How can research lead to real impact? Measure of America (MOA), a project of the Social Science Research Council, seeks to bridge research and policy by creating a common frame of reference about the nature, extent, and consequences of inequality. Here we discuss a specific example of this effort via a partnership with California’s Sonoma County Department of Health Services (DHS) and provide a concrete account of how research informs and shapes policy impacts.
Human development, American style
More than two decades ago, the United Nations Development Programme released its first global Human Development Report. This work introduced the world to a new way of thinking about development and included a new measure meant to help policymakers move past their overreliance on economic metrics, such as gross domestic product (GDP), as proxies for human well-being. The work was grounded in the capabilities framework of Nobel Laureate Amartya Sen. This measure, the Human Development Index, has become an influential and globally recognized metric, providing the conceptual spine of some 700 national and subnational human development reports published in 135 countries in addition to the annual global Human Development Report.
Measure of America was founded in 2007 by former staff of the United Nations and was based on interest in seeing whether the human development (HD) conceptual framework and the successful model of local and regional human development reports in other countries could be usefully applied in the United States. With The Measure of America: American Human Development Report 2008–2009, 1Burd-Sharps, Sarah, Kristen Lewis, and Eduardo Borges Martins. The Measure of America: American human development report, 2008-2009. Columbia University Press, 2008. MOA became the first to publish a human development report for a high-income country. It presented a modified American Human Development Index for the 50 states and all 436 US congressional districts that was built on the conceptual framework of the UN’s HD Index.“Human development index data help communities see themselves on a continuum of well-being, breaking traditional “us versus them” dichotomies comparing the poor to the non-poor or the advantaged to the disadvantaged.”
The main proxy indicator for human development used in MOA’s work is the American Human Development Index (AHDI), a version of the UN’s HD Index modified to be more relevant to high-income country conditions. The American HD Index is grounded in the same three basic dimensions as the conceptual framework behind human development: a long and healthy life, access to knowledge, and a decent standard of living. Life expectancy at birth is a proxy for the capability to live a long and healthy life; educational attainment among adults ages twenty-five and older and educational enrollment among three- to twenty-four-year-olds to measure access to knowledge; and median personal earnings for all workers ages sixteen and over are used to measure material standards of living. Encapsulated within each of these three broad areas are many other issues: for example, life expectancy is affected by air quality, the amount of stress in daily life, the presence or absence of occupational and environmental hazards, and many other factors. The Index is expressed on a scale of zero to ten, with ten being the highest level of human development.
As years of UNDP and, more recently, MOA research can attest, growth in GDP does not automatically translate into increasing human well-being. GDP is useful for understanding how the economy is doing, but it can give very misleading signals as to how people are doing. In part because of its emphasis on a broader series of indicators than just money metrics, human development index data help communities see themselves on a continuum of well-being, breaking traditional “us versus them” dichotomies comparing the poor to the non-poor or the advantaged to the disadvantaged.
A Portrait of Sonoma County: From data to policy
Sonoma County, California is a thriving northern California county known for world-class vineyards and breathtaking vistas as well as rich cultural diversity and the entrepreneurial spirit of its residents. But Sonoma County residents recognize that their community, like so many across the nation, also faces the difficult reality of deep disparities in access to opportunity.
In late 2013, the County DHS approached MOA to produce a report that would be the starting gun for a broad initiative to be the healthiest of California’s 58 counties by 2020. A Portrait of Sonoma County, produced after a year-long process of research and data analysis, stakeholder engagement, and writing, was released in May 2014. It documented sobering disparities in community well-being across the towns and cities that comprise Sonoma County by presenting indicators of health, education, and material living standards and analyzing them through a human development lens.
Although Sonoma County scores well on the American Human Development Index, outcomes in these basic areas are highly uneven. While those in county government, social service delivery agencies, foundations, and nonprofits working to improve life for struggling families and residents knew the county had pockets of poverty, the extent of the disparities caught even experts by surprise. The exact identification of groups and neighborhoods with residents struggling to meet their most basic needs gave momentum to their efforts.
Sonoma County’s HD Index value is 5.42 out of a possible 10. This score is well above the US score of 5.07 and slightly above California’s score of 5.39. Sonoma County, with a total population of roughly 480,000, is made up of ninety-nine census tracts, areas of roughly 5,000 inhabitants each designated by the US Census Bureau. At the top of the Sonoma County well-being scale are three census tracts in and around the largest city, Santa Rosa: East Bennett Valley, Fountain Grove, and Skyhawk. Three Santa Rosa neighborhoods are also at the bottom of the Index: Sheppard, Roseland, and Roseland Creek. Top-ranking East Bennett Valley (with an Index value of 8.47) is five miles from bottom-ranking Roseland Creek (with an Index value of 2.79). (Click here to explore an interactive map of Sonoma County.) The former has a Human Development Index value above that of top-ranked-state Connecticut, while the well-being outcomes of the latter are well below those of Mississippi, the lowest-ranked state on the American HD Index. The table below presents Index findings for the top- and bottom-three census tracts in Sonoma County.
Click to show Table 1
The American HD Index scores of Sonoma County’s major racial and ethnic groups also display considerable variation. The ranking of well-being levels by race and ethnicity in Sonoma County follows that of California as a whole, with Asian Americans at the top, followed by whites, African Americans, and Latinos. Detailed results are shown below. A similar pattern holds nationwide in some respects, although Latinos fare better than African Americans at the national level, and Native Americans have the lowest score.
