The health of Californians is shaped dramatically by “non-health” policies and community characteristics, such as housing, education, economic, and social factors. These community conditions, also called the "social determinants of health", are depicted in the graphic at right.
The California Healthy Places Index (HPI) is a powerful new tool, developed by the Public Health Alliance of Southern California (Alliance) in partnership with the Virginia Commonwealth University’s Center on Society and Health, that can be used to explore and change those community conditions that predict life expectancy. The purpose of the HPI is to prioritize public and private investments, resources and programs. It contains user-friendly mapping and data resources at the census tract level across California. The HPI also provides scores based on community conditions to allow for comparisons between areas, as well as deeper dives on conditions in any given area. The tool includes detailed policy guides to support specific policy interventions that improve community conditions and health.
The HPI combines 25 community characteristics into a single indexed HPI Score. HPI scores for each census tract can be compared across the state to paint an overall picture of health and well-being in each neighborhood in California. The tool also allows multiple census tracts to be pooled together into a single score, allowing the comparison of zip codes, project areas, and other geographies.
In addition to the overall score, the index also contains eight sub-scores for each of the Policy Action Areas (Economic; Education; Housing; Health Care Access; Neighborhood; Clean Environment; Transportation; and Social factors). The index was created using statistical modeling techniques that evaluated the relationship between these Policy Action Areas and life expectancy at birth. The statistics were designed to maximize the ability of the Healthy Places Index to identify healthy communities and quantify the factors that shape health. The graphic below shows the eight Policy Action Areas, their weights within the index, and the 25 community characteristics that are combined into the overall HPI score.
In addition to the characteristics calculated in the Healthy Places Index, the mapping tool includes additional selectable data layers such as: health outcomes; race/ethnicity; climate change effects; and other layers that will be valuable in advancing resilient, equitable communities in California. You can find out more about these additional layers in the sections below.
Public health professionals, including the Alliance, recognize the significant and well-documented role that race and ethnicity play in shaping health outcomes in the United States – including California. For example, on average African Americans suffer poorer health outcomes than their white counterparts. These inequities can be largely attributed to historic and persistent systemic factors—such as housing discrimination, differences in school funding, or employment opportunities. Areas with a high concentration of people of color have often endured many years of disinvestment and high rates of poverty, sub-standard schools, and trauma. These neighborhoods typically have higher pollution, unhealthy housing, and limited access to health care, parks, and fresh fruits and vegetables—all impacting their health.
Despite the important role these factors play in shaping health, California’s Prop 209 prohibits allocating certain kinds of public resources based on race and ethnicity. In order to ensure the Healthy Places Index can be used in a variety of applications, including informing policy decisions, the Alliance has produced two calculations of the index– one which includes a measure of racial segregation, and one which does not.
HPI + Racial Segregation
Recognizing the importance of a version of HPI that includes the impacts of race/racism on the total score, the Alliance developed a version of the index that includes a measure of racial inequities. For this version of the index, it was necessary to select a single metric to represent how race and racism shape community conditions and health. The Alliance included a frequently used measure of racial segregation (the dissimilarity index). Research suggests that racial segregation can starve communities of color of resources, political power, and other resources necessary for health—perpetuating health inequities by race. The dissimilarity index is calculated based on segregation of other groups from a “referent group”. In this case, the Alliance has based the dissimilarity index on the racial segregation of Black/African American communities, since these communities have been most harmed by housing discrimination and segregation.
Informational layers about Race
For all versions of the index, racial breakdown is provided as an informational layer at the census tract level. This is not built into the index, but instead allows users to understand index data in light of racial/ethnic composition. This version of HPI can be used by Prop 209-eligible programs without legal concern.
Health Behaviors and Outcomes
HPI is designed to provide information on factors at the local level that are known to predict health outcomes and life expectancy. Conditions such as employment, poverty, and education have a significant impact on both health behaviors and health outcomes. For example, workers employed in minimum-wage, unpredictable, or shift-based work may have limited time and resources for joining a gym, planning and preparing healthful meals, or getting adequate sleep. Behaviors such as exercise, healthful eating, adequate sleep, are significant drivers of health outcomes such heart disease and diabetes rates.
While the HPI is focused on the conditions underlying these health behaviors and outcomes, a range of other projects including the Centers for Disease Control / Robert Wood Johnson Foundation 500 Cities project, and the California Health Interview Survey (CHIS Neighborhood Edition) provide valuable data on health behaviors and outcomes at a neighborhood level. These data are made available through the HPI map interface as an additional informational layer so that health behaviors and outcomes can be analyzed in conjunction with core neighborhood conditions and factors that influence them.
