Frequently Asked Questions

What is RACE COUNTS?

RACE COUNTS is an initiative launched by Advancement Project California, USC PERE, PICO California and California CALLS that includes a comprehensive online tool ranking all 58 counties by seven issue areas critical to California’s future to paint a comprehensive picture of racial disparity in California. The initiative also includes a launch report and quarterly issue reports.

 

Why is RACE COUNTS needed?

As California’s racial makeup and needs have completely transformed over the past 40 years, many of our public institutions and policies remain stuck in the past. RACE COUNTS provides the data necessary to provide community organizations with the resources they need to frame these conversations and advance much needed improvements in our public safety, economy, health and governance.

 

Who created RACE COUNTS?

RACE COUNTS was created by Advancement Project California in partnership with California Calls, PICO California and USC Program for Environmental and Regional Equity. In addition, the initiative was informed by input from more than 80 organizations across the state. Additional statewide partners include Alliance of Californians for Community Engagement, Asian Americans Advancing Justice – Los Angeles, Chrissie M. Castro & Associates, Free Our Dreams, Mobilize the Immigrant Vote and PolicyLink. For a full list of partners, please visit http://www.racecounts.org/about/

 

Who is funding RACE COUNTS?

Race Counts was made possible by support from: The California Wellness Foundation, The California Endowment, Rosenberg Foundation, and Sierra Health Foundation.

 

How is RACE COUNTS different from other measures?

RACE COUNTS paints a more complete picture of racial equity in California than has ever been available because of the 3D analysis of performance, disparity and impact: performance is how well people are doing; disparity is how well racial groups are doing compared to each other; impact is how many people are affected.

 

Interpreting the Data

 

What was our methodology?

We leverage all three dimensions — performance, disparity, impact — to tell the real story of racial disparity in California. The mix of performance, disparity and impact goes beyond current analysis in the field. We can, for the first time, quantify racial disparity, allowing us to say one county is more racially disparate than another county for an indicator, issue area, or overall. For almost two years, we worked with people on ground and did literature review to focus and inform our indicator list. We calculated new indicators like elected representation rate, teacher diversity and for several indicators made data available by race for the first time. We included a comprehensive list of racial groups including White, Black, Latinos, Asians, Pacific Islanders, Native Americans and multiracial populations. We also analyzed data in less populous counties to create a broader view. It’s rare, and we believe important, to have this many issue areas covered in one report along with an interactive tool (RACECOUNTS.org) by county and race and with a focus on disparity.

 

What is our ranking methodology?

To get a comprehensive assessment of how different counties vary, we calculated z-scores, which measure deviation from the statewide mean, for each of the indicators we studied. By averaging together all of these z-scores by issue area, and then for all indicators to obtain a composite index, we arrived at a metric that shows how much better or worse a particular county is doing compared to all other counties in California.

 

What does performance mean?

Performance is how well all people in a given county are doing. For example, what is the average graduation rate?

 

How is impact measured?

Impact is how many people are affected and is determined by population. For example, how many people live in a county where graduation rates are high, but Latinos don’t graduate as often as other racial groups?

 

What is a key indicator, and how was this list determined?

Key indicators are measures that indicate specific performance and disparity in the context of the larger issue area. For example,  3rd grade math proficiency is an indicator of education. To develop a comprehensive list of these measures, we talked to more than 80 partners across the state to identify the seven issue areas and over 40 key indicators critical to California’s future.

 

How do I cite Race Counts?

To cite Race Counts, please follow the below format:

Advancement Project California; RACE COUNTS, racecounts.org, 2017.

 

Why is certain data missing for some racial groups and not others?

Data for certain racial groups was not available at the time that this research was compiled. For example, the category “Asian American” is extraordinarily diverse, including groups as disparate as the Japanese-Americans, Hmong communities, Filipinos and more. Advocates have long pushed for federal and state agencies to disaggregate the data they collect for Asian Americans by ethnicity or national original, this research reinforces the urgency of these demands.

