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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.

California Student Health Index

Users must select the ranking variable for either the overall vulnerability index score or for one of the four sub themes: Socioeconomic Status, Household Composition & Disability, Minority Status & Language, or Housing Type & Transportation.

A dictionary of terms used in this data resource are available at the bottom of this webpage: https://www.atsdr.cdc.gov/placeandhealth/svi/documentation/SVI_documentation_2018.html.

The CDC/ADSDR SVI is designed to help public health officials and local planners with preparing and responding to emergency events like hurricanes, disease outbreaks, or exposure to dangerous chemicals. The SVI databases and maps can be used to estimate the amount of supplies need (e.g. food, water, medicine, etc.), to identify areas in need of emergency shelters, to estimate the number of emergency personnel need, to create evacuation plans, and to “identify communities that will need continued support to recover following an emergency or natural disaster” (https://www.atsdr.cdc.gov/placeandhealth/svi/fact_sheet/fact_sheet.html).

The SVI determines the social vulnerability of every census tract in the United States. The index ranks each tract on 15 factors grouped into four related themes (see below).

Each census tract/county has a percentile ranking that represents the proportion of tracts/counties for which the tract/county of interest is equal to or lower in terms of social vulnerability. Higher percentile ranking values indicate greater vulnerability. For instance, ranking of 0.85 indicates that the tract/county of interest is more vulnerable than 85% of tracts/counties but less vulnerable than 15% of tracts/counties.

The CDC defines social vulnerability as the extent to which certain social conditions might affect a community’s capacity to respond to a disaster and prevent human suffering and financial loss.

Starting in 2014, the CDC has also added a database for Puerto Rice, as well as for Tribal Census Tracts, which are defined independently of standard county-based tracts.

Overall Vulnerability

1. Socioeconomic Status

• Below Poverty
• Unemployed
• Income
• No High School Diploma

2. Household Composition and Disability

• Aged 65 of Older
• Aged 17 or Younger
• Civilian with a Disability
• Single-Parent Household

3. Minority Status and Language

• Minority
• Speaks English “Less than Well”

4. Housing Type and Transportation

• Multi-Unit Structures
• Mobile Homes
• Crowding
• No Vehicle
• Group Quarters

In 2018, two adjunct variables (not included in the overall SVI rankings) were added: 2014-2018 ACS estimates for persons without health insurance, and an estimate of daytime population taken from LandScan 2018.