Analyze

I published this news article about a hunger strike against Formosa Plastics that occurred in Texas this fall. Despite the extremity of a 30-day hunger strike, the protesting tactic has not gained attention from national media outlets. At the time I published this article, two small environmental organizations had announced the beginning of the strike, but none continued to cover the event in the unfolding weeks. While activists are driven to take on dangerous protest tactics, little communication of these tactics has carried across mass media.

The article itself introduces Formosa Plastics through its reputation as a "serial offender" of environmental and workplace safety regulations. I list several statistics on legal fines that Formosa Plastics has accumulated overtime, using these quantities to demonstrate the scale of their harm to environmental and human health. An important limitation of this storytelling strategy, however, is that many of Formosa Plastics' actions go undocumented, and even when documented, do not lead to legal consequences. Furthermore, we should still strive to acknowledge the harms committed by Formosa Plastics that are technically within legal limits.

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.).

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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

The California Student Health Index is made available by the California School-Based Alliance, a statewide organization on a mission to put health care in schools in California, which has lagged behind other states in supporting the establishment of school-based health SBHCs. The alliance aims to increase the number of SBHCs in California to 500 by 2030. There are currently 291 SBHCs in California (and over 10,000 K-12 schools). They are generally implemented by local districts, community organizations, healthcare providers, and school leaders rather than by state officials. Funding also typically follows a grassroots model (placing the burden on local communities), despite the funding California received ($30 million in 2011-2012) from the Affordable Care Act ACA to build and expand SBHCs (out of $200 million nationwide).

According to the California School-Based Alliance, SBHCs offer a step forward towards health and education equity by providing easy and safe access to healthcare, addressing physical, mental, social, and emotional health, and offering integrated healthcare through coordination between schools and community health care providers. The establishment of SBHCs has been recommended by the Center for Disease Control’s Community Preventative Services Task Force based on evidence that they improve educational outcomes for low-income populations and generally promote health equity.

The Student Health Index is intended to support these goals by providing a quantitative analytical tool that supports statewide advocacy to increase and maintain the number of SBHCs, build awareness of the interrelations between health and education, and to provide access to comparative tools for parsing publicly available local data in ways that can help communities and stakeholders identify opportunities to improve health care access in schools.