Similarly, as Native Americans do not identify as a racial group, in order to provide as accurate a representation as possible for California’s Native populations, we worked with a Native American consultant who conducted focus groups across the state active in the issue areas examined in the RACE COUNTS data analysis.

 

How often will the data be updated?

The data  will be updated as soon as additional data becomes available. New data from the sources we relied on for this project will be released in January 2018, and we will work to update the site at that time.

Race Counts Key

What are the different ways to view the data?

A single composite scatterplot measures disparity across all issue areas in all counties across the state.

Users can view scatterplots for each of the seven issue areas.

Users can view a scatterplot for each of the indicators.

Each indicator also has dedicated bar charts by state and county broken down by race.

Finally, there are scatterplots measuring disparity for each racial group.

 

What do the colors on the scatterplots indicate?

The scatterplots throughout RACE COUNTS are color-coded to indicate performance and disparity. The bubbles represent counties and the size of the bubbles represent population/impact:

Green means there are some gains to build upon. This means counties are moving in the right direction but still need work to grow and sustain people of color, especially in the face of looming threats.

Orange means those counties are performing better but highly disparate and leaving people of color behind.

Yellow means all people are performing low and need a leg up to move into the green.

Red means all people are performing low and are highly disparate. These are the counties that require the most work to move into the green.

 

How are the sizes of the circles on the scatterplots determined?

Circle size is determined by population size and shows impact.

 

HEALTH CARE ACCESS REPORT

INTERPRETING THE DATA

Where does the data for this report come from?

RACE COUNTS relies on the most recent available data to assess health care access. This report supplements those sources with Office of Statewide Health Planning and Development data on CHC funding, staffing, and service provision. [i] To complement this health-center-level data, we also looked at each county’s most recent adopted budgets to understand how state and local funding of safety net programs shifted over time.

What is health care access?

Health care access means very different things in different contexts. Our RACE COUNTS assesses health care access by analyzing six separate key indicators related to health: Life Expectancy; Health Insurance; Preventable Hospitalizations; Low Birthweight; Usual Source of Care; and Access to Federally-Qualified Health Centers (FQHCs). In taking this approach, RACE COUNTS embraces an inclusive concept of health care access that incorporates coverage (health insurance), access to providers, patient utilization, and some key health outcomes.

What is a key indicator, and how was this list determined?

Key indicators are measures that indicate specific performance and disparity in the context of the larger issue area. To develop a comprehensive list of these measures, we talked to more than 80 partners across the state to identify the seven issue areas and over 40 key indicators critical to California’s future

What is a community health center vs. a Federally Qualified Health Center?

Federally Qualified Health Centers or FQHCs is a term used to capture those health centers that meet stringent federal guidelines and are thus eligible to receive federal grant funds. This group along with “look-alikes” – health centers that meet most if not all of the federal terms – are together commonly referred to as community health centers, or CHCs. For our tracking purposes, we have included all CHCs that provide health services in our analysis but not included any administrative hub sites that do not deliver direct medical care.

What do we mean by Preventable Hospitalizations?

These are individual visits to a hospital to treat a chronic condition (such as diabetes or hypertension) that – with proper primary treatment – could otherwise have been avoided. As calculated by RACE COUNTS, this information is then turned into a rate of visits per 100,000 county residents. This measure is not to be confused with Hospital Readmissions – a metric used to assess how well hospitals are serving those already under their care.

What is difference between performance and disparity as used in this report?

Performance is how well all people in a county are doing. For example, how high is the rate of insurance coverage for county residents? To get a comprehensive assessment of how different counties vary—disparity—we calculated z-scores, which measure deviation from the statewide mean, for each of the indicators we studied. By averaging together all of these z-scores by issue area, and then for all indicators to obtain a composite index, we arrived at a metric that shows how much better or worse a particular county is doing compared to California as a whole.

Why is certain data missing for some racial groups and not others?

Data for certain racial groups was not available at the time that this research was compiled. For example, the category “Asian American” is extraordinarily diverse, including groups as disparate as the Japanese-Americans, Hmong communities, Filipinos and more. Advocates have long pushed for federal and state agencies to disaggregate the data they collect for Asian Americans by ethnicity or national original, this research reinforces the urgency of these demands.

