity, and age. Core cities are those in which 25% or more of children are living below the federal poverty level.
  • Trends: With four years of data, we continue to examine trends in several topic areas. We are only able to examine trends for POP scores containing questions that were asked in at least 3 years. There were some changes in the survey between 2019 and 2020. One question that is part of the composite RI Life Index, Community Life, and Children POP scores was added in 2020. For 2019, we computed these three POP scores without the ideal and present these results, noting that the construction of the POP scores differed slightly in 2019.
  • Trends (continued): The data are weighted each year to be representative of the state of Rhode Island population with regard to age, gender, and race/ethnicity. When combining multiple years of data, these weights must be divided by the number of years being analyzed. This may result in small differences in the computed POP scores for each year in the trend analyses when compared to analyses using a single year of data.
  • Report Organization: The report stratifies data by core city vs. non-core area and by race and ethnicity as seen here. We begin at the widest point of the lens, with summaries of perceptions of community that incorporate a range of social determinants of health, and quickly moves into a breakdown of those key factors. Data on actual experiences of respondents with regard to certain topics is next, followed by special topics, reported as percentages rather than POP scores. We also report trends from 2019 to 2022 for topics where we have at least three years of comparative data.
  • Characteristics Of The RDD Sample: Seventy percent of respondents lived in non-core areas; 30% resided in core cities. Approximately one in four (23%) respondents reported living alone; 33% lived in households with at least one child under the age of 18. Fifty percent of survey participants identified as female, 46% identified as male, and the remainder did not identify a gender. Approximately half (51%) were aged 18 to 49. Thirty-two percent reported having a high school education or less. Of those who reported their income, 47% had a household income of less than $50,000. Seventy-one percent identified as non-Hispanic white, 84% identified as heterosexual/straight, and 31% indicated they were living in a household in which at least on person had a disability.
  • The Coalition: It's clear that in order to tackle the many social factors influencing health outcomes, key community partners must join together. The RI Life Index Coalition is a community coalition dedicated to improving the health and well-being of Rhode Islanders. Member organizations continue to shape the RI Life Index, helping to animate and activate the Index, and providing thought leadership on viable solutions to the challenges identified. Coalition members also provide recommendations about how best to leverage existing data resources. The following organizations are Coalition members, all of which are working in the areas highlighted in the survey, including basic human needs and social services.
  • Community Partnerships: At the Coalition's recommendation, in 2021 we extended the Index's reach to Rhode Islanders who do not speak English at home. In 2022, we once again partnered with four community-based organizations - Dorcas International; Center for Southeast Asians, Higher Ground International; and Progreso Latino. Working with our partners, we translated the random digit dial survey into 14 languages and trained organization staff to conduct the interviews in person or by phone. Interviewers were compensated for their time and expertise.
  • Characteristics Of The CBO Sample: Seventy-three percent of respondents live in a core city. Approximately one in ten (12%) reported living alone; 54% lived in households with at least one child under the age of 18. Two-thirds of survey participants (67%) identified as female. Approximately half (51%) were aged 18 to 49. Sixty-one percent reported having a high school education or less. Fifty-six percent had a household income of less than $25,000. Eighteen percent indicated they were living in a household in which at least one person had a disability. Fifteen percent indicated they do not speak English at all and 28% percent indicated they speak English, but not well.
  • Comparing RDD And CBO Data: We show scores from the random digit dial (RDD) survey compared with those from the survey conducted by community-based organizations (CBOs). Both sets of data are divided by language spoken at home (English, Spanish, all other languages). In 2022, for items not part of the core RI Life Index, the CBOs were provided the opportunity to ask the items most relevant to their organization. Therefore, some of the items were not asked by all of the CBOs.

RI Life Index

We show here a composite score of essential drivers of health and well-being as defined for the RI Life Index. The topic areas comprising the composite score focus on community life and quality of community elements, including affordable housing, quality education and good jobs. For all core measures, we first display the scores from the random digit dial (RDD) survey conducted from April through June of 2022. As you click deeper, you can explore trends, as well as scores from interviews conducted by community-based organizations.

2022
RI LIFE INDEX

Topics include access to affordable housing, childcare and activities for youth, quality education, affordable and nutritious food, good jobs, medical care, programs for seniors, transportation services, feeling safe at home, and cost of living.

RI Life Index: 59; Chart breakdown: Core City: 55 (broken down by Latinx, Black, and White ages less than and over 55) Non-Core: 61 (broken down by Latinx, Black, and White ages less than and over 55)

Summary: Perceptions of Community

The report begins at the widest point of the lens, with summaries of perceptions of community that incorporate a range of social determinants of health, and quickly moves into a breakdown of those key factors. For all core measures, we first display the scores from the random digit dial (RDD) survey conducted from April through June of 2022. As you click deeper, you can explore trends, as well as scores from interviews conducted by community-based organizations.

