Rhode Islanders report challenges with cost of living, access to affordable housing and nutritious food

PROVIDENCE, R.I. [Brown University]-Rhode Islanders continue to face considerable challenges related to cost of living, affordable housing and access to nutritious food, and they are increasingly concerned about health care access.

Those are among the key findings from the seventh R.I. Life Index, an annual statewide survey on well-being created by leaders at Blue Cross and Blue Shield of Rhode Island and the Brown University School of Public Health.

The survey captured how Rhode Islanders perceived their well-being in 2025 and added to a growing set of data the index has been collecting since before the COVID-19 pandemic. According to the results released on Wednesday, Feb. 4, there was virtually no improvement in 2025 in persistently low scores for how Rhode Islanders perceive their health and well-being.

The overall score stood at 57 on a scale of 0 to 100, with higher scores indicating more positive perceptions. That's unchanged from the previous year but down six points since 2021 and stuck at the lowest level since the index began collecting data.

By following Rhode Islanders' views on the factors that shape their health and quality of life year after year, the survey shows not just what people are struggling with, but what is - or is not - getting better, said Dr. Francesca Beaudoin, a professor of epidemiology and emergency medicine and interim dean of the Brown University School of Public Health.

"Seven years of results make clear this year isn't just a blip," Beaudoin said. "It's part of a longer pattern, suggesting many people feel the conditions that impact daily life haven't meaningfully changed. That perspective helps guide research and gives policymakers, community groups and health leaders a clearer target for building healthier, more equitable communities statewide."

Blue Cross and Blue Shield of Rhode Island and Brown's School of Public Health launched the R.I. Life Index in 2019, recognizing that health transcends what happens within the health care system and that factors such as housing, food security, employment, education and quality of life - collectively known as social determinants of health - contribute to health disparities. The index measures perceptions of these health-related factors based on a statewide random digit dial survey, conducted in Spanish and English, of a representative sample of Rhode Islanders. The collected data is then shared publicly to assist efforts to build healthier communities.

This year, there was little change in any individual category (quality of community, community life, access to nutritious food, and programs and services for older adults and children). The lowest score, once again, was cost of living (21). The next lowest score was affordable housing (30), also essentially unchanged from 2024 but down 14 points since 2020.

Among the meaningful changes in 2025 was a three-point drop, to 65 in 2025 from 68 in 2024, in perceptions about health care access. The largest declines for this category, ranging from four to five points, were observed among Black and Latino individuals. Researchers noted that the survey was conducted in the weeks and months that followed the announcement of the closing of a major primary care practice in Rhode Island.

The 2025 index also revisited Rhode Islanders' perceptions of their economic situations. The score declined by three points since 2023, when it was last measured, and five points since 2020.

Digging deeper into the data

Researchers also shared the results from Rhode Island Voices, a project within the R.I. Life Index that goes beyond perceptions to explore people's experiences. Launched in 2024, the project enlisted a panel of up to 1,000 Rhode Island adults to participate in web-based questionnaires throughout the year on a range of topics related to social determinants of health.

According to Rhode Island Voices data, the state is confronting record-high food insecurity: 44% of respondents experienced some level of household food insecurity in the last 12 months. Panel members indicated how rising grocery prices have changed how they shop for food, whether they've had to make choices between paying for food or paying for other expenses, and how confident they feel that they could find adequate support if they needed help accessing food.

The random digit dial component of the index included 2,117 adults from across the state. It was conducted in the first half of 2025, prior to disruptions related to the federal government shutdown and SNAP assistance.

Melissa Clark, a professor of health services, policy and practice, and director of the Survey, Qualitative and Applied Data Research Core at Brown's School of Public Health, led the team of researchers from Brown and the Siena College Research Institute that designed and managed the 2025 survey.

The project's 2025 results reflect the many challenges that Rhode Islanders continue to face in their everyday lives, said Blue Cross and Blue Shield of Rhode Island President and CEO Martha L. Wofford.

"Understanding those challenges through the index enables us to rally around a collective agenda to improve health and well-being for all Rhode Islanders," Wofford said. "We're deeply grateful to every community member who shared their perspective and to the R.I. Life Index Coalition members who work every day to create a brighter, heathier future for our state."