Innovation Ecosystem

How Rhode Islanders see themselves, during a time of COVID

The second annual RI Life Index offers a lens showing how Rhode Islanders perceive their lives, based on health, housing, economic and educational opportunities, revealing a broad consensus about how the state needs to improve its outcomes

Image courtesy of YouTube video of event

Kim Keck, president and CEO of Blue Cross Blue Shield of RI, talking at the virtual event for the RI Life Index.

By Richard Asinof
Posted 11/23/20
The release of the 2020 RI Life Index provides an insightful, data-driven look at the perceptions that Rhode Islanders have about their lives and their health and well-being.
Is there a way that climate change threats and environmental racism can be added to the scope of next year’s RI Life Index? Will the R.I. General Assembly coordinate a briefing for legislators on the 2020 RI Life Index? Is there a need to create an integrated database on the deaths of despair – alcohol, suicide, drugs, and gun violence connected to domestic violence, tied to economic disruption? What are the opportunities to measure the differences in bottom-up, community-led innovation, compared to top-down, corporate driven innovation? Is there a need to create an accurate census of nursing home residents, de-identified, by age, race, ethnicity, diagnoses and co-morbidities, as a way to understand the complexities of the care continuum?
The current disruption of the health care delivery system has made it difficult to chart the flow of state and federal money to hospitals, nursing homes, and specialty medical practices, making cost analyses difficult to conduct. There are numerous competing digital software platforms responding to the needs of patients in response to COVID-19. The concept of the ‘office visit” may go the way of Blockbuster video stores, given the rapid adoption of telehealth platforms for patient care.
The state is ill-equipped to manage and direct any efforts to impose accountability on the health care delivery system, without resorting to high-priced private corporate consultants. Who in the R.I. General Assembly will step up and demand accountability in the post-COVID era of health care?

PROVIDENCE – The virtual launch of the results of the second annual RI Life Index occurred on Monday morning, Nov. 16, a collaborative partnership between Blue Cross Blue Shield of Rhode Island and the School of Public Health at Brown University. [A link to a YouTube video of the entire 91-minute event is provided below.]

This year’s Index once again showcased the capability of data surveys and analysis to capture a better understanding of the lens through which Rhode Islanders perceive their own health and well-being, creating a mirror through which we can see ourselves, however dark the shadows, without the distortion from self-interest and corporate bias.

This year, amidst the greatest public health crisis in a century, the RI Life Index highlighted the ways in which the pandemic has made more visible the racial disparities and inequities in our communities, by itself a dramatic change in consciousness.

The larger question – how the survey can be translated into a plan of action – remains the ongoing challenge.

A public policy mirror
During a time when facts, evidence, and science have often seemed to have been “discarded” by political forces and social media manipulation, making it difficult to discern reality from conspiracy theory, the 2020 RI Life Index presented some incontrovertible evidence about how Rhode Islanders actually see themselves – a potential valuable tool in shaping public health policies and investment strategies, if elected officials, policy makers, and business leaders are willing to take heed.

For instance, last year’s inaugural RI Life Index highlighted the need for more investment in affordable housing. As a result, Blue Cross changed its Blue Angel investment strategy to focus on awards to spur affordable housing, channeling money to nonprofits working “at the intersection of housing and health.”

However, translating the Index’s findings into action – in essence “tying the bell on the cat” – has proven to be an elusive outcome. Efforts to create new affordable housing investments through a voter-approved bond still require the R.I. General Assembly to schedule a special election to be held sometime in early 2021. Legislators could have – but didn’t – include the bond as part of the Nov. 3 election.

As Brenda Clement, the director of HousingWorks RI, said during the panel discussion as part of the virtual event, findings from the 2020 RI Life Index reinforces the messages that housing advocates have been conveying for years. [See link below to ConvergenceRI story, “The path to prosperity still begins at the front door of your home.”]

“More than 146,000 Rhode Islanders are cost-burdened – that’s nearly 37 percent of our population that is spending too much on their housing costs,” she said, as reported by The Boston Globe. “And we know the issues that raises, particularly for lower-income workers.”

