2021

Assessing vulnerability indicators and race/ethnicity


A study assessed four vulnerability indicators being used by public agencies to select the most COVID-19 vulnerable neighborhoods for interventions.

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The UCLA Center for Neighborhood Knowledge, led by Professor Paul M. Ong, and supported by UCLA Fielding School professors Vickie Mays and Ninez Ponce and the UCLA Center for Health Policy Research's California Health Interview Survey, has published a study assessing four vulnerability indicators being used by public agencies to select the most COVID-19 vulnerable 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.

This study compares three pre-pandemic indicators and a more recently developed indicator based on pre-existing health conditions. The analysis focuses on the numbers of people of color residing in designated high-vulnerability neighborhoods, and the relative number of minority neighborhoods that fall into the high-vulnerability areas. Race/ethnicity is important because people of color encounter multiple dimensions of inequality that are only partially reflected in the indicators.

The findings show noticeable differences in the groups and places designated as being vulnerable, thus the choice of which indicator to use has highly consequential implications in terms of who is served and who is not along racial lines.

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 2020a 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.


The UCLA Fielding School of Public Health, founded in 1961, is dedicated to enhancing the public's health by conducting innovative research, training future leaders and health professionals from diverse backgrounds, translating research into policy and practice, and serving our local communities and the communities of the nation and the world. The school has 631 students from 26 nations engaged in carrying out the vision of building healthy futures in greater Los Angeles, California, the nation and the world.

Faculty Referenced by this Article

Dr. Ninez Ponce
Ninez Ponce
Health Policy and Management
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Vickie Mays
Vickie Mays
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Jose J. Escarce
Health Policy and Management
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Isomi Miake-Lye
Isomi Miake-Lye
Health Policy and Management
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Sangeeta Ahluwalia
Sangeeta Ahluwalia
Health Policy and Management
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Olivia Jung
Olivia Jung
Health Policy and Management
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Ty Robbins
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Jeanne Miranda
Jeanne Miranda
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Jean Balgrosky
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David Hayes-Bautista
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Dr. Anthony Schiff
Anthony Hunter Schiff
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Dr. Joann Elmore
Joann G. Elmore
Health Policy and Management
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Thomas Priselac
Health Policy and Management
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Dr. Daniel Eisenberg
Daniel Eisenberg
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Mangione, C
Carol Mangione
Health Policy and Management
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Robert Kaplan
Robert Kaplan
Health Policy and Management
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Leah Vriesman
Leah Vriesman
Health Policy and Management
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Linda Rosenstock
Environmental Health Sciences Health Policy and Management
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Dr. Beth Glenn
Beth Glenn
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Julie A. Elginer

EMPH Academic Program Director with expertise in healthcare marketing, finance, and reproductive health policy, teaching in the EMPH, MPH, MHA program

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Dr. Alice Kuo
Alice Kuo
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Corrina Moucheraud
Corrina Moucheraud
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Dr. Samuel Sessions
Samuel Sessions
Health Policy and Management
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James Macinko
James Macinko

Professor of Community Health Sciences & Health Policy and Management, and Associate Dean for Research

Community Health Sciences Health Policy and Management
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Dr. Aria Fallah
Aria Fallah
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Robert Brook
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Dr. Kenneth Wells
Kenneth Wells
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Paul Chung
Paul Chung
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Dr. Naomi Zewde
Naomi Zewde
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Dylan Roby
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Emily Abel
Emily Abel
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Galper, Michael
Michael Galper
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Dr. Felicia Hodge
Felicia Hodge
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Dr. John Lu
Z. John Lu
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Ron Andersen

Dr. Ron Andersen is the Wasserman Professor Emeritus in the UCLA Departments of Health Policy and Management.

Health Policy and Management
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Jody Heymann
Jody Heymann
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Dr. Paul Fu, Jr.
Paul Fu, Jr.
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Kadiyala, Srikanth
Srikanth Kadiyala
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Comanor, Bill
William Comanor
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Emmeline Chuang
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Michael Ong
Michael Ong
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Susan Ettner
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Clifford Ko
Clifford Ko
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Freund, Deborah
Deborah Anne Freund
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Arlene Fink
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Warren Scott Comulada
Warren Scott Comulada
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Dr. Risha Gidwani
Risha Gidwani
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Mark Litwin
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Roshan Bastani
Health Policy and Management
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Gerald Kominski
Gerald Kominski
Health Policy and Management
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Nadereh Pourat
Nadereh Pourat
Health Policy and Management
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Ron D. Hays
Ron D. Hays

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Health Policy and Management
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Dr. Jonathan Fielding
Jonathan Fielding
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Steven Teutsch
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Diana Hilberman
Diana Hilberman
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Yusuke Tsugawa
Yusuke Tsugawa
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Dr. Yvonne Flores
Yvonne Flores
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Pamela Davidson
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Neal Halfon
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Moira Inkelas
Moira Inkelas
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Brennan Spiegel
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Barbara Berman
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Thomas Rice
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Dr. Frederick Zimmerman
Frederick Zimmerman
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Dr. Lillian Gelberg
Lillian Gelberg
Health Policy and Management
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Avram Kaplan
Avram Kaplan
Health Policy and Management
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Dr. Stephanie Taylor
Stephanie L. Taylor

Nationally recognized health services researcher and sociomedical scientist with 25+ years' experience in effectiveness and implementation research.

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Thomas D. Gordon
Health Policy and Management
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Jack Needleman
Jack Needleman
Health Policy and Management
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Dr. Xi Zhu
Xi Zhu
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Burt Cowgill
Burt Cowgill
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Dr. Arturo Vargas Bustamante
Arturo Vargas Bustamante
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Dr. Jennifer Wortham
Jennifer Wortham
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Dr. Kristen Choi
Kristen Choi
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Aronberg, Sandra
Sandra Aronberg
Health Policy and Management
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Patricia Ganz
Patricia Ganz
Health Policy and Management
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Laura Erskine
Laura Erskine
Health Policy and Management
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Michelle Keller
Michelle S. Keller

Dr. Michelle S. Keller is a health services researcher whose research focuses on the use and prescribing of high-risk medications.

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Annette Maxwell
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Dr. Elizabeth (Becky) Yano
Elizabeth (Becky) Yano
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Lori Pelliccioni
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