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.
Health Priorities and Narrative
The municipal health department, local health advisory board, and health systems continue to provide leadership for health and services to the Louisville community. Louisville has seen the expansion of neighborhood-based facilities, parks, and infrastructural improvements in recent years.
Louisville is home to numerous collaboratives and initiatives focused on cradle-to-career programming for youth, with a focus on trauma-informed care and wrap-around services. Many local initiatives focus on providing and integrating data and research for community benefit.
Health Priorities and Narrative
Since the COVID-19 pandemic, there has been a shift from “understanding to action” on the root causes of poor health. The role of trauma and mental health in well-being have gained footing across sectors.
Racism and poverty are named explicitly across the community as drivers of inequality, replacing euphemisms previously used to refer to people of color and people with low incomes. Power structures have been evolving, with more support for Black-led organizations, a “sea-change” in racial representation in leadership bodies, and increasing efforts to engage community members in developing policy solutions.
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.
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
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