Climate Change and Health Vulnerability Indicators
Climate change already presents a significant threat to public health in California, and its impacts are expected to become more pronounced in the coming years. Building off of data assembled by California Department of Public Health’s Climate Change and Health Vulnerability Indicators (CHVIs), the Healthy Places Index allows users to see how existing conditions for health intersect with areas of climate risk (such as wildfire risk) and strategies for resilience (tree canopy). Additionally, the HPI Policy Guide includes strategies specifically designed to improve health while also building climate resilience. Policies building climate resilience are indicated within the policy guide text by the presence of the climate () icon.
Climate Health Vulnerability Indicators are built into the HPI platform in a variety of ways, as outlined below:
Built into HPI Score: Healthy communities are often climate-resilient communities. Many of the community conditions measured by the HPI score such as Employed, Above Poverty, Batchelor’s Ed or Higher, Automobile Access, Tree Canopy, Ozone, PM 2.5 and Insured are also conditions that are meaningful in the context of climate resilience. The HPI score itself can be an important metric of the climate resilience of a community. The HPI online map allows users to analyze climate resilience both by looking at the HPI score overall, and by allowing users to drill-down to investigate how these specific components of resilience compare across communities.
Additional Layers Available For Mapping: Some climate risks and vulnerabilities did not meet the criteria for inclusion in the HPI score itself, but are available to be mapped on the HPI site in relation to the HPI score. These include Air Conditioning Access, Percentage of Children, Crime, Cognitive Percentage Experiencing Cognitive Disability, Percentage Experiencing Physical Disability, Percentage Elderly, and the Urban Heat Index, Extreme Heat Days, Impervious Surfaces, Outdoor Workers, Public Transit Access and Sea Level Rise.
Climate Challenges Addressed Specifically by Policy Guide: The HPI Policy Guide provides policy strategies for localities wishing to address and build resilience. While many of the policy strategies are “win-win’ strategies that have positive impacts for both public health and climate resilience, the following guides are especially valuable for communities seeking to build climate resilience: Extreme Heat Days, Impervious Surfaces, Outdoor Workers, Public Transit Access and Sea Level Rise.
What’s not included?
Data sources included in the Healthy Places Index are 1) publicly available, 2) up –to-date at a neighborhood (census tract) level 3) available statewide in California and 4) actionable by policy and other action, and 5) demonstrably linked/correlated with life expectancy.
There are many neighborhood characteristics that are critical to health that were not included in HPI because they did not meet the criteria for inclusion. As an example, we know social cohesion, community power, inclusion/exclusion are fundamental to good health, but at this time there are not adequate data to measure these characteristics at the neighborhood level. Where possible, we have included proxy measures—such as “voting” and “two parent households under the social policy action area, which may be correlated with a sense of community efficacy in making change. When and where possible, we hope to include more nuanced measures as they become available.
Related Indicator Projects and Resources
While the HPI is focused on the community conditions underlying health behaviors and outcomes, a range of other projects including the Robert Wood Johnson Foundation/Centers for Disease Control and Prevention 500 Cities project, and the California Health Interview Survey Neighborhood Edition (AskCHIS NE) provide valuable data on health behaviors and outcomes at a neighborhood level. Health behaviors and outcomes are included, as available, through the HPI map interface as additional informational layer so these data can be analyzed in conjunction with core neighborhood conditions and factors that influence them.
The Healthy Places Index is situated within and benefits from an increasingly rich universe of tools, indicator projects, and policy guides that build connections between neighborhood conditions and health. HPI has been informed by the following projects:
- Robert Wood Johnson Foundation (RWJF) County Health Rankings and Roadmaps: has created an index to help counties nationwide identify areas of opportunity for improving population health. This project has produced an annual ranking starting in 2011, allowing counties to track their data over time. It includes a “what works” guide to evidence-based interventions counties can take to improve health.
- Policy Link National Equity Atlas: Provides key data on racial equity and equitable growth trends for large cities/metro areas, regions and states.
- EPA Smart Location Database: Provides valuable data on built-environment and economic characteristics down to a census tract-level.
- AARP Livability Index: Provides a score for “Livable Communities” based on eight domains down to a zip-code level.
- CalEPA CalEnviroScreen 3.0: CalEnviroScreen is an index that helps identify California census tracts disproportionately burdened by multiple sources of pollution, and those with population characteristics that make them more sensitive to pollution.
- California Department of Public Health Office of Health Equity (CDPH OHE) Healthy Community Indicators Project: Provides city-level data that can be used when planning healthy communities and evaluating the impact of plans, projects, policy, and environmental changes on community health.
- CDPH OHE Portrait of Promise: Provides data on health disparities in California and a detailed plan for addressing those disparities.
- Ask California Health Interview Survey Neighborhood Edition (AskCHIS NE): Web portal with health behaviors and outcome data from the California Health Interview Survey. It provides health estimates for California's diverse population at the local level (zip codes and cities and legislative districts).