Similarly, as Native Americans do not identify as a racial group, in order to provide as accurate a representation as possible for California’s Native populations, we worked with a Native American consultant who conducted focus groups across the state active in the issue areas examined in the RACE COUNTS data analysis.

FEDERAL LANDSCAPE

Was the ACA effective in terms of health care access in California?

Largely, yes – to the extent it was designed and the goals it aimed for. Our data clearly shows that ACA-era reforms (such as Medi-Cal expansion, creation of Covered California, increased CHC funding, prevention health emphasis, etc.) helped drive a number of positive health care access trends in California – with improved aggregate performance in key coverage, access, utilization, and outcomes measures. While necessary, these overall improvements were not sufficient to alone turn the tide of California’s stubborn health disparities – meaning our communities of color still face disproportionate barriers to good health. These disparities cut across counties and indicators – illustrating that in order for us to reach a true state of health equity, California’s leaders and advocates need to build local solutions directly aimed at reducing disparities upon the foundation of ACA performance gains.

How can we propose additional health care reforms when the bedrock of the funding structure (via Medi-Cal and the ACA) is under such extreme threat?

While recognizing federal actions (and inaction) continue to undermine the health access gains accumulated during the first 4 years of ACA implementation, we here in California cannot simply remain crouched in a defensive posture. The ACA remains the law of the land and continues to provide an important foundation from which advocates and leaders can look to build more-equitable health care access. We must use this moment to both protect those important gains AND seize the opportunity to make lasting equity improvements that will outlive the current federal volatilit

STATE & COUNTY LANDSCAPE

Are we suggesting that the state assume complete control of the disparate county safety net programs?

No, our county-driven safety net system is an entrenched part of California’s landscape. At its finest, this allows county officials and residents to jointly determine locally-driven solutions to best meet all residents’ health care challenges. Because this best-case scenario is all-too-rare, we are urging the state to create a framework and funding mechanisms to help counties establish baseline eligibility and care standards for their individual safety nets that ensure low-income residents – regardless of immigration status – receive important primary health care services.

Would a single-payer system fix the problems that we’ve laid out?

By the same token that the ACA was able to make considerable progress on overall performance but was unable to reverse disparities on its own, it stands to reason that a single-payer system that does not explicitly address health disparity reduction from a holistic, equity perspective will likely share a similar fate. This report illustrates that drivers of health disparities extend well beyond the health care system itself – localities need to take a deliberate, comprehensive approach to providing equitable health care access in order to make a dent in these multifaceted disparities.

FINDINGS & ANALYSIS

How is it that in a county like Merced, where the safety net was virtually disbanded and had severe health provider challenges, was still able to reduce rates of preventable hospitalizations better than our other spotlight counties?

This finding likely has a number of contributing factors. For one, the county saw a huge uptick in residents gaining Medi-Cal eligibility during this period – increasing their financial ability to access primary care and lessening their reliance on emergency hospital care. Secondly, for those Merced residents who remain ineligible for any type of medical coverage or local safety net care – primarily the thousands of undocumented residents – may be avoiding hospitalization altogether due to lack of physical access or documentation concern

How is it that Los Angeles County invested in a model safety net program (MHLA) – considered a success by most – and yet continues to show poor countywide health care access performance and continuing disparities?

The sheer population size of Los Angeles County – in conjunction with deep pre-existing health disparities – makes rapid improvements hard to come by. The growth of clinic infrastructure across the county and the 140,000+ residents taking part in MHLA have certainly helped improve access for local communities of color – but the recentness of the ACA and MHLA implementation has not yet been able to reverse the legacy of disparity. Beyond this matter of timing, however, is the astoundingly-high cost of living and housing in the county. This mounting challenge puts health care out of the reach for many due to cost while simultaneously squeezing the pipeline of health care professionals willing to serve the county’s low-income communities.

[i] Office of Statewide Health Planning and Development, Primary Care Clinic Annual Utilization Reports, 2011– 2015, https://www.oshpd.ca.gov/HID/PCC-Utilization.html.

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