Confronting federal censorship of social vulnerability index

Social and structural factors—collectively the social determinants of health (SDOH)—drive up to 70% of health outcomes and must be identified, considered, and addressed if we are to improve individual and population health.^1,2 Geographically defined metrics that capture multiple domains of social, economic, and medical vulnerability are particularly important because they can be meaningful, informative, and actionable for many sectors of the healthcare ecosystem³ from clinicians and health systems to community-based organizations and businesses to public health agencies and regulatory bodies. These area-level measures reveal the geographic maldistribution of SDOH to highlight potential mechanisms of, vulnerabilities to, and adverse sequelae of disease, underscoring the necessity of simultaneously considering multilevel drivers of health in a community context.³ This is why the continuing threat to remove the U.S. Centers for Disease Control and Prevention (CDC) Social Vulnerability Index (SVI) tool⁴ would lead to a major setback to research, practice, and policymaking for improving health and preventing disease.

The utility of SVI and other area-level SDOH measures in quantifying social and environmental risks is currently unparalleled. The CDC’s SVI tool⁵ (introduced in 2011) provides an easy-to-understand measure of SDOH within a defined geographic region (Table 1), with interactive maps, free data download tools, and application guidance to help public health officials and local planners better prepare communities for emergency events such as severe weather, disease outbreaks, and chemical exposures. As of March 3rd, 2025, Scopus had 5460 articles that used “social vulnerability index” to examine health outcomes as critical and wide-ranging as early death, cancer, diabetes, heart disease, surgical outcomes, healthcare spending, infectious diseases, and opioid overdoses.^3,6

Table 1.

Measures of social determinants of health as alternatives to CDC’s social vulnerability index.

Measure	Base data	SDOH construct	Unit of analysis	Host organization
Social Vulnerability Index (SVI)a	Census	Social vulnerability	Census tract	Federal/CDC
Area Deprivation Index (ADI)b	Census	Neighborhood deprivation	Census block group	University of Wisconsin Center for Health Disparities Research
Social Deprivation Index (SDI)c	Census	Social deprivation	Census tract, ZCTA	Robert Graham Center
Index of Concentration at the Extremesd	Census	Racial residential segregation	County/Census tract	IPUMS USA
American Neighborhood Changee	Census	Gentrification	Census tract	University of Minnesota Law School
County Health Rankingsf	Various	County health factors ranking	County	University of Wisconsin Population Health Institute
Child Opportunity Indexg	Various	Various, childhood environment	Census tract	Diversitydatakids.org
Social Vulnerability Index (SoVI)h	Census	Social vulnerability	County	University of South Carolina
Baseline Resilience Indicators for Communities Index (BRIC)h	Various	Disaster resilience	County	University of South Carolina
Contextual Determinants of Healthd	Various	Population-specific policy and outcomes measures	Various	IPUMS USA
Opportunity Atlasi	Census	Childhood environment, mobility	Census tract	Harvard University Opportunity Insights

All datasets listed are available from their respective repository locations at no cost. Census tracts are small statistical subdivisions of counties with a population of 1200–8000 people. Census block groups are subdivisions of census tracts. SDOH: Social determinants of health. ZCTA: Zip Code Tabulation Area which is a US Census crosswalk between census units and US Postal Service zip code mail routes.

^aThe restored SVI site is: https://www.atsdr.cdc.gov/place-health/php/svi/index.html. We also preserved a copy of CDC’s 2022 SVI from October 2024 in preparation for its potential removal: https://doi.org/10.5281/zenodo.14848085.

^bhttps://www.neighborhoodatlas.medicine.wisc.edu/.

^chttps://www.graham-center.org/maps-data-tools/social-deprivation-index.html.

^dhttps://cdoh.ipums.org/download.

^ehttps://myottetm.github.io/USMapBoxIMO/USLwDispConc.html.

^fhttps://www.countyhealthrankings.org/health-data.

^ghttps://data.diversitydatakids.org/dataset/coi30-2010-tracts-child-opportunity-index-3-0-database--2010-census-tracts?_ga=2.215245911.1908926386.1738891239-1038762740.1738891239.

^hhttps://www.sc.edu/study/colleges_schools/artsandsciences/centers_and_institutes/hvri/data_and_resources/bric/index.php.

ⁱhttps://www.opportunityatlas.org/.

On January 31, 2025, all mentions and applications of the SVI were abruptly removed from CDC and other federal sites⁴ to comply with President Trump’s Executive Order 14168 targeting transgender health equity amidst a broader push to eliminate diversity, equity, and inclusion programs.⁷ The website was ultimately restored on February 11, 2025, after a temporary restraining order—now lifted—in a Doctors for America (DFA) lawsuit challenging the removal for violating process requirements.⁷ However, in a court filing, the federal government reiterated its intention to modify or eliminate federal data tools like the SVI in accordance with Executive Order 14168 after following the process requirements cited in the DFA suit.⁷ This unprecedented censure of a vital taxpayer-funded resource addressing key drivers of health violates the widely accepted FAIR (Findability, Accessibility, Interoperability, and Reusability) data stewardship principles⁸ (promoted by the NIH⁹) and will undoubtedly have far-reaching effects on public health. Moreover, the cost—in time and treasure—of redesigning automated workflows reliant on the CDC’s SVI tool will result in otherwise unnecessary burden, including ultimately at taxpayer expense.

There are alternatives that can support health systems, researchers, public health professionals, and policy makers if SVI is permanently removed. SVI can be manually recalculated per Flanagan et al.⁵ using county or census tract level data from the US Census website,⁵ much of which is also archived on non-governmental sites such as diversitydatakids.org. Other ways of measuring SDOH at the area level (Table 1)—albeit with differing underlying constructs with their own strengths and limitations³—may also meet end-user needs for the inclusion of specific indicators (Supplementary Table). Notably, federal datasets are used to derive many of these indices, deepening concerns about censure of public health information.

While the present moment demonstrates the necessity of non-governmental archival work to preserve publicly funded data sources, any area-level datasets on social factors held by single key or backbone institutions inherently lack resiliency to institutional capture, changing priorities, or even personnel turnover. We can and should reduce the risk of resource loss through confederated and redundant data infrastructure¹⁰ to measure social vulnerability and SDOH and share code repositories to build datasets on the fly. Redundancy may raise short-term costs and present data validation challenges, but these are problems that have been considered and addressed in other academic fields. For example, the international high energy physics collaboration CERN runs Zenodo to host datasets (including life sciences datasets) outside of national governments’ purviews while providing free and open data that benefits all.

SVI has been an essential tool for researchers, clinicians, policymakers, and the public to quantify the self-evident link between our social and environmental vulnerabilities and health. Open, unrestricted access to it must be maintained. Alternative measures for area indices of SDOH can be leveraged to continue building a more equitable future as we build towards a more resilient data infrastructure.

Contributors

SJH: conceptualization, data curation, writing–original draft, writing–review & editing.

RGM: conceptualization, supervision, writing–original draft, writing–review & editing.

Declaration of interests

The authors have no conflicts of interest to declare.