Summary: This study assesses four vulnerability indicators that are being considered by public agencies as policy tools to select the most-at-risk neighborhoods for interventions. These indicators can play a role in prioritizing the provision of pandemic resources and services; consequently, they have implications for how many people of color and minority neighborhoods are served. The study compares three vulnerability indicators developed prior to COVID-19 and one developed in response to the pandemic, the UCLA Pre-Existing Health Vulnerability (PHV) index, which captures the risks or severity of COVID-19 infection due to preexisting health conditions. The PHV index is based on data from the California Health Interview Survey (CHIS).
Findings: Two sets of assessments are conducted. The first calculates the degree of concordance between pairs of indicators, that is, how frequently they identify the same tracts as being disadvantaged. The analysis finds that low rates of commonality (approximately less than half of all designated tracts); therefore, the choice of indicator inherently translates into a significant variation in the tracts classified as being eligible or ineligible for prioritization.
The second set of assessments examines the differences among the indicators by comparing the racial composition of the residents in designated high-vulnerability tracts, and by comparing the relative number of minority neighborhoods included in high-vulnerability tracts. The analyses find substantial differences among the indicators in population compositions and proportion of minority neighborhoods included. The findings can help ameliorate a policy dilemma. Despite the reality that African Americans and Hispanics have suffered disproportionately from COVID-19, the 1996 Proposition 209 prohibits the state from explicitly using race as a factor in the provision and distribution of pandemic relief and coronavirus vaccines.
The study’s findings provide insights into which of the four vulnerability indicators can serve as a reasonable proxy, one that captures an important underlying mechanism producing systemic racial inequality. By several criteria, among the indicators that do not explicitly include race/ethnicity as an input, the indicator based on preexisting health conditions (medical vulnerabilities) performs best in including African Americans.
A final recommendation is that public agencies should develop and construct new pandemic-oriented indicators to help guide policies beyond racial equity.
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