The following measures and tools have been or could be used to evaluate recovery progress toward healthier communities after disasters.
AMERICA’S HEALTH RANKINGS®
America’s Health Rankings® is an “annual assessment of the nation’s health on a state-by-state basis.” It is a collaborative partnership between United Health Foundation, the American Public Health Association and Partnership for Prevention™, which together created the Scientific Advisory Committee that recommends improvements that will maintain the value of the comparative, longitudinal information that is collected and measured. The ranking system is based off of the World Health Organization holistic definition of health. American’s Health Rankings® has been measuring states’ population health for the past 25 years, making it the longest-running complete annual assessment of the nation’s overall population health (America’s Health Rankings®, 2014).
America’s Health Rankings® analyzes two types of measures—determinants and outcomes. The health determinants, such as air pollution and underemployment rate, account for 75 percent of the overall score and are divided into groups: behaviors; community and environmental conditions; public and health policies; and clinical care. The remaining 25 percent of the overall score are health outcomes. The system combines 27 individual core measures and 22 supplemental measures from each of these areas and merges them into one comprehensive view of the overall population health of a state. The report is ranked from 1-50, with each state being ranked against others by their health determinants score and health outcomes score. For a state to improve its health rank, focus must be on improving the determinants of health. Recently added in 2013 was a Senior Report that focuses on the population health of citizens 65 years old and above. The goal of these rankings is to stimulate conversations and actions in communities to improve the health of the state as well as the nation (America’s Health Rankings®, 2014).
COUNTY HEALTH RANKINGS
The annual County Health Rankings measures health factors for nearly every county in the United States and then ranks them for each state. It is a partnership between the Robert Wood Johnson Foundation
and the University of Wisconsin Population Health Institute (County Health Rankings, 2010). Community leaders can use the ranking system to assess baseline health status, prioritize, and organize community action plans before a disaster to inform post-disaster redevelopment planning.
The annual County Health Rankings reveals how factors such as where we live, learn, work, and play impacts health. As part of this process, County Health Rankings compiles county-health measures from national data sources (e.g., the American Community Survey and the Federal Bureau of Investigation’s Uniform Crime Reporting). These measures are then standardized and combined to produce rankings within states.
Included to encourage improvements in community and county health is an action plan called Road-maps to Health that will help guide community members in the development of a healthier community. The continuous Action Cycle provides information and action steps (listed below) for each community role and how it fits into the cycle as a whole.
- Work Together
- Assess Needs and Resources
- Focus on What’s Important
- Choose Effective Policies and Programs
- Act on What’s Important
- Evaluate Actions
- Communicate (County Health Rankings, 2013)
The County Rankings are designed to help each county understand its own unique health needs and to implement programs and policies that will improve the overall population health of the county, which will improve the overall health of the state and the nation.
SUSTAINABLE COMMUNITIES INDEX
The Sustainable Communities Index (SCI) is a set of methods to measure environmental, economic, and social conditions of cities and neighborhoods (SCI, 2014b). The conditions that SCI measures, including housing, transportation, civic engagement, education, and health systems, all affect human health (SCI, 2014b). The SCI does not provide data for each community; rather it provides a list of health objectives, the indicators of that objective, and the specific methods to measure the indicators. For example, one objective is “Increase park, open space and recreation facilities” (SCI, 2014e). The indicators of this objective are recreational area score, recreation facility access, and community garden access (SCI, 2014e). Recreation facility access is measured by calculating the number of people living within ¼ mile of a community recreational facility, then dividing that number of people by the total number of people in the neighborhood (SCI, 2014d). This measurement—the percentage of people who live within ¼ mile of a facility—is used as an indicator of how well a community is achieving the objective to “Increase park, open space, and recreation facilities.” Using these tools, a city can measure how and where the community needs improvement and use the data to guide policy, planning, and development (SCI, 2014b).
The development of SCI began with the Eastern Neighborhoods Community Health Impact Assessment (ENCHIA), created by the San Francisco Department of Public Health (SFDPH) to assess the health impact of the intense development happening in San Francisco in the early 2000s (SCI, 2014c). The experience with ENCHIA led to the development of the Healthy Development Measurement Tool (HDMT), which was designed to support evidence-based and health-oriented planning for development projects (SCI, 2014c). Over the next several years, the HDMT was applied to planning projects in San Francisco, as well as adapted for use in cities including Denver, Colorado, Philadelphia, Pennsylvania, and Geneva, Switzerland (SCI, 2014c). In 2012, the Sustainable Communities Index was launched, building on the experiences with ENCHIA and HDMT (SCI, 2014c).
The SCI and its predecessors have been used in both large and small communities to guide planning
for projects ranging from the location of a new preschool in Bernal Heights, California, to recovery after a hurricane in Galveston, Texas (SCI, 2014a). After Hurricane Ike, Galveston was faced with the challenge of rebuilding housing and neighborhoods; one of the hardest-hit neighborhoods contained the majority of all public housing. This rebuilding gave Galveston the opportunity “to make housing and neighborhood development choices that promote a healthier future” (Nolen et al., 2014, p. 4). The SCI was adapted for the local context of Galveston, and through a community engagement process, 23 indicators were chosen (Nolen et al., 2014). Indicators were chosen based on their link to health outcomes, especially for low-income residents. Indicators included, for example:
- Proximity to parks and recreational facilities
- Proximity to elementary schools
- Proximity to health care services
- Density of stores selling alcohol
- Presence of environmental hazards (Nolen et al., 2014)
The indicators were divided into neighborhood-level, block-level, and unit-level (Nolen et al., 2014). Data on these indicators were collected and analyzed and then used to develop recommendations on how to rebuild Galveston in a way that mitigates health-harming conditions and encourages choices that have a positive impact on health (Nolen et al., 2014).