The man/woman/camera in the mirror
The virtual event began with a brief introduction by Dr. Ashish Jha, the new dean at the School of Public Health [who seems to be everywhere these days], followed by brief remarks from Kim Keck, the president and CEO of Blue Cross Blue Shield of Rhode Island, who will be departing her position at the end of December to lead the national Blue Cross Blue Shield Association. [The moment captured what might be described as a “peaceful transition” of power within the state’s public health hierarchy.]

Jha framed the import of the RI Life Index in the context of health equity. “Today’s discussion comes at a time in the middle of the biggest health crisis that we as a nation and the world have faced in the a century, the COVID-19 pandemic.”

While the global pandemic has affected all of us, Jha continued, “We know that it has not affected all of us equally. In fact, the pandemic has affected our most vulnerable communities and our most vulnerable individuals the most.”

The findings of the RI Life Index, Jha said, showed “the importance of hearing directly from the people of Rhode Island.”

What the Index captured, Jha said further, was the entire context in which people live their lives, the factors often referred to as the social determinants of health.

“We know that important, long-standing structural issues in our society, such as racism, racial inequities and poverty, end up having profound effects on health, both directly and through other mechanisms, such as limited access to healthy food, safe neighborhoods, and the quality and access to education that people want.”

Jha said out loud what many have been arguing for years around the issues of health equity: “While we care about things like universal [insurance] coverage, which is very important, and while we often focus on what happens in the doctors’ offices and in the hospitals, we have to known, and we do know from the data, that what is happening at home, what is happening in the neighborhood, what is happening in the school, has at least as profound an effect, if not more so.”

Ending on an optimistic, hopeful note, Jha said: “If we can apply that knowledge in [shaping] our policies and our approaches, I believe that we can make Rhode Island one of the healthiest places in the county to live in, if not the healthiest.”

Life factors
In her introductory remarks following Jha, Keck talked about the importance of context to the Index, focused on racial inequities that, translated, made it clear that Black lives and Latinx lives matter.

“We have known for a long, long time that ZIP Code matters more than genetic code,” Keck said. “But this year’s results also starkly highlight the greater challenges that Black and Latinx Rhode Islanders perceive in achieving the pursuit of health and well being. We must do better.”

Keck explained that the need to focus more on racial inequities was identified in feedback on last year’s RI Life Index. “When we shared results last year, we got some great advice from many of you [was the need] to focus on how perceptions [about health and well being] vary greatly, based on race.”

Since March, Keck continued, COVID-19 has had such a profound impact, shining a spotlight on racial inequities in Rhode Island and across the world. “And these inequities are impossible to ignore,” she continued. “If there is anything we have learned in this crazy, tumultuous year, [it is] we must be accountable for turning the tide on system racism and inequity in our state and in our country. Poverty and racism have an enormous impact.”

Room for improvement
In her presentation at the virtual event, Melissa Clark, a professor at the School of Public Health with expertise as a methodologist in survey research, characterized the results of the perceptions of health and well being were “mediocre at best” for many Rhode Islanders, with scores only in the 50-60 percent range and generally lower in the core cites.

Clark further said that the 2020 results analyzed in the RI Life Index “should be viewed specifically through the lens of the COVID-19 pandemic.”

Unlike the 2019 RI Life Index, when the survey was conducted during the spring months, the 2020 RI Life Index surveys were conducted during the summer months, because it would have been inappropriate to conduct the surveys in the spring this year, given that it would have been at the beginning of the state’s stay at home orders, “a time which none of us believed was appropriate to conduct a survey.”

Further, Clark emphasized that no comparison was being made to the 2019 RI Life Index findings, because “two data points do not allow us to say anything about a trend in one direction or another; we need at least three data points to make any comments about trends.

Clark also talked about the importance of the creation a new community group, the RI Life Index Coalition, which brought together “thought leaders and subject matter experts to be sure that we were asking questions in the right content areas, so that the Index can be used as a resource for organizations working to improve the lives of Rhode Islanders and develop viable solutions to the barriers identified.”

