May 2 2014
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Place Matters: Eliminating Health Disparities in Cuyahoga County, Ohio

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The Cuyahoga County, Ohio Place Matters team's focus is on ensuring health implications and equity considerations are at the forefront as policy makers and others make decisions that substantially impact the county’s residents and the neighborhoods in which they live.

Key Team Objectives:

  • A broader definition of health. Health is not simply the absence of disease—health begins where people live, work, learn, age and play. Health includes the social conditions one lives in, such as the jobs we do, the money we're paid, the schools we attend and the neighborhoods we live in, as well as our genes, our behaviors and our medical care.
  • Inform, influence and engage policy makers and community members to develop policies—using an overarching health equity lens—that have long-term impacts, create conditions for optimal health and reduce inequities.
  • Utilize "place-based" interventions to engage and empower residents in under-resourced communities to revitalize their communities.

East Cleveland is one of the most densely settled communities in Cuyahoga County. The city has a poverty rate of 32 percent, while its heart disease mortality rates (355/100,000) are higher than in the county (10 percent higher) and the nation (32 percent higher).

Team objectives include building effective partnerships; striving for equal opportunity for all; equity; recognition that neighborhood condition is the context in which health and wellbeing begins; health in all policies; mobilizing the community for action; and measuring indicators of social determinants of health.

Community partners include:

Team co-leader Sandra Chappelle, who is also the senior program officer for Strong Communities at the Saint Luke’s Foundation in Cleveland, said that a health equity lens is often not used simply because people aren’t aware of the type of policies that have set the conditions that are creating inequitable results in communities.

“That’s why our team is working to inform and influence and engage policy makers, so that there’s an increased awareness of how past practices have created equitable results and actually producing poor health outcomes to this day,” she said.

Chappelle said the team has been trying to increase the level of understanding around “this new, redefined approach to public health, so that people don’t believe that health is shaped solely by access to health care and things like standards of care, which are important, but we do believe that the social and economic conditions in which people live are the factors that greatly influence health outcomes.”

Chappelle said the team’s goal is to have policy makers include a health equity lens in everything that they do.

Team co-leader Martha Halko, Deputy Director of Prevention and Wellness at the Cuyahoga County Board of Health, said the team has seen a tremendous movement toward better understanding about how to ensure that health equity considerations are infused in all policies.

“We’ve been with our planning commission so that they begin to infuse an equity lens into their work,” she said. “At this point they are working to change the planning commission’s design review guidelines so that they include not only community voice, but also take an approach that looks at unintentional consequences of policies, plans, or decisions that they may be ready to adopt.”

The commission has been working to infuse new tools—such as health impact assessments—in its work, particularly as it relates to how they approve development projects, according to Halko. Place Matters partners from the team have engaged in advancing health impact assessment in the region as a key tool to help them really look at how to integrate health equity considerations in land-use planning decisions, neighborhood revitalization decisions and redevelopment community design decisions.

“We’ve partnered with both city planning and county planning to begin to look at how we integrate health and equity into these types of decisions,” she said. “The goal is to improve health outcomes and reduce inequities by addressing these issues at the policy level and the systems level.”

Among the initiatives the Place Matters team has been able to influence is Health Improvement Partnership Cuyahoga (HIPC), the county’s health improvement planning process, a multi-sector partnership of more than 50 organizations, institutions and community members that is working to improve the health of everyone who lives or works in the county.

By hosting two land use summits, the team was able to “jumpstart a broader movement to promote the integration of health and equity into land use planning and community development decision-making,” she said, adding that land use has been “instrumental for us in gaining local attention, as well as national attention, and it’s really helped our team describe and communicate the scope and the magnitude of health inequities in our county and to build a network of partners who are really working with us to utilize place-based approaches which engage the community and focus on addressing these inequities.”

Tags: Health disparities, Heart and Vascular Health, Heart disease, Place Matters, Poor and economically disadvantaged, Poverty