Perceptions of Community
QUALITY OF COMMUNITY

DEFINITION
Quality of community scoring represents a summary of how residents rate social and economic aspects of their community, including the following topics:

  • Access to childcare
  • Activities for youth
  • Employment
  • Access to affordable food
  • Cost of living
  • Availability and quality of services and programs for seniors

QUESTION WORDING: For each statement, tell me if that statement is completely descriptive, somewhat descriptive, not very descriptive, or not descriptive at all of your community.

Quality of Community: 54
Chart breakdown: Core City: 50 (broken down by Latinx, Black, and White ages less than and over 55) Non-Core: 55 (broken down by Latinx, Black, and White ages less than and over 55)

Perceptions of Community
COMMUNITY LIFE

DEFINITION
Community life scoring represents a summary of how residents perceive the lived experiences of typical individuals in their community, in the following areas:

  • Employment
  • Education
  • Convenient locations for nutritious food
  • Access to affordable housing
  • Access to healthcare
  • Feeling safe at home

QUESTION WORDING: For each statement, please tell me how likely each is for a typical person living in your community: very likely; somewhat likely; somewhat unlikely; and very unlikely

Community Life: 67
Chart breakdown: Core City: 61 (broken down by Latinx, Black, and White ages less than and over 55) Non-Core: 69 (broken down by Latinx, Black, and White ages less than and over 55)

Perceptions of Community: Vulnerable Residents

Here we show perceptions of Rhode Island’s most vulnerable residents. For all core measures, we first display the scores from the random digit dial (RDD) survey conducted from April through June of 2022. As you click deeper, you can explore trends, as well as scores from interviews conducted by community-based organizations.

Perceptions of Community
CHILDREN

DEFINITION
How do residents rate programs and services available for children?

TOPICS: Place to raise children; access to quality education; activities for youth

Children: 72
Chart breakdown: Core City: 63 (broken down by Latinx, Black, and White ages less than and over 55) Non-Core: 76 (broken down by Latinx, Black, and White ages less than and over 55)

Perceptions of Community
OLDER ADULTS

DEFINITION
How do residents rate the availability of services in their community for older adults?

TOPICS: Availability of special transportation services; availability of social and civic programs; quality of healthcare services;

Older Adults: 66
Chart breakdown: Core City: 64 (broken down by Latinx, Black, and White ages less than and over 55) Non-Core: 66 (broken down by Latinx, Black, and White ages less than and over 55)

Perceptions of Community: Social Determinants of Health

Here we show perceptions of specific social determinants of health. For all core measures, we first display the scores from the random digit dial (RDD) survey conducted from April through June of 2022. As you click deeper, you can explore trends, as well as scores from interviews conducted by community-based organizations.

Perceptions of Community
ACCESS TO
NUTRITIOUS FOOD

DEFINITION
How do residents rate access to affordable, nutritious food?

TOPICS: Access to nutritious affordable food; convenience of location of nutritious food

Access to Nutritious Food: 69
Chart breakdown: Core City: 64 (broken down by Latinx, Black, and White ages less than and over 55) Non-Core: 71 (broken down by Latinx, Black, and White ages less than and over 55)

Perceptions of Community
AFFORDABLE
HOUSING

DEFINITION
How do residents rate access to affordable, quality housing?

TOPICS: Cost of housing; availability of affordable housing

Affordable Housing: 33
Chart breakdown: Core City: 33 (broken down by Latinx, Black, and White ages less than and over 55) Non-Core: 33 (broken down by Latinx, Black, and White ages less than and over 55)

Perceptions of Community
COST OF LIVING

DEFINITION
How do residents rate the cost of living in their community?

TOPICS: Affordable, high-quality childcare; cost of quality housing; difficulty paying for utilities

Cost of Living: 26
Chart breakdown: Core City: 23 (broken down by Latinx, Black, and White ages less than and over 55) Non-Core: 27 (broken down by Latinx, Black, and White ages less than and over 55)

Perceptions of Community
JOB
OPPORTUNITIES

DEFINITION
How do residents rate job opportunities and job training programs?

TOPICS: Availability of jobs; employment with living wage; access to adult education

Job Opportunities: 55
Chart breakdown: Core City: 51 (broken down by Latinx, Black, and White ages less than and over 55) Non-Core: 57 (broken down by Latinx, Black, and White ages less than and over 55)

Perceptions of Community
HEALTHCARE ACCESS

DEFINITION
How do residents rate their ability to access healthcare?

TOPICS: Access to routine medical care; access to mental health or substance abuse treatment

Healthcare Access: 69
Chart breakdown: Core City: 66 (broken down by Latinx, Black, and White ages less than and over 55) Non-Core: 70 (broken down by Latinx, Black, and White ages less than and over 55)

Actual Experiences

Here we show data on the actual experiences of respondents with regard to their economic situation, food security, access to technology, and racial equity. For all core measures, we first display the scores from the random digit dial (RDD) survey conducted from April through June of 2022. As you click deeper, you can explore trends, as well as scores from interviews conducted by community-based organizations.

Actual Experiences
RACIAL EQUITY

DEFINITION
How do residents rate racial equity at work, when seeking healthcare, and in personal interactions?