The robust data analysis in the 2020 RI Life Index featured interviews conducted between July and August in 2020, both in English and Spanish, with 2,126 surveys completed, with an intentional over-sampling of Black and Latinx Rhode Islanders, asking 18 questions. There were 650 surveys conducted by landline, 966 by cellphone, and 5610 through a web survey tool.

In addition to segmenting the survey responses by age, gender, education levels, sexual orientation, wealth, and race/ethnicity, the survey also broke down where the respondents lived, differentiating between core cities – Woonsocket, Pawtucket, Providence and Central Falls, where 25 percent or more of children are living the federal poverty levels – and other areas of the state.

In terms of demographics, half of the survey participants were female, and half were aged 18 to 49. One-third reported having a high school education or less. One-quarter lived alone; one-third lived in households with at least one child younger than 18, and one-third lived in a household in which at least one person had a disability. Half of the participants reported household incomes of less than $50,000.

The majority of respondents identified themselves as “non-Hispanic white, heterosexual/straight, and living in a non-core city.”

As part of the data collection for the 2020 RI Life Index there was an oversample of Black and Latinx participants, with responses from more than 250 individuals who identified themselves as Black or African American, and more than 560 individuals who identified themselves as Latino or Hispanic.

The interviews were conducted in partnership with the Siena College Research Institute, which has more than 40 computer assisted telephone interviewing stations and more than 100 experienced interviewers who were trained specially for the RI Life Index project.

Follow-up questions
ConvergenceRI asked a number of follow-up questions following the virtual event, which Carolyn Belisle, the managing director of community investment at Blue Cross Blue Shield of Rhode Island, answered.

“These are all great questions,” Belisle said. “Our partners at Brown reinforce how important it is to convey the limitations of the RI Life Index survey data, especially in regard to your questions about data integration. The RI Life Index survey method is designed to be anonymous. Respondents are de-identified and all possible identifying characteristics are separated from the publicly available data.”

Belisle continued: “This intentional survey method allows for greater participation and typically richer data, which can then be used to reinforce existing data resources. The only identifier within our evaluation is the ZIP Code, which allows us to present results at a geographic level, but limits the ability for full integration of these results with other data sources.”

Further, Belisle said: “The principal survey methodologist for the RI Life Index suggests triangulation [vs. integration] of the data – that is, using or looking at it with multiple measures/data sources to capture or highlight opportunities or areas of greatest need.”

ConvergenceRI: Can the data collected as part of the second annual RI Life Index be integrated with the data collected by Health Equity Zones as part of their survey of community needs?
BELISLE: [See the response above regarding integration of data.] We are working with Chris Ausura, co-director of the Health Equity Institute at the R.I. Department of Health, and Morgan Duffney, Health Equity Zone program assistant at the Health Equity Institute, to facilitate specific sessions with the Health Equity Zones.

ConvergenceRI: In particular, ONE Neighborhood Builders has done a recent survey of the residents they serve about the most pressing needs during the COVID-19 pandemic. How can those findings be integrated with the findings of the RI Life Index?
BELISLE: [See the response above regarding integration.]

ConvergenceRI: United Way of Rhode Island is working on creating a database resource cataloguing all of its 211 calls. Is there a way to cross-correlate the datasets that United Way is developing with the RI Life Index findings?
BELISLE: [See the response above regarding integration.]

ConvergenceRI: Is there a way to translate the findings from the RI Life Index into actionable programs? Such as, transportation needs related to public transit?
BELISLE: We hope that stakeholders find utility in the findings of the RI Life Index. The RI Life Index offers a unique window into what state residents see as community strengths and those they believe to be significant challenges.

The RI Life Index provides further recognition of the need and also the framework for what needs should be prioritized. We hope these results compel action. Blue Cross will continue its investment in safe and affordable housing with the second year of the housing-focused BlueAngel Community Health grants going into effect in 2021. We are also exploring other opportunities with additional partners as well.

ConvergenceRI: Were there any specific inquiries related to the perceptions of the threat from climate change?
BELISLE: No, this was not a topic we included. We had so many topics we needed to ask about and we also had to be mindful of limiting the number of questions to ensure a high rate of participation.


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