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Context

margauxf

The Global Burden of Disease (GBD) study that the authors reference and model their call to action around is the worlds' largest scientific effort to quantify trends in health. It is lead by the Institute foe Health Metrics and Evaluation (IHME) at the University of Washington. It began in 1990 as a World Bank-commissioned study and is known for having introduced the disability-adujusted life year (DALY) as a new metric to quantify the burden of disease, injuries, and risk factors (or determinants), and enable comparisons. 

The 1990s were  a turning point for global health structures of governance and knowledge production, which the GBD study exemplifies. Global health experts began increasingly reframing health and healthcare in technical terms like DALY, removing health from public governance in ways that complemented and bolstered structural adjustment policies that were introduced in the 1980s (Janes 2004). As a result of these policies, the size, scope and reach of healthcare delivery and public health services were steadily reduced and downgraded. Anthropologists have been critical of these processes and other perceived failures in global health: the collapse of primary care initiatives fostered at Alma Ata in 1978, the resurgence of selective forms of primary care and vertical public health programs, and the ascendency of the World Bank as the principal health policymaking institution (Janes 2004, 2009).

Janes, Craig R (2004). "Going global in century XXI: medical anthropology and the new primary health care." Human Organization 63, no. 4: 457-471.

Janes, C. R., & Corbett, K. K. (2009). Anthropology and global health. Annual Review of Anthropology, 38, 167–183. doi:10.1146/annurev-anthro-091908-164314

Songs as artifacts

sharonku

There are manu artifacts mentioned in your fieldnote--songs, stories, fishing tools, grocery stores, etc. How do you analyze these artifacts--why and how were they constructed, used? What are the social, economic, cultural meanings/functions of these artifacts? And how have these artifacts helped construct the sense of place and identity of the Naluwan people?

10.What steps does a user need to take to produce analytically sharp or provocative data visualizations with this data resource?

margauxf

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.

 

8. How has this data resource been critiqued or acknowledged to be limited?

margauxf

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.).

6. What visualizations can be produced with this data resource and what can they be used to demonstrate?

margauxf

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).

5. What can be demonstrated or interpreted with this data set?

margauxf

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.