TOPICS: Treatment at work; experiences seeking healthcare; unfair treatment; fear for personal safety

Racial Equity: 73
Chart breakdown: Core City: 69 (broken down by Latinx, Black, and White ages less than and over 55) Non-Core: 75 (broken down by Latinx, Black, and White ages less than and over 55)

Actual Experiences
FOOD SECURITY

DEFINITION
How do residents rate their level of food security?

TOPICS: Worries about having enough food; financial ability to buy food

Food Security: 80
Chart breakdown: Core City: 73 (broken down by Latinx, Black, and White ages less than and over 55) Non-Core: 84 (broken down by Latinx, Black, and White ages less than and over 55)

Actual Experiences
ECONOMIC
SITUATION

DEFINITION
How do residents rate their current financial situation?

TOPICS: Personal economic and financial situation; money in savings

Economic Situation: 58
Chart breakdown: Core City: 52 (broken down by Latinx, Black, and White ages less than and over 55) Non-Core: 61 (broken down by Latinx, Black, and White ages less than and over 55)

Special Topics

Here you will see findings from this year’s special topics, reported as percentages rather than POP scores.

CONFIDENCE IN MANAGING HEALTH
PROBLEMS

DEFINITION
Thinking about your health, how confident are you that you can manage any health problems you have? (Percent responding Somewhat or Very Confident)

Managing Health Problems: 87% (broken down by 40% somewhat and 47% very); Core City: 83% (broken down by 36% somewhat and 47% very); None-Core: 89% (broken down by 42% somewhat and 47% very)

CONFIDENCE IN
USING TECHNOLOGY

DEFINITION
Overall, how confident do you feel using computers, smartphones,
or other electronic devices to do the things you need to do online?

Using Technology: 81% (broken down by 25% somewhat and 56% very); Core City: 80% (broken down by 21% somewhat and 60% very); None-Core: 82% (broken down by 27% somewhat and 55% very)

Acknowledgements

The RI Life Index, a partnership between Blue Cross & Blue Shield of Rhode Island and the Brown University School of Public Health, would not have been possible without the collaboration of the following people and organizations: Melissa Clark, PhD, Professor of Health Services, Policy and Practice, Professor of Obstetrics and Gynecology, and Director of the Survey Research Center, Brown University School of Public Health, who served as Principal Investigator of the project, overseeing survey design and execution, and offering expert guidance along the way; Michelle Rogers, PhD, Assistant Professor of Behavioral and Social Sciences and Associate Director of the Survey Research Center, Brown University School of Public Health, who completed all of the data analysis; Tamara Sequeira, RN, MSN, Project Manager, Survey Research Center, Brown University School of Public Health, for her invaluable assistance with the community-based organization interviews; Don Levy, PhD, Meghann Crawford and all the interviewers and technical staff of the Siena College Research Institute for the data collection; staff of Dorcas International, Progreso Latino, Higher Ground International, and the Center for Southeast Asians for conducting community-based interviews; and the more than 2500 Rhode Islanders who answered the call by taking the survey, providing this invaluable data to benefit all of our communities as we work to create health equity in Rhode Island.

We also thank the following leaders:
Martha L. Wofford, MBA, President & CEO, Blue Cross & Blue Shield of Rhode Island
Christina H. Paxson, PhD, President, Brown University
Ronald Aubert, PHD, Interim Dean, Brown University School of Public Health
Megan Ranney, MD, MPH, FACEP, Academic Dean, Brown University School of Public Health
Social Mission Committee of the Blue Cross & Blue Shield of Rhode Island Board of Directors

RI Life Index Coalition Membership
Melissa Clark, PhD, Professor of Health Services, Policy and Practice, Director of the Survey Research Center, Brown University School of Public Health
Christopher Ausura, Rhode Island Department of Health
Angela Bannerman Ankoma, Rhode Island Foundation
Marcela Betancur, Latino Policy Institute
Adama Hathaway Brown, United Way of Rhode Island
Carolyn Belisle, Blue Cross & Blue Shield of Rhode Island
Carrie Bridges Feliz, Lifespan Community Health Institute
Elizabeth Burke Bryant, Rhode Island Kids Count
Brenda Clement, HousingWorksRI
Weayonnoh Nelson Davies, Economic Progress Institute
Rachel Flum, Economic Progress Institute
Jeff Gilbert, Medical Legal Partnership Boston
Michele Lederberg, Blue Cross & Blue Shield of Rhode Island
Katie Murray, Rhode Island Foundation
Andrew Schiff, Rhode Island Community Food Bank
Tina Spears, Community Provider Network of Rhode Island
Catherine Taylor, AARP

Communication Support
Jasmine Arnold, Blue Cross & Blue Shield of Rhode Island
Melanie Coon, Blue Cross & Blue Shield of Rhode Island
Sasha Dolgicer, Brown University Division of Advancement
Rebekah McKinney, Brown University Division of Advancement
Karen Scanlan, Brown University School of Public Health
Mark Sheldon, Blue Cross & Blue Shield of Rhode Island