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In the interview with Emily Roehl, artist Steve Rowell describes his style in contrast to the more "didactic" approach of land use and documentary photography. Instead, he has come to combine his visual works with sound installations that are meant to unsettle. These sounds are often generated based on air pollution data that he has collected (Roehl and Rowell, 2022, p. 137). Rowell further describes how changes in the development of aerial video and photography technology have shaped his work. In the past, Rowell would rent expensive camera equipment and attach them to a helicopter to generate fly-over images (Roehl and Rowell, 2022, p. 140). Though commercial drones have become available, Rowell says that he soon got dissatisfied with the "slick" images they produce. When using drones, Rowell relies on an angle that faces down or is close-up, creating feelings of uncanniness. These unusual perspectives are combined with split imagery and mirroring to achieve a specific effect: “There’s a value in giving the viewer/listener a chance to distrust the work in the same way there’s value in giving them room to question the work. The landscapes I feature are all altered. What landscape isn’t now? That’s the point.” (Roehl and Rowell, 2022, p. 140).

Steve Rowell is an educator and research artist, currently working on “long-term projects that use image, sound, and archival practice to interrogate the relationship between humans, industry, and the environment” (Roehl and Rowell, 2022, p. 136). Rowell has worked extensively with the Center for Land Use Interpretation (CLUI) in Los Angeles, including a comissioned project for which he photographed every petrochemical plant in Texas (ibid, p. 137). In subsequent projects, he has focused on tracing pipelines going from the Alberta Tar Sands to petrochemical communities in Long Beach, California and Port Arthur, Texas. Another recent project focuses on the industrial ecology of Houston's Buffalo Bayou. 

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