HOI INDICATORS.
Consumer Profile
The consumer profile of the HOI is a measure of the consumer resources available within a community and includes social needs such as housing and transportation which affect health and well-being. Rural-Urban disparities exist in the access to social resources, which influences population health. The indicators in this profile include, Affordability, Townsend deprivation, population churching, and population weighted density indicators.
Affordability Index:
Affordability indicator is the proportion of a household’s income spent on housing and transportation which influences disposable income available for other priorities, including food, healthcare, and social activities. The cost of housing and transportation consumes about half of the average household budget (U.S Department of Housing and Urban Development, 2023).
Affordability index estimates the trade-offs that households make between housing and transportation costs and the savings they derive from living in communities that are near shopping, school, work, and boast a transit-rich environment (Brookings Institution, 2006).
The index provides consumers, policymakers, lenders, and investors with the information needed to make better decisions about which neighborhoods are truly affordable and showcases the implications of policy and investment choices (Brookings Institution, 2006).
Population Weighted Density Index:
The population-weighted density indicator captures the density at which the average individual lives. The Population-weighted density index is critical to better understand the spatial differences between rural and urban populations (Stankowski, 1972).
The index is calculated by dividing the total population-weighted by the square miles in the area. The higher the index score, the higher the concentration of people per square mile. Population-weighted density can be a useful tool to control and manage outbreaks, particularly during the early stages of spread. Population-weighted density is a better measure than conventional density, because the variation in density across the subareas matters more than the density in the total area for contagious diseases such as COVID-19 (Yuce et al., 2024).
Population Mobility Index:
Population Mobility rate is a standardized measure of the movement of individuals in relation to the total population in a given geographic area over a time period.
The in-migration can bring an influx of social capital, and new businesses and employment opportunities (Ogojiaku et al. 2020). Out-migration can lead to the disruption of local services that are critical to health and wellness. Population mobility rates can provide a useful measure of the potential disruption to local services caused by migration into and out of a given area which can influence public health interventions (Ogojiaku et al. 2020).
In the study by Handley et al. (2020), population turnover in a community significantly moderated the association between socioeconomic deprivation and psychiatric admission rates. Areas with higher residential churn exhibited greater social gradients in psychiatric admission rates and exacerbated the negative effects of economic deprivation on mental health (Handley et al.2020).
Townsend Material Deprivation Index (TMDI):
TMDI is a composite measure of material deprivation in a geographic area. Material deprivation entails the lack of goods, services, resources, amenities, and physical environment which are typically found in the society under consideration (Pampalon et al., 2012). A higher TMDI score means a higher degree of deprivation.. The indicators used to calculate TMDI include:
Unemployment: this indicator measures the proportion of economically active residents who are unemployed (Yousaf and Bonsall, 2017). Studies show that people with a disability and some racial and ethnic minority groups are more likely to experience unemployment (Avendano & Berkman, 2014). Unemployment is associated with a higher risk of developing chronic conditions such as stroke, heart attacks, heart disease, and arthritis (Robert Wood Foundation, 2013). A good-paying job makes it easier for workers to live in healthier neighborhoods, access nutritious food, all of which affect health (U.S Department of Health and Human Services,2023).
Non-car ownership: is the proportion of households that do not have a car. Transportation challenges influence an individual’s access to health care services and can result in missed or delayed health care appointments and overall poorer health outcomes (American Hospital Association, 2024). Transportation challenges affect rural and urban communities (American Hospital Association, 2024).
Non-home ownership:is the proportion of households that are not owner occupied. Housing is an important social determinant of health. Poor housing conditions or a lack of housing can negatively impact health and wellbeing. Homeowners are more likely to address poor housing conditions and make housing improvements, hence, better health outcomes (Haurin et al., 2002). Home ownership could also impact on psychological health, by providing a sense of physical and emotional security, neighborhood associations, socialization, and a sense of control over an individual’s life (Elsinga et al., 2008; Rohe and Stegman, 1994).
Overcrowding:: crowding is defined as housing units with more than one person per room (Blake et al., 2007). When the rental market becomes unaffordable, people may be forced to move in with others, potentially resulting in crowding (Healthy People, 2030). Crowding may affect sleep, mental health, increase stress levels, and it may increase the risk for infectious disease (U.S Department of Health and Human Services, 2023).
Social Impact Profile
The Social Impact Profile is a measure of disparate access to health services within a community. Social factors have a powerful role in shaping health across a wide range of health indicators, settings, and populations (Braveman and Gottlieb, 2014).
