Toledo, Ohio

Toledo, county seat of Lucas County, is a sprawling city in northwest Ohio whose proximity to the Great Lakes bolstered its manufacturing might in the 19th and early 20th centuries.

Toledo’s population peaked in 1965 with 392,000 residents, who were drawn to jobs in manufacturing companies, automotive factories, strong cultural institutions, and a local public research university. But like many Rust Belt cities, Toledo’s fortunes—and population—declined as U.S. manufacturing began to falter in the 1970s. Causes for the decline were job automation and the exit of companies to non-union states or overseas.

Of the seven Fortune 500 manufacturing companies that called Toledo home in the early 1980s, just one, Owens Corning, remains today. General Motors continues to operate a plant in Toledo, as does Jeep-Chrysler, although many auto supply manufacturers have departed. Decades of an unpredictable, generally declining economy have taken their toll on the health and social well-being of Toledo residents. Residents struggle with depressed household incomes, a high prevalence of chronic disease risk factors, high rates of infant mortality, and an emerging opioid crisis. Federal health agencies, community groups, and other stakeholders are collaborating to address these challenges through initiatives that address policy, systems, and environmental change strategies to shape and sustain improvements in population health and well-being.

Overview

Population and Demographics

Population: 283,932

SOURCES:
U.S. Census Bureau; photography courtesy Flickr user cmh2315fl, CC BY-NC 2.0.

Context and Actions

Community Context and Challenges

Approximately 40% of children live in poverty, which is twice as high as the county (20%) and significantly higher than state (23%) and national levels (22%).
Racial/ethnic disparities in educational attainment are striking; nearly 19% of Black and 30% of Hispanic residents in Toledo have less than a high school education, compared to about 12% of the white residents.
Chronic disease risk factors are prevalent among Lucas County residents; 65% of the county’s Black residents and 79% of its Hispanic residents are either obese or overweight, while nearly 1 in 5 adults (19%) are current smokers.
Deaths from heroin and fentanyl, an opiate considered more potent than heroin, increased in Lucas County and surrounding counties from 145 in 2014 to 215 in 2015.

SOURCES:
Ohio Department of Health. 2014 Ohio infant mortality data: General findings. (2014).

Taking Action

Today, Toledo is investing in the revitalization of its downtown area, rebuilding its economy, and combating its most pressing health challenges.

Revitalization efforts are focusing on clean energy technology, such as solar panels, wind turbines, and extended-life batteries, while across the city and county, civic agencies and organizations are joining forces to educate the public on health risk factors and help shape targeted interventions. While the impacts of the city’s approaches are not yet fully realized, Toledo continues to address its traditional and emerging challenges.

NOTE:
These baseline reports, created in 2016, reflect our initial observations on select community programs and initiatives to gauge ongoing, as well as newer, efforts to improve community health. Future reports will provide more in-depth insights and analysis into this community's activities.

Curbing Opioid Abuse

Stakeholders working with the Governor’s office in early 2016 helped to craft new prescribing guidelines that curb physicians’ ability to prescribe the maximum dosages of opioid painkillers and to encourage use of non-opioid treatments. The Toledo-Lucas County Health Department pharmacy was the first site in the state to dispense naloxone to individuals as an overdose reversal medicine and to train police to use and administer the medication.

Public Education and Intervention

Toledo is in the early stages of developing partnerships to address the growing epidemic of opioid addiction and overdoses. To combat this emerging problem, representatives from the Lucas County-Toledo Health Department, state government, community organizations, fire departments, law enforcement and health and mental health providers have joined forces to educate the public about the risks and offer guidance on intervention.

Framework for Addressing Risk Factors

Toledo's complex interaction of economic, cultural and social forces has contributed to significant health disparities that defy simple interventions. Stakeholders are taking a comprehensive approach by using a multilevel framework to address chronic disease factors. This framework uses policy- and system-change approaches to create environments that support health and healthy behaviors, rather than focusing solely on disease-specific interventions.

Healthy Lucas County

Healthy Lucas County is a collaboration of organizations serving Toledo and the surrounding area. It is coordinated by the Hospital Council of Northwest Ohio, whose mission is to improve resident health and reduce health disparities.

Going Forward

Questions for Consideration

Some of the major challenges affecting the health and well-being of Toledo’s residents are being addressed through a multilevel framework of government and community stakeholders. This approach addresses the unique roles of policy, systems, and the environment in promoting population-wide change. Early indications suggest that this approach may be beneficial in addressing complex problems such as chronic disease and infant mortality. However, continued progress will likely depend on the outcome of multisector collaborations and the extent to which these broad-based partnerships continue to work effectively. Additional surveillance, data and information gathering, analysis, and reporting will examine the progress of ongoing initiatives and assess their value as a model to address other health concerns.

The following questions provide opportunities for further exploration:

To what extent are community residents involved in multistakeholder efforts to improve options for healthy food choices; increase smoke-free housing options; and promote more physical activity?
Several initiatives to improve health and well-being in Toledo are at an early stage, including CDC’s Partnership to Improve Community Health and the Ohio Department of Medicaid’s efforts to reduce infant mortality. In advance of having measurable population-level outcomes—to what extent have these efforts generated ongoing commitment from partners; participation from community residents; and sustained implementation of evidence-based policy, system, and environmental change interventions?
How are stakeholders measuring the impact or outcomes of initiatives to improve options for healthy food and promote more physical activity?
Since the Pathways HUB model has shown success in addressing Toledo’s high rates of infant mortality, especially among Black infants, which components of this model appear to be most meaningful?