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“...Toxic Wastes and Race at Twenty (Bullard et al., 2007) revealed that communities of colour and poor communities were still being used as dumping grounds for all kinds of toxic contaminants. The authors discovered evidence that the clustering of environmental hazards, in addition to single sources of pollution, presented significant threats to communities of colour. Furthermore, the research showed that polluting industries frequently singled out communities of colour in siting decisions, countering the “minority move-in hypothesis”: the claim that people of colour voluntarily move into contaminated communities rather than being targeted in situ by dirty industries.” (122)

“Bullard (1990) has highlighted the problem of “Black Love Canals” throughout the United States, where issues of environmental injustice are deeply connected with environ- mental racism. For example, Bullard highlights the case of toxic DDT water contamination in the African American community of Triana, Alabama. In 1978, in the midst of the national media attention focused on Love Canal, residents in Triana raised complaints over ill-health effects and contaminated fish and waterfowl. Lawsuits in Triana against the Olin Corporation continued throughout the 1980s. Although the case is noted within environ- mental justice histories (see Taylor, 2014), it is not widely recognized or commemorated.” (126)

“Underpinning the slow, structural violence (see Galtung, 1969; Davies, 2019) of unequal and unjust toxic exposures is the problem of “expendability” … Pellow (2018) proposes that indispensability is a key pillar of critical environmental justice studies (alongside intersectionality, scale, and state power). This idea builds on the work of critical race and ethnic studies scholar John Marquez (2014) on “racial expendability” to argue that, within a white-dominated society, people of colour are typically viewed as expendable.” (127)

“National and international media headlines followed the Flint water crisis story as it unfolded, but, after the initial shock, Flint faded from media attention. It shifted from being a spectacular disaster to a case of slow violence. This paral- lels the dynamics of public memory surrounding many toxic disasters, struggles, and legacies.” (128)

The author’s main argument is two-fold. Acute environmental disasters (e.g., Chernobyl, BP Horizon Spill, Hurricane Katrina) that garnered public attention leave behind legacies of increased support for environmental action and legislation, although the public attention span is often too short for lasting change. At the same time, these disasters have received a disproportionate amount of public attention compared to the many more slow-moving toxicity disasters that affect people in more systematic but often less visible ways. Examples of this disparity include the contrast between the 1984 Bhopal disaster coverage, and the persistent toxicity in the area in the time since then in the form of industrial waste and infrastructure that is not maintained. It is additionally important to note that the cases that don’t receive much attention often affect marginalized groups (by race, socioeconomics) disproportionately.

Creators of the Student Health Index recommend using the tool in combination with qualitative data collection and stakeholder/community engagement (e.g. working with school leaders, local community leaders, and healthcare providers).

A full guide to using the dashboard is available here.

Data sources utilized by the index are not always the most current due to data collection limitations (e.g. covid-19 has caused disruptions in the collection of CDE data).

The Index is limited in that it does not offer data for schools that were not large enough to warrant the construction of a School-based Health Center. Thus, schools that did not meet specific enrollment targets were excluded from the dashboard. This includes rural schools (designed as such by the USDA) with an enrollment under 500 students, urban schools (without a high school) with less than 500 students, and urban schools (with a high school) with less than 1000 students. California had more than 10,000 active public schools in 2020-21. The final dashboard for the Student Health Index includes 4,821 schools.

The lack of available data on health indicators at a school-level restricted the Student Health Index to using proxies for the health outcomes. Some health indicators are included, but they are not school-specific, instead linked to specific schools geographically through the census tract. However, community-level data does not always accurately reflect the characteristics of a school’s population. As a result, school-level indicators in the Index were weighted more heavily than community-level indicators.

Additionally, race was not included as a measure in the Student Health Index because of California’s Proposition 20, which prohibits the allocation of public resources based on race and ethnicity. However, the dataset does contain measures of non-white students at each school. 

The Index has also been limited as a quantitative measure of need, which may overlook the influence of other factors that might be better illuminated through qualitative evidence (e.g. stakeholder engagement, focus groups, interviews, etc.).

No information thus far

The Student Health Index can produce visualizations that represent data on conditions, school characteristics and risk factors that affect education outcomes and could be improved through access to school-based health care. These visualizations can be used to demonstrate need for expanding school-based health care access in California.

In addition to maps, the index can also be used to generate graphs and visual displays of data (e.g. ratio of highest need schools to all schools, by county).

The visualizations can be used to demonstrate the correlations between final need scores and race, the impact of specific indicators in health, and the concentration of need to certain regions of California (hot spot analysis).

The Student Health Index enables users to identify where SBHCs will have the most impact for students. The index uses 12 indicators, each of which can be scored from 1 to 4 for any given school. These scores are generated using percentiles and represent relative values. The 12 indicator scores are combined into a Need Score, which is calculated using percentiles along a scale of 1 to 4. Schools with a score of 4 (in the 4th quartile) have the highest Need scores relative to other schools in California.

The index is composed of 12 diverse indicators (percentages, rates, and index values) that have been transformed using percentiles in order to enable comparisons on a common scale. These indicators are divided into 3 categories: health indicators, school-level indicators, and socioeconomic indicators.

Health Indicators

1. Diabetes
2. Asthma ED admissions
3. Teen birth
4. Health Professional Shortage Areas (HPSA)

Socioeconomic Indicators

1. Poverty among individuals under 18
2. Uninsured among under 19
3. Healthy Places Index

School-Level Indicators

1. Percent FRPL (students eligible for free or reduced-price meals)
2. Percent English Learners
3. Percent Chronically Absent
4. Percent experiencing homelessness
5. Suspension rate

Other Data

1. Mental health hospitalization rate
2. Percent in foster care

Indicator selection was guided by CDC estimations on the primary contributing factors that shape health (social determinants of health, medical care, and health behaviors). The indicators included in the index are all either directly associated with the absence of health services that could be provided at a school level, act as proxies for health behaviors, or represent social determinants of health that could be addressed through access to school-based health services.

Indicator selection was influenced by recommendations from the Research Initiative of the Campaign for Educational Equity at Columbia Teachers College, which found that seven health disparities affecting school-aged youth could be addressed through school health programs. These disparities include: (1) vision, (2) asthma, (3) teen pregnancy, (4) aggression and violence (including bullying), (5) physical activity, (6) hunger, and (7) inattention and hyperactivity.

More detailed description of the rationale shaping indicator selection is available here.

Census tract, school-level

The Student Health Index draws from data that is publicly available and up to date on a statewide level. Sources include the University of California San Francisco Health Atlas, the American Community Survey, the U.S. Census Bureau, the California Department of Education’s Downloadable Data Files site, and the CDC.

Detailed list of sources:

PLACES Project, CDC (available through the UCSF Health Atlas)

CalEnviroScreen (available through the UCSF Health Atlas)

Opportunity Atlas (available through the UCSF Health Atlas)

Health Resources and Services Administration (available through the UCSF Health Atlas)

American Community Survey (available through the UCSF Health Atlas)

California Department of Education’s Downloadable Data Files site

Kidsdata.org