This profile demonstrates the direct influence of social factors on the opportunity of all Virginians to live a long and healthy life. The profile includes the following indicators: Education, access to care, spatial segregation, and incarceration indicators.
Education Index:
Education indicator is a measure of the average number of years of schooling among adults in a community (Benneth, 2001). The index can range from zero (those with no formal schooling) to 20 (those with a doctorate /professional degree). Empirical literature has used average years of education as a proxy of human capital stock. Higher levels of human capital stock leads to faster technological development and higher growth rates because education and skills training are crucial in avoiding poverty traps. Education is a powerful driver of worker mobility, economic growth and ultimately positive health outcomes (Ehrlich, 1990; Romer, 1990; Saint-Paul & Verdier,1993; Solow, 1991).
Access to Healthcare Index:
The Agency for Healthcare Research and Quality (2024) describes “access to care’’ as the timely use of personal health services to achieve the best health outcomes. Access to health care consists of four components, which include, insurance coverage, availability of services, timeliness of receiving services, and workforce availability (AHRQ, 2024).
Access to care indicator measures “physician availability” as the ratio of physician FTEs to total population within a threshold travel distance of 30 miles from the physician’s geographic location. Subsequently, the physician-population ratios around each geographic location and based on a population-weighted centroid are summed. The sum is then added to the uninsured population to obtain access to care index.
Spatial Segregation Index:
Racial and ethnic residential segregation (RERS) is the isolation of poor and/or racial minorities that live in communities and neighborhoods separated from those of other socioeconomic groups (Hahn, 2017). However, spatial segregation index/dissimilarity index (most common measure of racial and ethnic segregation) measures how different the population composition of a sub-area (e.g county) is from the population composition of the state as a whole. It includes measures of both community diversity and the distance between communities with different racial or ethnic profiles.
The dissimilarity index varies from 0 (i.e., no residential segregation) to 100 (i.e., total residential segregation) (Massey & Denton 1988).Residential segregation and neighborhood-level socioeconomic inequality are central dimensions of social stratification and structural determinants of health that influence access to quality education, good housing, job access, and other socioeconomic factors that influence health (Steale & Arcaya, 2023).
Incarceration Index:
The Prison Policy Initiative’s incarceration rate is the number of people incarcerated in the United States per 100,000 people. This includes people in state and federal prisons, local jails, immigration detention, and juvenile justice facilities (Prison Policy Initiative, 2024).
The Prison Policy Initiative (2024) reported that the U.S has the highest incarceration rate of any independent democracy worldwide. Incarceration can affect the health and well-being of those currently incarcerated, those with a history of incarceration, their families and communities (U.S. Department of Health and Human Services, 2024).
Studies have shown that when compared to the general population, people with a history of incarceration are in worse physical and mental health (U.S. Department of Health and Human Services, 2024). Incarcerated people are more likely to have high blood pressure, asthma, cancer, arthritis, and infectious diseases like HIV and hepatitis C.
The Economic Opportunity Profile
The Economic Opportunity Profile is a measure of the economic opportunities available within a community. Economic opportunity is positively associated with health behaviors and self-reported health. Policies seeking to expand economic opportunities might have important cascading effects on health (Venkataramani et al., 2016). The profile includes the following: income inequality and job participation rate indicators.
Income Inequality (GINI Coefficient) Index:
The income inequality indicator refers to the extent to which income is evenly distributed within a population (International Monetary Fund, 2022). Income inequality is a marker of the unequal distribution of goods and services in a community (Marmot, 2024). Gini coefficient is a typical measure of income inequality. The coefficient varies between 0 and 1, with 0 representing perfect equality and 1 perfect inequality (IMF, 2022).
Gini coefficient measures the diversity of actual earned income in a neighborhood (Ogojiaku et al., 2020). The income inequality gap between the rich and poor is at high levels and continues to rise (Mdingi and Ho, 2021).
Although income inequality might itself be a driver of economic opportunity, the association between economic opportunity and health is independent of and distinct from the association between area-level income inequality and health (Venkataramani et al.,2016). Previous studies have shown that high income inequality (high income gap) has a negative impact on the health of a population (Marmot, 2024).
Labor Force Participation Index:
The civilian labor force participation rate is the number of civilians employed and unemployed (but looking for a job), as a proportion of the civilian population within the age group of 16 to 64 years (Trading Economics, 2023).
