How healthy is your community? Building a new wellness index
How do you know if the people within a community are healthy? It’s a question at the heart of public health research and policy, yet gaps in data collection can make it difficult to track and understand the key factors that drive greater community well-being.
In 2019, Boston University School of Public Health, led by the Biostatistics and Epidemiology Data Analytics Center (BEDAC), and the digital health company Sharecare agreed to a five-year partnership to mine health and community data to create a more comprehensive index for determining community health.
The result is the newly created Community Well-Being Index, which combined data from the existing Well Being Index (WBI) and the newly derived Social Determinants of Health Index (SDOHi) to help researchers understand the full impact that environment has on one’s overall health, from access to healthcare to supportive relationships within that community.
“This effort will improve the health of all, by providing information to all,” said Kimberly Ann Dukes, executive director of BEDAC, who led the School of Public Health team on the project. “We’re providing information to help people who are in vulnerable communities, or who are vulnerable personally, and providing policymakers the ability to make decisions based on data.”
How to build a better index
To build this new index and data platform, researchers and officials from Sharecare, a digital health information company, combined two health data indexes: The WBI and the SDOHi. These indexes contain valuable individual information to provide an overall picture of the health and well-being of the greater community.
The WBI includes indicators such as:
- Physical health
- Financial security
- The safety and quality of one’s community
- Sense of purpose
- The quality of social relationships
The SDOHi includes indicators such as:
- Healthcare access
- Resource access, such as libraries and religious institutions
- Food access, such as access to grocery stores and healthy food
- Housing and transportation affordability and availability
- Economic security, such as rates of employment and labor force participation
In 2019, when BUSPH and Sharecare announced their five-year partnership, the organizations began collecting over 600 data points using various spatial and temporal scales, including the American Community Survey, United States Department of Agriculture, Area Health Resources, National Park Service, United States Geological Survey, Centers for Disease Control and Prevention (CDC), National Aeronautics and Space Administration, and more.
The newly developed Community Well-Being Index gives equal weight to county-level WBI and SDOHi scores and then aggregates county-level scores with weights proportional to county population sizes. The CWBI now provides data representation across 3,140 counties in the United States, or roughly 99.9% of the country.
Public health policy driven by data
The resulting Community Well-Being Index now includes more than 3 million individual assessments of well-being and the factors that shape it, creating a vast set of data from which researchers and partners in the private sector can draw upon to create better informed public health policy.
“I don’t believe there’s another resource like this that is available academically,” Dukes says. “Nobody’s done this before.”
By considering a wider range of factors that influence well-being and including factors such as marginalization, pollution, and economic and educational opportunities, it is expanding the concept of social determinants of health and providing a fuller picture of community well-being, right down to individual neighborhoods, for researchers looking for public health solutions and answers to public health policy questions.
“The innovation is in taking the individual and placing them in their context,” says Sandro Galea, dean of the School of Public Health and Robert A. Knox Professor. “This is a partnership between us and Sharecare to help advance what they’ve done before to the next level.”
The 2019 CWBI report
Part of the partnership between BUSPH and Sharecare is the release of the Community Well-Being Index 2019 State Rankings report showing which states are excelling in community health, and which are in the greatest need of improvement.
Topping the list of states who are doing a good job addressing community health are:
- Hawaii
- Massachusetts
- New Jersey
- New York
- California
In the lowest percentile for well-being are:
- Alabama
- Kentucky
- Arkansas
- West Virginia
- Mississippi
One of the more interesting takeaways from the new Community Well-Being Index is that rural communities, on average, score one point lower than those in urban communities, largely because of the community-level social determinants and health factors that shape overall well-being and health. For example, the report found that New Hampshire comes in at #1 when looking only at individual-level well-being, but falls to #9 when taking into account community-level social determinants of health factors that also shape health, like healthcare access and quality or built environment.
“I really love this project because I enjoy working with groups of people with diverse opinions, thoughts, and specialties and getting everyone to work cohesively and speak the same language,” Dukes says. “Typically, physicians, sociologists, biostatisticians, and business executives speak different languages—and now we all speak the same language, because we all have one objective: improving health for all.”
For more information about the work being done at BUSPH, get in touch, or visit ideahub.org. And, to learn more about building healthier communities to address the effects of climate change, visit this page.
