Analyze

"An EJ approach could provide new and different tactics to prisoner advocates and their allies.  If we understand death row inmates to be a particularly vulnerable population, could the EPA itself become more involved in monitoring conditions, and if so, what are the benefits or risks of such an approach? " (219)

"Instead of environmentally invisible spaces, death row should be viewed as involuntary state homes and therefore particularly deserving of attention and regulation. " (220)

"the EPA’s unique powers can be characterized as (1) information gathering, and (2) enforcement actions.93  The EPA’s tools apply to carceral facilities as they would any other business or agency.  By statute, the EPA has the authority to enter and inspect facilities, to request information, and assist facilities in developing or remedying violations." (220) ...  "Individual EPA offices have at times attempted to examine the conditions of incarceration at several federal facilities, primarily through information gathering.  For example, under an agreement between the EPA and the federal Bureau of Prisons (BOP) in 2007, over a dozen facilities were audited for environmental hazards.100  These consent arrangements can promote environmental improvement by limiting the potential sanctions for discovered violations." (221)

"Through an environmental justice lens, we may see patterns that were previously hidden.  Unlike traditional prisoner advocacy tools, environmental assessments include cumulative impacts over time and in context, rather than single isolated acts." (224) ... "A pattern-based approach may help to discern the underlying factors that result in diagnoses like Glenn’s. " (225)

"An EJ approach fundamentally centers the voices of the impacted and allows for contextual reasoning.  Although carceral facilities, and death row in particular, are externally perceived as sites of punishment, incarcerated people may have a different view.  Glenn Ford’s cell, where he was confined days at a time, was his involuntary home.  Viewing jails and prisons as homes illuminates the humanity of the people who live there.  Understanding these spaces as homes underlines the need for carceral facilities to be safe and for individuals to be protected from all types of harm, environmental and otherwise.124 " (225)

"Based on Glenn Ford’s experience, the conditions on death row in Louisiana can be grouped into the following environmental hazards:  indoor air pollution, water pollution, hazardous waste, and exposure to lead." (217)

"Glenn’s story of the conditions on death row is a story about environmental justice.  His accounting forces us to see prisons as involuntary homes, where residents are held captive to environmental harms.  Yet, the experience of Glenn and others sentenced to live on death row are largely excluded from environmental justice conversations.10" (207)

"The U.S. Environmental Protection Agency (EPA) itself has acknowledged that carceral facilities present environmental challenges.11  In 2007, the EPA noted that “[p]otential environmental hazards at federal prisons are associated with various operations such as heating and cooling, wastewater treatment, hazardous waste and trash disposal, asbestos management, drinking water supply, pesticide use, and vehicle maintenance.”12  Yet, the EPA, which is the lead federal agency for environmental justice, completely excluded jails and prisons from its 2011 planning document for addressing environmental justice through 2014.13  Similarly, the EPA’s 2020 Action Agenda for environmental justice does not even mention carceral facilities, much less recognize prisons and jails as environmentally “overburdened communities.”14 " (207)

"Data on conditions within carceral facilities is generally not available,53 and even when it is available, the data is rarely complete." (214)

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