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Rhode Islanders weigh in on the factors shaping public health

The 2020 Rhode Island Life Index reveals a need for more affordable housing and jobs in cities including Providence, Pawtucket, and Central Falls

The "Rhode Island Life Index" survey unveiled Monday by Blue Cross & Blue Shield of Rhode Island and the Brown University School of Public HealthBlue Cross & Blue Shield of Rhode Island

PROVIDENCE — A survey unveiled on Monday underscores the need to provide more affordable housing, a lower cost of living, and greater job opportunities to all Rhode Islanders amid the pandemic, particularly to residents of the state’s core cities with large Black and Latino populations.

Blue Cross & Blue Shield of Rhode Island partnered with the Brown University School of Public Health to produce the “2020 Rhode Island Life Index” as a way to gauge key factors shaping public health and well-being.

The survey asked more than 2,100 state residents about their perceptions of 18 life factors, including housing, food, jobs, education, and access to health care, with a score of 100 being the “ideal or healthy community.”


The overall score for Rhode Island communities was 62, a composite score of 64 in non-core cities and a composite score of 56 in the core cities of Central Falls, Pawtucket, Providence, and Woonsocket.

Rhode Islanders saw strengths such as access to affordable and nutritious food, programs for children, and social and healthcare services for older adults, the survey found, but they also saw a clear need to improve the availability of quality affordable housing, to provide more job opportunities and job training programs, and to lower the cost of living.

The survey discovered sharp differences in certain categories. For example, Black residents older than 55 in core cities rated their financial situation at 47, while white residents older than 55 in non-core cities rated their financial situation at 71.

“While this is truly a global pandemic that has affected all of us, we know that it has not affected all of us equally,” said Dr. Ashish Jha, dean of the Brown University School of Public Health. “In fact, the pandemic has affected our most vulnerable communities and our most vulnerable individuals the most.”


He said the survey provides crucial information about the “social determinants of health” – the context in which people live their lives.

“We know that important long-standing structural issues in our society, such as racism, racial inequities, and poverty end up having these profound effects on health – both directly and through these other mechanisms, such as limiting access to healthy food, creating safe neighborhoods, and impacting quality and access to education," Jha said.

Attention should be paid to policy priorities such as expanding access to health insurance and the quality of care at a doctor’s office, he said, but these life factors can have just as big an impact on health.

“If we apply that knowledge directly into our policies and our approaches, I believe we can make Rhode Island one of the healthiest places in the country to live – if not the healthiest,” Jha said.

Kim Keck, president and CEO of Blue Cross & Blue Shield of Rhode Island, said the survey results illuminate the inequities that have been exacerbated by the COVID-19 pandemic.

“We have known for long, long periods of time that zip code matters more than genetic code," she said. "But this year’s results also starkly highlight the greater challenges that Black and Lantinx Rhode Islanders perceive in achieving their pursuit of health and well-being. We must do better.”

The nation cannot ignore the fact that poverty and racism have a enormous impact on health, Keck said. “If there is anything we have learned in this crazy, tumultuous year, we must be accountable for turning the tide on systemic racism and inequity in our state and our country," she said.


Blue Cross conducted the first Rhode Island Life Index survey last year. But it did not compare those results to this year’s findings because two points don’t make a trend and the surveys took place at different times of the year, said Professor Melissa Clark, director of the Survey Research Center at Brown’s School of Public Health.

“Therefore, the 2020 results should be viewed specifically through the lens of COVID-19 pandemic,” she said.

Keck said Blue Cross is already acting on the results of the 2019 survey. For example, the company has made grants of more than $800,000 to organizations working “at the intersection of housing and health.”

During a Zoom panel discussion about the survey, Brenda Clement, director of HousingWorksRI at Roger Williams University, said the survey reinforces the messages that housing advocates have been conveying for years.

“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, "and we know the issues that raises, particularly for lower-income workers.”

Carrie Bridges Feliz, director of Lifespan’s Community Health Institute, said the index reinforces the point that the pandemic is having a disproportionate impact on people of color.

“COVID has certainly illuminated, as if there were any doubt before, the fact that social factors can drive health outcomes," she said. "The fact that we are seeing disparities in the rates of folks being exposed to coronavirus, falling ill from it, being hospitalized from it, and also succumbing to it just drives home what we have been talking about for decades.”


Bridges Feliz noted the nation is still at the point of documenting and measuring those disparities. “That’s frankly not enough,” she said. “We have not come far enough fast enough to try to implement strategies to reduce those disparities.”

Rachel Flum, executive director of the Economic Progress Institute, said the survey shows the need for federal and state assistance to help not just those who are below the official poverty level but a large number of Rhode Islanders affected by the pandemic. She noted that it will be soon get colder and people are worried about utility shutoffs.

Flum noted the state legislature will soon come back into session to pass a state budget, and she said the data from the survey bolsters the case to “pass a budget that helps ensure families can continue to weather this pandemic."

Edward Fitzpatrick can be reached at Follow him @FitzProv.