HEALTHY COMMUNITIES TRANSFORMATION INITIATIVE
The U.S. Department of Housing and Urban Development (HUD) has recently launched the Healthy Communities Transformation Initiative (HCTI) and is in the process of developing two key tools for the initiative: the Healthy Communities Index (HCI) and the Healthy Communities Assessment Tool (HCAT). The goal of the HCTI, and its associated tools, is to help local communities “assess the physical, social, and economic roots of community health” and to use this assessment to inform evidence-based policies, planning, and development (HUD, 2014).
The HCI will be comprised of standardized healthy community indicators chosen based on their link to health outcomes, ease of measurability, and relationship to established national public health objectives. The indicators will cover topics ranging from housing to employment to social participation. These indicators can be used to assess the baseline status of a community’s health and then to track progress as the community moves forward. The HCI indicators will form the basis for the HCAT, which will facilitate the use of the indicators and also feature tools to help communities select and prioritize objectives. For example, the HCAT may include a guideline of recommended health targets, or provide sample policies designed to improve community health (HUD, 2014).
The AARP Public Policy Institute developed and launched the Livability Index in April 2015. The Livability Index measures the livability of a community based on individual preferences, objective indicators, and policy interventions. Users can search the index by address, ZIP Code, or community. The index will generate an overall score as well as a score for seven major livability categories: housing, neighborhood, environment, health, transportation, engagement, and opportunity. Through this effort, AARP is working to identify what is considered a “livable” community by the 50+ population; provide a framework for local and state changes in policy, planning, and investment; inform residents about what it means to be a livable community, thereby allowing them to make informed choices; and encourage participation in community change. The Livability Index serves as a Web-based tool, integrating mapping technology, preference survey results, quantitative measures, and public policies. It also incorporates nationally available data to yield a better understanding of the needs of the older adult population (AARP, 2015).
SOCIAL VULNERABILITY INDEX
Developed in 2003 by Cutter et al., the Social Vulnerability Index (SVI) is “intended to spatially identify socially vulnerable populations, to help more completely understand the risk of hazards to these populations, and to aid in mitigating, preparing for, responding to, and recovering from that risk” (Flanagan et al., 2011, p. 16). The Social Vulnerability Index has four domains: socioeconomic status, household composition and disability, minority status and language, and housing and transportation. The source of data for this model is 15 census variables from the 2000 U.S. Census of Population and Housing at the census tract or “community” level. For each community in the nation, the SVI toolkit provides an SVI value for each of the 15 census variables, each of the four domains, and an overall SVI. Also included in the report were flags, representing a percentile ranking of 90 or higher for each of the variables and domains as well as the total flags for each tract (Flanagan et al., 2011).
The Social Vulnerability Index can be used during all phases of a disaster to inform decision making. The SVI was used after Hurricane Katrina, for example, to understand the impact of the disaster and recovery progress in New Orleans. Areas with socioeconomically vulnerable populations were found to have recovered more slowly from heavy flood damage than those without socioeconomically vulnerable populations. By using the Social Vulnerability Index, state and local agencies may better identify vulnerable populations, allowing disaster recovery decision makers to better target and support community-based disaster mitigation and preparedness (Flanagan et al., 2011).
AARP. 2015. Livability index. https://livabilityindex.aarp.org/livability-defined (accessed June 17, 2015).
America’s Health Rankings®. 2014. About the annual report. http://www.americashealthrankings.org/about/annual (accessed December 4, 2014).
County Health Rankings. 2010. Our approach. http://www.countyhealthrankings.org/our-approach (accessed December 1, 2014).
County Health Rankings. 2013. Action center. http://www.countyhealthrankings.org/roadmaps/action-center (accessed December 4, 2014).
Cutter, S. L., B. J. Boruff, and W. L. Shirley. 2003. Social vulnerability to environmental hazards. Social Science Quarterly 84(2):242-261.
Flanagan, B. E., E. W. Gregory, E. J. Hallisey, J. L. Heitgerd, and B. Lewis. 2011. A social vulnerability index for disaster management. Journal of Homeland Security and Emergency Management 8(1).
HUD (U.S. Department of Housing and Urban Development). 2014. HUD Healthy Communities Transformation Initiative. http://healthyhousingsolutions.com/wp-content/uploads/2014/11/HUD_HCTI_project_overview_FINAL.pdf (accessed June 17, 2015).
Nolen, L., J. Prochaska, M. Rushing, E. Fuller, J. E. Dills, R. Buschmann, C. Miller, S. Tarlekar, H. Avey, E. Ruel, and D. Oakley. 2014. Improving health through housing and neighborhood development in Galveston, Texas: Use of health impact assessment to develop planning tools and coordinated community action. http://www.pewtrusts.org/en/~/media/Assets/External-Sites/Health-Impact-Project/GalvestonHIAFinalSummaryReport1 (accessed December 4, 2014).
SCI (Sustainable Communities Index). 2014a. Case studies. http://www.sustainablecommunitiesindex.org/case_studies.php (accessed October 20, 2014).
SCI. 2014b. Frequent questions. http://www.sustainablecommunitiesindex.org/webpages/view/46 (accessed October 20, 2014).
SCI. 2014c. History. http://www.sustainablecommunitiesindex.org/webpages/view/47 (accessed October 20, 2014).
SCI. 2014d. Indicator PR.3.B recreation facility access. http://www.sustainablecommunitiesindex.org/indicators/view/92 (accessed October 20, 2014).
SCI. 2014e. Measures. http://www.sustainablecommunitiesindex.org/indicators (accessed October 20, 2014).