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 third 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 vision to passionately lead a state of health and well-being across Rhode Island. 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.
Key Findings
This year, for the first time, we can report on trends, based on three 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 as our baseline against which to measure progress.
The most notable trend is in programs and services for children. Overall and for every comparison group, there has been a significant decrease in the scores from 2019 to 2021 for how residents rate these programs and services. Overall, there is no significant trend in the perceptions of the availability of services in the community for older adults. For individuals living in core cities, as well as those who identified as Latinx, however, there was a significant decrease in perceptions of the availability of services for older adults from 2019 to 2021. It is also worth noting that in virtually all topic areas from 2019 through 2021, BIPOC Rhode Islanders living in core cities perceived social factors such as access to affordable housing and cost of living as much greater impediments to health and well-being than have white Rhode Islanders living in non-core areas.
We were not surprised that most 2021 findings largely mirrored those of 2020 and 2019.
What’s new in 2021
Confidence in managing health problems and reasons people avoided seeking a doctor’s care when needed continued as special issues for 2021. Added to this category were confidence using technology, as well as reasons for not having high speed internet access at home.
At the Coalition’s recommendation, we extended the Index’s reach to Rhode Islanders who do not speak English at home. BCBSRI and the Brown University School of Public Health team partnered with four community-based organizations – Dorcas International; Center for Southeast Asians; Higher Ground International; and Progreso Latino – to translate the random digit dial survey into 11 languages and trained organization staff to conduct the interviews in person or by phone. Interviewers were compensated for their time and expertise.
We show here a composite score of essential drivers of health and well-being as defined for the RI Life Index. The topic areas comprise the RI Life Index, focused on community life and quality of community elements, including affordable housing, quality education, and good jobs. We ask consistent questions around these topics every year so that we can address areas of concern and measure progress towards improving the overall quality of life, health, and well-being of Rhode Islanders.
2021
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.
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.
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.
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
Perceptions of Community: Topics
Here we show perceptions of specific social determinants of health.
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
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;
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
Perceptions of Community
AFFORDABLE
HOUSING
DEFINITION
How do residents rate access to affordable, quality housing?
TOPICS: Cost of housing; availability of affordable housing
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
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
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
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.
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
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
Actual Experiences
ECONOMIC
SITUATION
DEFINITION
How do residents rate their current financial situation?
TOPICS: Personal economic and financial situation; money in savings
Actual Experiences
ACCESS TO TECHNOLOGY
DEFINITION
How do residents rate their access to technology?
TOPICS: High-speed Internet access; smartphone access
Special Topics
Here you will see findings from this year’s special topics, reported as percentages rather than POP scores.
Health Management
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)
DEFINITION
Was there a time in the past 12 months when you or anyone else in your household needed to see a doctor but did NOT go for medical care?
Health Management
REASON NOT TO SEE A DOCTOR
DEFINITION
For those indicating there was a time in the past 12 months when someone in the household needed to see a doctor but did NOT go for medical care, what was the most important reason.
Special TOPICS
INTERNET & TECHNOLOGY
DEFINITION
Overall, how confident do you feel using computers, smartphones, or other electronic devices to do the things you need to do online?
DEFINITION
Please tell me whether the following applies to your household: You have high-speed internet access at home.
For those indicating they do not have high-speed internet access at home (14%): Please tell me whether any of the following are reasons why you do not have high-speed internet access at home.
The monthly cost of a home subscription is too expensive
The cost of a computer is too expensive
Your smartphone lets you do everything online that you need to do
Don’t like/don’t use computers and/or internet
You have other options for internet access outside of your home
High-speed internet service is not available where you live, or is not available at an acceptable speed
All Trends (2019-2021)
In these tables, we present the 2019-2021 trends for the POP scores for the aspects of community health and well-being that were assessed in all three years. The red and blue triangles indicate when the trend was significantly different from zero (that is, there was no change over time): a red triangle indicates there was a decrease from 2019 to 2021; a blue triangle indicates there was an increase from 2019 to 2021. Due to sample sizes for some of the subgroups and the rounding of results to whole numbers, some trends that may appear significant are not.
Trend results may differ slightly from the individual-year results due to two analytic approaches necessary to conduct the statistical tests for the trends: One question that is part of the composite RI Life Index, Community Life, and Children POP scores was added in 2020. Because of this, to be able to show the trends, we dropped this item from the 2020 and 2021 indices and re-computed the POP scores. Each year, the data are weighted 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.
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, Associate Dean for Education, 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, April Backus, 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
Ashish Jha, MD, MPH, 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, and Associate Dean for Education, 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
