2023 RI Life Index shows Rhode Islanders still perceive steep challenges in housing, cost of living and access to health care and nutritious food

5th annual statewide survey is a partnership between Blue Cross & Blue Shield of Rhode Island and Brown University School of Public Health.

PROVIDENCE, RI – The 5th Annual RI Life Index, a statewide survey created by Blue Cross & Blue Shield of Rhode Island (BCBSRI) and the Brown University School of Public Health, shows Rhode Islanders still perceive steep challenges finding affordable housing, meeting the rising cost of living, and getting access to health care and nutritious food. The results capture how Rhode Islanders perceive their well-being in 2023 — a year the data portray as fraught with concerns about economic challenges — and a five-year period spanning the turbulent years preceding, during and following the COVID-19 pandemic. These emerging trends illustrate perceptions that deteriorated during the pandemic and have since stabilized, but which largely persist at troubling levels.

Explore 2023 RI Life Index

The RI Life Index asks Rhode Islanders for their perceptions on key issues including the availability of affordable housing; programs and services for children and older adults; and access to health care, food security, employment, and transportation. Scoring is on a scale of 0 to 100, with higher scores indicating more positive perceptions. In 2023, similar to previous years, 2,317 surveys were completed by adults randomly selected from across the state, in Spanish or English, with an oversample of Black and Latinx Rhode Islanders.

And for the third year in a row, to ensure that Rhode Islanders who do not speak English at home are also represented, 582 surveys were conducted this year by community-based organizations in 16 languages.

“There are real challenges facing the people of Rhode Island and this survey provides a roadmap to reducing inequities and improving the health and quality of life for the people in the Ocean State, especially for those struggling the most,” said Dr. Ashish K. Jha, Dean of the Brown University School of Public Health. “The RI Life Index is providing critical information on the real-life experiences of Rhode Islanders, information we can all use to build healthier, more equitable communities for all.”

BCBSRI President and CEO Martha L. Wofford added, “The RI Life Index reflects the reality of the people of Rhode Island and unfortunately the data show that experience is getting harder for some, particularly for underserved communities. The Index provides shared understanding so that we can have a shared agenda on how to address the gaps. We’re grateful to the RI Life Index Coalition members who are working hard to address the gaps and making collective progress in areas like affordable housing policy. And we’re grateful to those who participated in the survey and to the community organizations that joined with us to ensure that the voices of diverse Rhode Island communities are heard.”

The RI Life Index was launched in 2019 in recognition that health transcends what happens within the health care system and that factors such as employment, education, and housing — collectively known as social determinants of health — contribute to health inequities in our diverse communities. The index is updated every year by surveying a representative sample of Rhode Islanders to measure their perceptions of these health-related factors. The collected data are then presented graphically and shared broadly and publicly with the goal to assist efforts to address health disparities among Rhode Island’s diverse racial, ethnic, and geographic populations, and build healthier communities.

In 2023, the overall score for the statewide random digit dial (RDD) survey was essentially unchanged from last year, dropping one point from 59 to 58, the lowest in five years. The overall score for the survey completed by community-based organizations was also essentially unchanged, rising one point this year, from 54 to 55.

Key Findings

Here are some of the key findings from the 2023 RDD survey:

score: 32

Affordable housing

In 2023, as housing prices hit record highs, the score for affordable housing was 32, meaning that more than two-thirds of respondents perceive housing costs as out of reach, the second lowest overall score and down from 44 in 2020. All subgroups scored low in 2023 and saw meaningful declines in the past four years.

Score: 23

Cost of living

As inflation persisted throughout the year, the overall score for cost of living was among the lowest in 2023, at 23, down from 31 in 2020, meaning more than three-quarters of respondents perceive the cost of living as a challenge. These scores were low for all subgroups (21 to 27) but lowest for Blacks in core cities (18 for those younger than age 55, 16 for those ages 55+).

Score: 55

Economic situation and jobs

The economic situation score was essentially unchanged from 2022 at 59 but is down five points from two years earlier. Job opportunities scored 55 and has remained steady over the past five years.

Score: 66

Access to nutritious food

With food prices remaining high, this score fell in 2023 by three points, to 66. That’s down from 73 in 2019, the largest decline in a topic area since the Index began. The scores during that five-year span dropped in both core cities and non-core areas. Food security, a separate category, saw a substantial decline in core cities, down 6 points since 2020.

Score: 67

Health care access

As the pandemic disrupted medical services, perceptions about health care access have fallen. It was one of the largest drops in scores for core cities, down 7 points to 64 since 2019, and it was the largest five-year decline for younger adults.

Score: 73

Racial equity

The lowest scores for equity were for Blacks in core cities (59 for those under age 55 and 62 for those ages 55 and up). In 2023, there were notable decreases in almost all scores for Black respondents and for all scores for Latinx respondents.

Score: 71

Programs and services for children

After seeing a drop in 2020 amid the pandemic, positive perceptions of programs and services for children have remained relatively stable. But at 71, they are down five points from 2019.

Score: 64

Older adults

The overall score was 64, down four points from 2019.

Survey findings are reported by race, ethnicity, age, and geography (“non-core” communities versus the “core cities” of Central Falls, Pawtucket, Providence, and Woonsocket, which have the most children living below the federal poverty level). And findings are identified as coming from either the random digit dial (RDD) survey conducted from March to June 2023 or from interviews conducted by community-based organizations from July to October 2023. This year, surveys were completed in person or by phone by six organizations: Capeverdean American Community Development, Center for Southeast Asians, Dorcas International, Genesis Center, Higher Ground International, and Progreso Latino.

The RI Life Index Coalition, a group of community partners from across the state, assists in shaping the survey. Coalition members also offer thought leadership on solutions to the challenges identified in the Index. Coalition member organizations include BCBSRICommunity Provider Network of Rhode Island; United Way of Rhode IslandLatino Policy Institute; the Rhode Island Department of HealthRhode Island Community Food BankBrown University School of Public HealthHousingWorks RIRhode Island Kids CountAARP Rhode IslandThe Economic Progress InstituteRhode Island FoundationLifespan Community Health Institute, and Medical Legal Partnership Boston.

The 2023 Index results were presented on Nov. 29 at a public event at Brown University School of Public Health. Dr. Jha and Ms. Wofford gave opening remarks and David Williams, Ph.D., professor of public health at Harvard University’s T.H. Chan School of Public Health, delivered the keynote address. Carrie Bridges Feliz, MPH, Vice President of Community Health and Equity at Lifespan, moderated a discussion with RI Life Index Principal Investigator Melissa Clark, Ph.D., professor of health services, policy and practice, and director of the Survey Research Center at the School of Public Health, and Dr. Williams.

For more information on the RI Life Index, please visit RILifeIndex.org.

See this year's RI Life Index Findings