Click to show Table 2
In addition to these descriptive findings (and more) about variations in well-being across Sonoma County, the report concluded with an “Agenda for Action,” a set of broad policy recommendations that DHS and its allies could implement to improve well-being for the residents of Sonoma and help the county advance toward its health goals. The agenda included a variety of place- and population-based recommendations. The place-based recommendations focused on two groups of census tracts with particularly low scores on the American HD Index. Among the population-based recommendations were the importance of meeting the needs of Sonoma’s families for high-quality preschool for young children and the reduction of tobacco use among teens and adults.
Human development in action
Shared understanding has been instrumental in catalyzing advocacy and policy changes to promote greater equity. Reform efforts built on the foundation of the Portrait in several ways, some of which are detailed here.
Following the Portrait’s recommendation to “make universal preschool a reality,” the Board of Supervisors requested a cost estimate for this program. Policymakers estimated requiring $70 million for instruction and facilities, and the board is exploring financing options for the county’s first-ever universal preschool program. This was in part possible because of the Portrait’s goal of making clear the interconnections between health, education, and material standards of living. Policymakers and philanthropists often work in silos—focusing uniquely on one aspect of public health or education policy, for example—and rarely look outside of their area of expertise or their epistemic communities when crafting policy or making funding decisions. The executive director of a local private foundation reported that, “most business people don’t think about the fact that health is so tied to education,” but the Portrait helped make this clear. “It’s been so powerful for this community to understand that those pieces fit together, and the Portrait did that.” Recently, Sonoma County has begun exploring the use of social impact bonds, a promising innovation, to finance effective programs and improve outcomes for children.“In the first six months after the report’s launch, DHS staff made ninety public presentations of the Portrait and its data.”
Not every impact of the report follows neatly from the Agenda for Action or from the groups that initially supported the Portrait. Endowed with community legitimacy, findings from the report are being used in novel ways by organizations outside the coalition that guided its creation and have supported its use. Advocates of instituting a county “living wage” of $15 per hour have cited figures from the Portrait on the very low median earnings in some Sonoma communities as evidence that a higher minimum wage is needed. And the North Bay Organizing Project has used the Portrait to identify communities for their organizing around tenant protections and affordable housing. LandPaths, a local nonprofit group, organized an “Urban Hike” in March 2015 in collaboration with the Department of Health Services through the Sonoma census tracts that rank highest and lowest on the HD Index. These two communities, geographically separated by only five miles, are nonetheless worlds apart in human development terms, with a half-decade life expectancy gap and typical earnings that range from $69,000 at the top to $22,000 at the bottom. The hike, to places some participants had never been, was a moving exercise in creating neighbors from strangers and seeing life through another’s eyes. One immediate result was discussion on how to connect these two worlds through some sort of path.
What are some of the elements that have contributed to such a robust impact from a research report? First and foremost, it was a rich collaborative process spearheaded by the commissioning organization, the County Department of Health Services and their vibrant Health Action Council network. The report featured a “Pledge of Support” signed by seventy-five organizations and individuals who committed to “to using A Portrait of Sonoma County to better understand gaps in opportunities and to partnering with the community to identify the strengths and assets on which to build a comprehensive and inclusive response to this report.” This public endorsement of the Portrait from such a diverse group helped lend the report credibility even before it went to press. Once the Portrait was launched in May 2014, its official acceptance by the Sonoma County Board of Supervisors further imbued the report with a high degree of legitimacy.
Furthermore, collaboration helped establish the ubiquity of this report as the resource on well-being in Sonoma County, due in large part to DHS’s extensive awareness-building campaign following the report’s launch to communicate the report’s findings to audiences well beyond their traditional health partners. In the first six months after the report’s launch, DHS staff made ninety public presentations of the Portrait and its data, addressing other local government entities, community groups, business leaders, and the general public.
A second element was the accessibility and transparency of both the process and the final products. Accessibility meant communicating findings in plain language (with the report produced and printed in both English and Spanish) and framing issues in a way that avoided jargon and political polarization. Transparency meant carefully documenting goals, data sources, and calculations, and providing the data on which the analysis was based to the public. And of course, the report was made available free of charge online, as were the underlying data. Analysis of downloads of Portrait data shows strong interest in the data for grant proposals. Stakeholders in Sonoma related how having data to quantify the challenges that exist has been vital to make the case for why funders should invest resources in specific communities or in issues like school readiness and universal preschool. By being accessible and transparent, the report reached a broad and diverse set of community members and was seen as legitimate and trustworthy portrait of life in Sonoma County.
Thirdly, our research on the mosaic of well-being and access to opportunity focused on a single county, a scale which is more open to impact than more abstract analyses of inequality writ large. While important, much work studying inequality at the national or state scale does not lead easily to politically feasible policies to mitigate inequality. At the local level, where residents can “ground truth” in the findings of a place- and population-based analysis of inequality, there are greater possibilities to mobilize support based on shared understanding.
Measure of America’s experience in Sonoma County has shown that creating shared understanding in order to address inequality and improve well-being is possible with three key factors. First, a stakeholder engagement process imbues research with legitimacy and accuracy, especially crucial when research is conducted at a distance. Second, conveying results in a readily accessible and transparent fashion with the highest methodological rigor is indispensable. Last, but not least, focusing efforts intensively at a local scale to take advantage of the nexus of responsive institutions and motivated citizens is absolutely crucial to enact policy change in order to improve the well-being of communities.
The impacts of A Portrait of Sonoma County can be seen firsthand via a minisite created by the County of Sonoma dedicated to compiling the policy, programmatic, philanthropic, financial, and other impacts of the report.