- Health Department Dashboards: Many Public Health Departments in California maintain public health data dashboards that show localized health data in a user-friendly format. Visit your local Public Health Department’s web page to view the dashboard for your area.
- RWJF/Centers for Disease Control and Prevention 500 Cities Project: Provides city- and census tract-level small area estimates for chronic disease risk factors, health outcomes, and clinical preventive service use for the largest 500 cities in the United States. You can view data from the 500 Cities project as an additional decision-support layer within the Healthy Places index online mapping tool.
- University of California, Berkeley's Cal-Adapt: Cal-Adapt provides downscaled data on how climate change might affect California. Find tools, data, and resources to conduct research, develop adaptation plans and build applications.
- Southern California Association of Governments ReVision tool: SCAG, the Southern California Metropolitan Planning Organization (MPO), in conjunction with the UCLA Lewis Center provides detailed built environment and transportation data for the SCAG region, including a guide to understand economic factors/demographic factors that may cause displacement.
- San Diego Association of Governments (SANDAG) Data Surfer: The San Diego-Area MPO provides detailed built environment and transportation data for San Diego County.
- UCLA, UC Berkeley, and Portland State University's Urban Displacement Project: Provides geographic data detailing displacement in the Bay area and in Southern California, and tools to help communities identify the pressures surrounding them and take more effective action.
The California Healthy Places Index was developed by the Public Health Alliance of Southern California in partnership with the Virginia Commonwealth University’s Center on Society and Health to help communities delve into the complex factors that produce healthy communities at a neighborhood level. Development of the index was guided by a steering committee comprised of epidemiologists and public health experts from across California. Refinements to messaging and the Policy Actions were guided by the work of the HPI Communications team. The online, interactive HPI map tool was developed by Axis Maps.
The Alliance gratefully acknowledges the contribution of the following people and institutions to this project:
Public Health Alliance of Southern California
Tracy Delaney, PhD Executive Director
Carla Blackmar, MCP Founding Program Manager
Stephanie Caldwell, MPH Director of Strategic Initiatives
Will Dominie, MURP Policy Manager
Helen Dowling, MPH Program Associate
Grace Kono Project Specialist & Finance
Neil Maizlish, PhD, MPH Senior Data Adviser
Bill Sadler, JD, MURP Director of Operations
Virginia Commonwealth University Center on Society and Health
Sarah Simon Blackburn, MS
Derek Chapman, PhD
Latoya Hill, MPH
Roy Sabo, PhD
Lauren Snellings, MPH
Steven Woolf, MD, MPH
HPI Steering Committee
Meileen Acosta, Solano County Department of Public Health
Matt Beyers, Alameda County Health Department
Dulce Bustamante, Office of Health Equity, California Department of Public Health
Charlene Contreras, Los Angeles County Department of Public Health
Dave Dauphine, California Department of Public Health
Satvinder Dhaliwal, Fresno County Department of Public Health
Scott Fujimoto, Center for Health Statistics and Informatics, California Department of Public Health
Elizabeth Gazarek, Kings County Department of Public Health
Solange Gould, Office of Health Equity, California Department of Public Health
Wendy Hetherington, Riverside County Department of Public Health
David Holstius, Bay Area Air Quality Management District
Trav Ichinose, Orange County Department of Public Health
Melissa Jones, Executive Director, Bay Area Regional Health Inequities Initiative
Tammy Lee, Alameda County Health Department
Meredith Milet, Office of Health Equity, California Department of Public Health
Julie Nagasako, Fusion Center for Strategic Development, California Department of Public Health
Racheline Napier, Riverside County Public Health Department
Linda Rudolph, Director, Center for Climate Change and Health, Public Health Institute
Michael Samuel, Fusion Center for Strategic Development, California Department of Public Health
Paul Simon, Los Angeles County Department of Public Health
Latesa Slone, California Department of Public Health
Jason Vargo, Office of Health Equity, California Department of Public Health
HPI Communications Advisory Team
Elizabeth Baca, California Office of Planning and Research
Rye Baerg, Southern California Council of Governments
Dalila Butler, PolicyLink
Lianne Dillon and Julia Caplan, California Strategic Growth Council, Health In All Policies Team
Solange Gould and Meredith Millet, California Department of Public Health, Office of Health Equity
Melissa Jones, Bay Area Regional Health Inequities Initiative
Jennifer Lopez, Kaiser
Kate Meis and Paul Zykofsky, Local Government Commission
Sarah Reyes, The California Endowment
Kathi Shaff, Berkeley Media Studies Group
Kerri Timmer, Sierra Business Council
Elva Yanez and Rob Baird, Prevention Institute
Special Thanks to Our Funders
The California Endowment
Kaiser Foundation Hospitals