The Job participation indicator is a cardinal indicator of economic growth and income, both of which influence individual and community health (Ojoniaku et al., 2021). The indicator is sensitive to the following local community attributes, such as educational attainment, car ownership and household composition, all of which can influence the employment rate in an area (Ojoniaku et al., 2021).
Salary aid programs that impact socioeconomic determinants of health are important public health predictors and are closely associated with health outcomes (Hellmann et al., 2023). There is evidence that labor force participation is an important contributor to mental wellbeing (Hellmann et al., 2023).
Built Environment Profile
The built environment profile is an indicator of a community’s natural, built, and social environment. Indicators of this profile influence population health. The burden of chronic diseases in the population is amenable to reduction through an active lifestyle, adequate nutrition, and reduced exposure to toxic environmental conditions (Perdue et al., 2003). The indicators include, Air quality, walkability, employment access, and food access indicators.
EPA Hazard Index:
The air quality indicator includes the Environmental Protection Agency’s (EPA) measures of pollution, including on-road, non-road, non-point pollution, and measures of neurological, cancer, and respiration risk (EPA, 2024). The EPA’s National-Scale Air Toxics Assessment (NATA) provides estimates of the risk of cancer and other serious health effects from inhaling air toxics (O’Neil et al., 2019).
The NATA is EPA’s ongoing review of air toxics in the United States (Johnson et al., 2020). Toxic air pollutants, or hazardous air pollutants (HAPs), are chemicals that, at sufficient concentrations and exposures, are known or suspected to cause cancer and other serious health problems or cause adverse environmental effects (Christian et al., 2016). The assessment from NATA can inform both national and more localized efforts to identify and prioritize air toxics, emission source types, and locations which are of greatest potential concern in terms of contributing to population health risk (O’Neil et al., 2019).
Employment Accessibility Index:
The index is a measure of the number of jobs accessible to members of a given community. Accessibility is determined by distance. Jobs closer to where people live are more accessible than jobs farther away. Job accessibility in a zone is defined as the number of jobs that are accessible within a given commuting time by a particular mode of transportation for a worker living in that zone (Kawabata, 2006).
Many existing studies measured job accessibility as a function of the sum of total job opportunities weighted by the travel impedance in terms of the distance or time between the origins (residences) and destinations (workplaces) of a study area (Liu and Kwan, 2020).
Access to employment is a key factor in the health of an individual (Roberts, 2021). An individual involved, engaged and active in the community is a healthier individual overall (Roberts, 2021).
Walkability Index:
The index is a measure of how walkable a community is based on residential and employment density, land use (destination) diversity, street connectivity and public transit accessibility. Research demonstrates a relationship between the environment, and physical activity behavior of a community (IPEN, 2009). Regular physical activity prevents and mediates noncommunicable diseases such as heart disease, stroke, diabetes, and colon cancer. Physical activity is valuable in preventing hypertension and obesity and can improve mental health, quality of life and overall well-being (AHA, 2024).
The walkability index is derived from four variables that includes the residential and employment density, which measures the concentration of activity types within a walkable area and represents the total activity per acre of land-use. Land use diversity is another variable that measures a mix of activities within an available walkable area and represents the range of land use per census tract (Ogojiaku et al. 2020).
The third variable factored into the walkability index is design of the built environment, which measures the degree of connectivity for safe pedestrian travel, such as the number of street crossings by census tract. The fourth variable is the distance to transit, which measures the level of accessibility for pedestrians to reach a transit stop. The indicator is the aggregate frequency of transit services per square mile (Ogojiaku et al. 2020).
Food Accessibility Index:
Food accessibility indicator is a measure of the access to healthy food by low-income people within a community, based on distance travelled to the nearest supermarket, supercenter, or large grocery store. It measures the proportion of the low-income community that has a large grocery store within 1mile in urban areas or 10miles in rural areas (USDA, 2024). Studies suggest that some areas have easier access to fast food restaurants and convenience stores but limited access to supermarkets (Ver Ploeg et al, 2009). A study found that distance, lack of transportation, limited resources, travel time to the nearest store may influence the choice of stores to shop for food (Ver Ploeg et al, 2009).
Limited access to supermarkets, grocery stores, or other sources of healthy food may make it harder to eat a healthy diet. Relatively easier access to less nutritious food may be linked to poor diets and to obesity and diet-related diseases (Babey et al., 2008; Saurez et al., 2015).
HOI Indicator/Profile References