Jenny Wagner

Neighborhood conditions significantly impact health and well-being, leading public health agencies to focus interventions on disadvantaged areas. Yet, a growing number of composite indices have been developed to measure neighborhood opportunity, deprivation, or vulnerability, and little is known about how they compare in relation to health. Our study compares 13 composite indices of neighborhood conditions commonly used in public health research. Using data for over 57,000 US census tracts, we evaluate correlations among indices and assess their associations with four health outcomes—poor mental health, diabetes, smoking, and life expectancy—relative to the poverty rate, a standard single-variable measure of neighborhood deprivation. We used spatial regression models to account for autocorrelation and ordinary least squares regression to compare explanatory power across measures. While indices correlate with one another and with poverty, their associations with health outcomes and explanatory power vary considerably. Some indices exhibit stronger associations with health compared to poverty, suggesting they may offer more nuanced insights into neighborhood health inequities. Conversely, other indices explained less variation in health outcomes, questioning their utility in guiding interventions. Our findings underscore that indices are not interchangeable and highlight the need for careful selection of indices based on specific public health contexts and outcomes. Our study suggests simpler measures like poverty may, in some cases, be equally or more effective while offering a more interpretable and practical benchmark for targeting resources.

Environmental justice (EJ) seeks to correct legacies of disproportionately burdening low-income and Black, Indigenous, and people of color (BIPOC) communities with environmental hazards that contri...

Backed by decades of empirical research, there has been increasing acknowledgment in policy, practice and research of the importance of neighborhood opportunity in shaping well-being. This has led to the proliferation of opportunity maps in cities throughout the United States with the purpose of identifying low opportunity neighborhoods in need of investment and intervention and high opportunity neighborhoods that can offer access to resources and amenities to disadvantaged population groups. By explicitly linking investment to the identification of neighborhoods that are high or low in opportunity, opportunity indices have the potential to help transform local and regional landscapes of spatial inequality. Despite this common goal, indices rely on varying theoretical conceptualizations, data, variables, and statistical approaches. How much these opportunity definitions overlap has yet to be fully examined. In this study, we compared five approaches to measuring neighborhood opportunity in California. We found low to moderate overlap across the indices, with disagreement higher for low opportunity designations. As with any quantitative analysis, opportunity mapping is not a purely technical exercise and requires a series of subjective decisions. The only way to validate these decisions is for opportunity measures to be constructed transparently and vetted by the research community. This study is a first step in this process.

Background: National guidelines have called for greater integration of primary care and behavioral health services, with more recent attention to social care and community-based services. Under growing resource constraints healthcare organizations have tended to rely on referrals to external entities to address social care needs. Traditional referral models, however, may not be equipped to provide for the complex needs of older adults with depression. The Care Partners Project was designed to strengthen late-life depression care through integrated partnerships between primary care clinics and community-based organizations. We sought to understand how these integrated partnerships, with shared tasks and accountability across organizations, changed the nature of depression care for older adults. Methods: We conducted 65 in-depth, semi-structured interviews and six focus groups with service providers involved in the project, including care managers, primary care providers, and psychiatric consultants, and applied inductive and deductive qualitative thematic analysis to develop themes around participants’ experiences with the partnered initiative. Results: We found the partnerships established by the Care Partners Project reshaped late-life depression care in two ways: (1) bidirectional communication across organizations facilitated greater recognition among providers of intersecting medical and social needs associated with late-life depression; and (2) depression care became more coordinated and effective as care teams established or strengthened relationships across organizations. Conclusions: These findings highlight the ways cross-organizational health and social care partnerships that move beyond traditional referrals can strengthen late-life depression care and enhance organizational capacities.

BackgroundNational guidelines have called for greater integration of primary care and behavioral health services, with more recent attention to social care and community-based services. Under growing resource constraints healthcare organizations have tended to rely on referrals to external entities to address social care needs. Traditional referral models, however, may not be equipped to provide for the complex needs of older adults with depression. The Care Partners Project was designed to strengthen late-life depression care through integrated partnerships between primary care clinics and community-based organizations. We sought to understand how these integrated partnerships, with shared tasks and accountability across organizations, changed the nature of depression care for older adults. MethodsWe conducted 65 in-depth, semi-structured interviews and six focus groups with service providers involved in the project, including care managers, primary care providers, and psychiatric consultants, and applied inductive and deductive qualitative thematic analysis to develop themes around participants’ experiences with the partnered initiative. ResultsWe found the partnerships established by the Care Partners Project reshaped late-life depression care in two ways: (1) bidirectional communication across organizations facilitated greater recognition among providers of intersecting medical and social needs associated with late-life depression; and (2) depression care became more coordinated and effective as care teams established or strengthened relationships across organizations. ConclusionsThese findings highlight the ways cross-organizational health and social care partnerships that move beyond traditional referrals can strengthen late-life depression care and enhance organizational capacities.

Partnering across health clinics and community organisations, while worthwhile for improving health and well‐being, is challenging and time consuming. Even partnerships that have essential elements for success in place face inevitable challenges. To better understand how cross‐organisational partnerships work in practice, this paper examines collaborations between six primary care clinics and community‐based organisations in the United States that were part of an initiative to address late‐life depression using an enhanced collaborative care model (Archstone Foundation Care Partners Project). As part of an evaluation of the Care Partners Project, 54 key informant interviews and 10 focus groups were conducted from 2015 to 2017. Additionally, more than 80 project‐related documents were reviewed. Qualitative thematic analysis was used to code the transcripts and identify prominent themes in the data. Examining clinic and community organisation partnerships in practice highlighted their inherent complexity. The partnerships were fluid and constantly evolving, shaped by a multiplicity of perspectives and values, and vulnerable to unpredictability. Care Partners sites negotiated the complexity of their partnerships drawing upon three main strategies: adaptation (allowing for flexibility and rapid change); integration (providing opportunities for multi‐level partnerships within and across organisations) and cultivation (fostering a commitment to the partnership and its value). These strategies provided opportunities for Care Partners collaborators to work with the inherent complexity of partnering. Intentionally acknowledging and embracing such complexity rather than trying to reduce or avoid it, may allow clinic and community collaborators to strengthen and sustain their partnerships.