Neighborhoods and Health: Building Evidence for Local Policy. Site-specific Analysis

05/01/2003

In this component, the selected NNIP partners were asked to assemble and analyze new neighborhood level indicators pertaining to local health issues (data not already in the local information system they maintain), and to do so in a way that would contribute directly to local health improvement initiatives in their cities. They were asked to choose topics that were recognized as important in local policy deliberations.

This component, therefore, was to contribute to both of the project's major purposes. First, it would include analysis of ecological relationships utilizing the new health indicators the sites identified in relation to the other demographic and contextual data already assembled. Second, the experiences of the sites in conducting the work would provide lessons on (1) approaches and barriers to expanding the availability of health indicators at the neighborhood level and (2) the efficacy of various processes of applying such data in local policy-making and program implementation.

Research Questions

For the site-specific analysis, HHS specified the following research questions:

  1. What ecological correlations emerge between the unique health, demographic, and contextual variables selected for study by each site?
  2. Are census tract data useful for identifying contiguous or non-contiguous groups on the basis of health and demographic indicators?
  3. What implications for policy and planning do these findings have?
  4. As a result of site-specific analysis, are any actions planned such as specific public health initiatives, strategic plans, or metropolitan-wide policy changes?

Study Topics

In their proposals, the five sites specified the topics they would examine. In their selection of a topic, the sites were asked to try to meet two implied requirements simultaneously. First, they needed a health-related topic pertaining to children or youth (if possible) that was already recognized as important in policy discussions in the community. Second, they needed a topic that offered a reasonable prospect for them to acquire and analyze new data in the time available and one in which their analyses would take community understanding of the issue to a new level.

We recognized at the outset that there would be limits to what we could accomplish in this component given our schedule. It might prove impossible, for example, for some sites to overcome bureaucratic barriers to data assembly, or to do an adequate job of data editing, in the time available. Similarly, policy change processes started-off by the partners' new studies could not be expected to have an impact on health outcomes in the limited time remaining in the contract period. Nonetheless, it was judged that valuable insights could be gained from a serious critical examination of these experiences, even if partial. The selected topics were as follows:

  • Cleveland developed neighborhood indicators of child access to primary care using eligibility, claims, and encounter data from Ohio's Medicaid data system. Cleveland's analysis sought to clarify relationships between neighborhood conditions and children's access to primary care (as indicated by use of emergency services for non-emergency conditions and regularly-scheduled well-child doctor's visits).
  • Denver explored new datasets focused on (1) the relationship between the spatial pattern of environmental hazards and other conditions and the locations of Denver's poorer neighborhoods (where children represent a much higher than average share of the population) and (2) violence as a public health issue for children using data files on violent crime, violence-related school suspensions and expulsions, and child abuse and neglect.
  • Indianapolis used spatial analysis to study the relationship between community conditions and obesity in children in Marion County from 1998 to 2000. The contextual variables they used came from three broad areas including socioeconomic conditions, proximity to exercise opportunities, and social barriers to physical activity.
  • Oakland focused on the relationship between neighborhood conditions and the incidence of tuberculosis. Staff sought in particular to examine fresh approaches to analyzing the data, applying new techniques developed in the fields of Geographic Information Systems (GIS) and spatial statistics.
  • Providence undertook analysis to determine the extent of residential mobility of young children and the impact of mobility on delivery of child health care services. In particular, Providence looked at measures of continuity of care (from immunization data files) timely blood lead screenings, and consistent care with a primary provider.

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