Index Uses Social Determinants Data to Rank Community Health

September 02, 2020 - Boston University School of Public Health (SPH) and Sharecare have released their Community Well-Being Index (CWBI) state rankings report, which leverages social determinants of health data to measure community wellness.

For over ten years, Sharecare has measured community well-being by assessing both physical and non-physical individual risk factors across five health domains: purpose, social, financial, community, and physical.

The CWBI combines this original index with social determinants of health data to measure additional risk factors across five domains related to one’s environment: healthcare access, food access, resource access, housing and transportation, and economic security.

"By leveraging sophisticated statistical techniques across small area estimation, multiple imputation, and machine learning, and integrating social determinants of health into our core measure, the CWBI has established a critical baseline that provides a holistic understanding of where we were from a well-being perspective pre-pandemic, while enabling year-to-date and ongoing views of the impact that systemic inequities and COVID-19 are having on our nation's well-being," said Dr. Sandro Galea, dean of the Boston University School of Public Health.

"Further, CWBI will optimize Sharecare's delivery of data-driven interventions to communities and individuals alike, helping each person chart an evidence-based, location-centric health journey that, ultimately, will empower Americans to make the healthy choice the easy choice."

The report showed that Hawaii scored in the top quintile across five of the ten domain rankings, including social, financial, community, healthcare access, and housing and transportation.

New Hampshire also ranked highly, landing number-one positions across four of five well-being domains: financial, purpose, physical, and community. Utah took the top spot for the social domain, and ranked third overall in well-being.

Conversely, Mississippi took last place based on bottom positions in three of ten domains – financial, physical, and food access – and ranking in the bottom quintile in five additional domains, including social, community, healthcare access, housing and transportation, and economic security. Maryland took the bottom ranking for community well-being, while South Dakota took the bottom spot for social well-being.

By incorporating factors like additional health behaviors, reported comorbidities, and mortality risk, CWBI achieved county-level coverage for the first time. The report enables visibility into well-being and social determinants risk for communities not previously included in state rankings, and ensures comprehensive coverage of rural and underserved areas.

"While our previous rankings revealed a great deal about individual resilience, with more communities being represented in our new CWBI data construct, we are seeing shifts in rankings due in part to broadly lower levels of well-being in rural communities," said Elizabeth Colyer, lead for Sharecare's Community Well-Being Index.

"Further, on average, well-being scores in rural counties were considerably less than their urban counterparts. We look forward to examining this trend in greater detail, especially in our upcoming rankings report for municipalities and counties that will be released in the fall."

The report authors expect that the newly enhanced CWBI will provide additional insights into patient health during the COVID-19 pandemic, allowing the healthcare industry to better understand how to meet individuals’ needs during this time.

"Through CWBI, we have developed a unique and deeper understanding of America's most pressing health challenges at a hyperlocal level and further contextualized the critical impact that environment has on one's access to health resources, readiness to change and overall health risk," said Jeff Arnold, founder and CEO of Sharecare.

"While this first report is focused more specifically on 2019 state rankings, over the last six months, in particular, we have also examined the well-being impact that critical external forces – such as COVID-19 and racism – are having on our country. By tapping into the power of our action-oriented data and collaborative partnerships to deliver personalized interventions through the Sharecare platform, we can make virtual health a reality, empowering each American to improve their well-being and ultimately inspiring a collective movement to heal our country."