Community Context 

Louisville is located on the Ohio River along the northern Kentucky border. It is known for hosting the Kentucky Derby and has been an important trading, manufacturing, and commercial hub for most of its history. After the decline of the manufacturing industry in the late 20th century, the community developed a diversified economy built on several industries, including healthcare, food and beverage, and logistics, with recent growth in the technology sector. 

The city has been led by three-term Democrat Mayor Greg Fischer since 2010. Louisville has been recognized as a leader among peer cities: Mayor Fischer served as the Vice President of the U.S. Conference of Mayors between 2020 and 2021. 

However, persistent patterns of segregation in the city have created a legacy of economic, educational, and health-related inequalities between the city’s Black and White residents. Further, there are geographic disparities. For instance, neighborhoods in West Louisville are prone to flooding and suffer from poor air quality due to the presence of heavy industry, particularly rubber plants, which gave the area its “Rubbertown” nickname. 

The COVID-19 pandemic has disproportionately impacted the city’s Black residents, and a “second pandemic,” focused on heightened awareness of systemic racism and social injustice in the city, was sparked by views that city leaders’ response to the fatal shooting of Breonna Taylor was inadequate. Changes followed: The LMPD chief was fired; the city promised police reforms; and racism was declared a “public health crisis.” 

Other pressing health priorities have evolved to focus primarily on reducing alcohol and drug use and improving community safety, particularly as violence rose during the pandemic and during periods of civil unrest. 

Kentucky expanded Medicaid with the passage of the Affordable Care Act, which has alleviated some historic concerns with healthcare access.

Louisville’s Journey to Promote Health, Well-Being, and Equity

Louisville’s efforts are led by various city government departments, but also involves healthcare organizations, a robust nonprofit sector, workforce development organizations and coalitions, local foundations, and anchor institutions.

Stakeholders in Louisville have pursued new initiatives related to equitable policy development and access to resources; continued trauma-informed cradle-to-career services for children and youth; and enhanced data and research centered on equity, coordination, and environmental health. A long-standing focus on the social determinants of health has only deepened in Louisville, with additional stakeholders seeing the connection between factors like the built environment, access to supportive services, workforce development opportunities, and health, and independently initiating action to address those factors. Louisville’s approach to health equity has evolved over the past five years, from established structures dedicated to equity to naming racism and poverty as drivers of inequality, investing in communities of color, empowering grassroots leaders, and aligning community-wide measurement and investments with racial equity priorities.


Baseline research started in 2016 to track community programs and initiatives. The most recent report, from 2022, provides more in-depth insights and analysis into the community's efforts to build a Culture of Health.

Lessons Learned: Where is Louisville Five Years Later?

Louisville’s journey to promote health, well-being, and equity is one that illustrates how a community can start to move from shared values to action on health equity and upstream drivers of health. It also sheds light on how entrenched power structures may inhibit change despite good intentions. 

Capacity from the Center for Health Equity (CHE), Louisville Urban League, and others laid the groundwork by establishing common language and providing technical assistance, data, and reporting resources. The events of 2020 catalyzed even more new commitments. 

Other communities can learn from Louisville’s approaches to make these changes, as well as the challenges they encountered, to inform their own journeys. And as COVID-19 recovery continues, with historic funding flowing to local communities, future research could consider the ways in which momentum around health, equity, and well-being influences community health narratives and decisions moving forward.

Louisville is leveraging external funding, a collaborative culture, and dedicated organizations working on health equity and root causes to address long standing factors that influence health and well-being outcomes. Yet, inertia in philanthropy and local leadership, as well as the city’s diverse array of initiatives and organizations, present barriers to addressing significant unmet needs in the community.

Facilitators:

  • Mid-size city with extensive capacity, strong networks, and gifted leaders 

  • Organizations focused on health equity and civil rights

  • Participation in national networks and funding and attention from external organizations 

  • Long history of data usage and integration

  • Medicaid expansion in Kentucky

Barriers:

  • Challenges with prioritization and sustainability of efforts

  • Trauma from events of 2020

  • Lack of representation in leadership

  • Residential segregation and endemic poverty

  • Fragmentation of effort

  • Lack of charitable culture