The Virginia Health Opportunity Index
The Virginia Health Opportunity Index (HOI) is a group of indicators that provide broad insight into the overall opportunity Virginians have to live long and healthy lives based on the Social Determinants of Health. It is a hierarchical index that allows users to examine social determinants of health at multiple levels of detail in Virginia. It is made up of over 30 variables, combined into 13 indicators, grouped into four profiles, which are aggregated into a single Health Opportunity Index. The HOI is reported at both the census tract and county/independent city level.
The Community Environment Profile is a measure of the natural, built and social environment of a community. It includes the following indicators:
1. Air Quality Indicator: Includes EPA measures of pollution, including on-road, non-road and non-point pollution, and EPA measures of neurological, cancer and respiration risk.
2. Population Churning Indicator: The amount of population turnover within a community. It measure the rate at which people both move into a community and move out of a community.
3. Population Density Indicator: A measure of population density that takes into account the density levels most people in the community experience.
4. Walkability Indicator: A measure of how walkable a community is based on residential and employment density, land use (destination) diversity, street connectivity and public transit accessibility.
The Consumer Opportunity Profile is a measure of the consumer resources available within a community. It includes the following indicators:
5. Affordability Indicator: The proportion of a community’s income spent on housing and transportation. This indicates how much income remains for other priorities, including food, health care and social activities.
6. Education Indicator: The average number of years of schooling among adults in the community. It can range from zero (those with no formal schooling) to 20 (those with a doctorate/professional degree).
7. Food Accessibility Indicator: A measure of access to food by low income people within a community. It measures the proportion of the low income community that has a large grocery store within 1 mile in urban areas or 10 miles in rural areas.
8. Material Deprivation Indicator: Based on the Towsend Material Deprivation Index, it examines the private material resources available to households in a community. 4 indicators make up Towsend:
- overcrowding (>2 persons per room)
- unemployment
- % of persons no vehicle or car
- % of person who rent
The Economic Opportunity Profile is a measure of the economic opportunities available within a community. It includes the following indicators:
9. Employment Accessibility Indicator: A measure of the number of jobs accessible to members of the community. Accessibility is determined by distance: close jobs are more accessible than jobs farther away.
10. Income Inequality Indicator: The Gini Index, a common measure of income inequality, measures whether the income earned within a community is distributed broadly or concentrated within the hands of small number of households.
11. Job Participation Indicator: The percentage of individuals 16-64 years of age active in the civilian labor force. It includes both those currently working and those seeking work.
The Wellness Disparity Profile is a measure of the disparate access to health services within a community. It includes the following indicators:
12. Access to Care Indicator: Whether community members have access to a primary care physician and the means to pay for care. It includes the proportion of uninsured residents and the number of physicians within 30 miles of the community.
13. Segregation Indicator: A measure of whether and how much people of different racial and ethnic backgrounds live together in diverse communities. It includes measures of both community diversity and the distance between communities with different racial or ethnic profiles.
The Youth Well-being Index
Similar to the HOI, The Youth Well-being Index (YWBI) is a group of indicators that provide broad insight into the overall opportunity communities provide young people to live long and healthy lives. Using variables specific to Virginia residents age 18 and younger, the YWBI is made up of 24 variables combined into eight indicators. The YWBI is reported at the census tract level. The eight indicators are:
1. Crime Indicator: An indicator of crime levels using data from the Federal Bureau of Investigations Uniform Crime Report.
2. Family Stability Indicator: An indicator of a stable family situation which includes the proportion of children living in divorced or separated households, single-parent households or as foster children.
3. Housing Indicator: An indicator of housing quality that includes the proportion of housing units built before 1951 and without plumbing facilities, along with the proportion of overcrowded households defined as more than two occupants per room.
4. Population Density Indicator: The number of persons per square mile in the census tract.
5. Poverty Indicator: An indicator of stress caused by economic conditions, including measures of the proportion of children living in poverty, living in households receiving Supplemental Security Income and the proportion of households receiving public assistance.
6. Pre-K Enrollment Indicator: The proportion of 3 and 4 year old children enrolled in nursery or preschool programs.
7. Primary Care Access Indicator: The number of primary care physicians within a 30- minute drive of the census tract.
8. Psychiatrist Access Indicator: The number of psychiatrists within a 60 minute drive of the census tract.
Initial versions of the YWBI included an Education Index, which is a indicator of fourth grade math and reading prficiency. However, we found that the education indicator was as predictive of health outcomes as the other indicators combined. Additionally, the remaining indicators were predictive of the education indicator. So we have included the education index as a separate indicator with the YWBI and used it to calibrate the YWBI.