As public health practitioners increasingly look upstream to identify the determinants that put people on a trajectory toward lifelong health and wellbeing, early childhood is often tapped as a pivotal intervention point. Now, a new tool is available that practitioners can use to measure neighborhood-level opportunity indicators that are fundamentally linked to children’s health.
In the November issue of Health Affairs, researchers presented the newly developed Child Opportunity Index for the 100 largest U.S. metropolitan areas. The index covers three domains of opportunity: educational, health and environmental, and social and economic. Within those three domains are 19 indicators, such as proximity to high-quality childhood education, proximity to health care facilities, proximity to parks and open spaces, and rates of poverty and unemployment. In addition to measuring opportunity, the index can also help explain current and persistent child health inequities. The index is unique in that it considers a variety of opportunities that underpin child health, reflecting the many contributors to healthy child development. In introducing the index, study authors Dolores Acevedo-Garcia, Nancy McArdle, Erin Hardy, Unda Ioana Crisan, Bethany Romano, David Norris, Mikyung Baek and Jason Reece write:
Socioeconomic factors and the environments where children live, learn, and play — that is, their homes, neighborhoods, and schools — affect a variety of important child health outcomes, such as birthweight, mental health, and language development. …Community development and other interventions to improve neighborhood environments may help reduce child health inequities. However, most of the research on the places where children live and children’s health has examined a single attribute of place — neighborhood poverty — and has ignored information about the broader set of neighborhood-based opportunities that may matter for children’s health.
The new index measures child opportunity by census tract, focusing on the nation’s largest metropolitan areas, and all of the indicators were “vetted for their relevance to child development,” the study stated. Overall, researchers found that high concentrations of black and Hispanic children living in the lowest-opportunity neighborhoods were a common occurrence across U.S. metropolitan areas. In addition, 40 percent of black children and 32 percent of Hispanic children live in “very low-opportunity” neighborhoods within their metropolitan areas, compared to only 9 percent of white children. The index also found that metropolitan areas with greater levels of residential segregation were also home to greater levels of inequities between the percentages of white and minority children living in very low-opportunity neighborhoods.
Among white children, some of the metropolitan areas with the highest percentages of children living in very low-opportunity neighborhoods were Honolulu, Hawaii; Cape Coral, Florida; and Knoxville, Tennessee. Among black children, metropolitan areas with high percentages of children living in very low-opportunity neighborhoods included Albany, New York; Omaha, Nebraska; and Boston. Among Hispanic children, the metropolitan areas included Lancaster, Pennsylvania; Providence, Rhode Island; and Denver, Colorado. To give some specific examples: In Honolulu, 23 percent of white children are living in very low-opportunity neighborhoods; in Omaha, more than 59 percent of black children live in very low-opportunity neighborhoods; and in Denver, 50 percent of Hispanic children live in very low-opportunity neighborhoods.
On the flip side, some of the metropolitan areas with the fewest numbers of children living in very low-opportunity neighborhoods were Chicago (for white children); McAllen, Texas (for black children); and New Orleans (for Hispanic children). The study authors cautioned that the index measures relative opportunity within a metropolitan area and is not a comparison of opportunity between metro areas.
So, what does this mean for health? The study authors write that the Child Opportunity Index can be useful in monitoring progress on health equity. (What is health equity? The Centers for Disease Control and Prevention cites this definition: When all people have "the opportunity to 'attain their full health potential' and no one is 'disadvantaged from achieving this potential because of their social position or other socially determined circumstance.'") The tool can also be used to tease out the neighborhood factors that are especially protective of child health as well as encourage cross-sector and regional collaborations between the public health and community development sectors.
“Through its web-based mapping system and database, the Child Opportunity Index offers a valuable new tool to the housing and community development fields that is unique both in its focus on children and in its ability to facilitate analyses of racial/ethnic disparities,” the researchers write.
The read the full Health Affairs study, click here. To learn more about using the Child Opportunity Index, which was developed by researchers at the DiversityDataKids.org project and the Kirwan Institute for the Study of Race and Ethnicity, click here and here.
Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for more than a decade.