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  4. Louisville, Kentucky

Louisville, Kentucky

With abundant transportation resources and a central location on the banks of the Ohio River, Louisville, Kentucky is a manufacturing, distribution, and service hub.

Louisville is home to shipping and logistics giant UPS, as well as national insurer Humana and two major health systems, which employ a combined total of 29,000 residents. In the mid-20th century, many industrial giants like General Electric and Ford opened manufacturing plants in Louisville; however from the 1970s to 2000, the manufacturing industry went into decline. All four of the city’s cigarette manufacturers eventually shuttered operations in Louisville, with thousands of jobs lost.

Beginning in the 1990s, Louisville’s civic, business, and educational leaders have worked together to build a thriving, 21st-century economy based largely on shipping and logistics, health care, and technology. However, a persistent legacy of economic and educational inequality between the city’s black and white residents, as well as patterns of segregation, have contributed to profound inequities in health outcomes between the two communities. To improve the health and well-being of Louisville residents, civic, business, public health leaders, and public-private partnerships have collaborated on ambitious educational and health initiatives, whose impact is beginning to be realized.

Overview

Population

605,672

Race/Ethnicity

Median Household Income

Population Living in Poverty by Race/Ethnicity

Sources:

U.S. Census Bureau; photography courtesy Flickr user StevenW., CC BY-SA 2.0

Community Context and Challenges

  • Renewal efforts in the 1960s pushed many low-income black residents to areas with concentrated poverty and a shrinking business base, and left them them unable to move due to housing policies that restricted development of subsidized housing.

  • Due to disparities in educational attainment, many black residents are ill prepared to meet local employers’ needs; they are thus more likely to hold lower paying jobs and experience unemployment.

  • At 13%, unemployment among black residents is higher than for Hispanic (10%) and white (5%) residents.

  • Cigarette smoking prevalence in Louisville and the state are among the highest in the nation; more than 27% of Kentucky adults are cigarette smokers, compared to 17% nationwide.

  • Nearly 13% of Louisville residents suffer from asthma, compared to the national average of 8%; it is the leading cause of emergency room visits among children.

Community Actions: A First Look

Today, Louisville is focused on health in all policies and setting its sights on better preparing the region’s workforce for high-demand jobs.

Recognizing the need to narrow health disparities and to improve its competitiveness and quality of life, Louisville has adopted a “health-in-all-policies” approach to improving population health and engaging broad sectors of the community.

These baseline reports, created in 2016, track community programs and initiatives in their early stages and measure initial progress only. Future reports will provide more in-depth insights and analysis into this community's efforts to build a Culture of Health.

  1. 1

    Making Health A Shared Value

    Healthy Hometown Movement Coalition

  2. 2

    Fostering Cross-Sector Collaboration

    Health in all policies

  3. 3

    Creating Healthier, More Equitable Communities

    55,000 Degrees

  4. 4

    Strengthening Integration of Health Services and Systems

    Humana’s Bold Goals

Making Health A Shared Value

Healthy Hometown Movement Coalition

Mayor Fisher’s Healthy Hometown Movement Coalition consists of approximately 70 members representing more than 50 community-based organizations, faith-based groups, foundations, and employers.

Fostering Cross-Sector Collaboration

Health in all policies

The “health-in-all-policies” philosophy, championed by Mayor Greg Fisher, advocates for health-promoting policies and programs to be interwoven into many aspects of residents’ daily lives, including schools, workplaces, child care facilities, and neighborhoods. The approach is incorporated in the Healthy Louisville 2020 plan, which emphasizes prevention and evidence-based interventions to improve community health.

Creating Healthier, More Equitable Communities

55,000 Degrees

A major initiative, called “55,000 Degrees,” was created in 2008 with the goal of equipping Louisville’s working age population with an additional 40,000 bachelor’s degrees and 15,000 associate degrees by 2020.

Strengthening Integration of Health Services and Systems

Humana’s Bold Goals

Health insurer Humana, Louisville’s second largest business, is spearheading an ambitious effort to improve health among local employees, their family members, and enrollees across the nation. The organization’s “Bold Goals” initiative aims to enhance health and well-being through technology-supported means, including using mobile devices to track vital signs, communicating virtually with health providers, and connecting with health-related communities. In Louisville, Humana’s initiative is targeting three priorities for improvement among employees and enrollees: behavioral health; diabetes; and respiratory conditions, including asthma, allergies, chronic obstructive pulmonary disease, and smoking.

Going Forward: Questions for Consideration

Responding to decades-old challenges in a proactive manner, Louisville’s business, community, and public health sectors have worked collaboratively to narrow the social, economic, and educational disparities that have long plagued the city and hampered progress toward health equity. Comprehensive initiatives to improve educational attainment, expand health insurance, and address long-standing health disparities have gained the cooperation of diverse stakeholders and influential partners across the community. Additional surveillance, data and information gathering, analysis, and reporting will examine the impact of these and other initiatives on Louisville’s residents, especially members of its underserved low-income, black community.

The following questions will be addressed in future reports:

  • To what extent will the proposed Medicaid waiver influence future access to health insurance coverage among the city’s low-income population? How will changes to the current “one-stop shopping” eligibility system affect access to insurance coverage?

  • In what ways are stakeholders in the business, health, and public health sectors coordinating their initiatives to ensure that all residents are served and can attain the maximum possible benefit?

  • What has been the success of workplace initiatives in Louisville to reduce unemployment and underemployment among racial minorities?

  • In what ways will Louisville continue to use or expand its use of civic data to drive decision making?

  • To what extent is the “health-in-all-policies” philosophy being adopted across initiatives, included in Healthy Louisville 2020, and what lessons can be learned from how is this philosophy being applied?

  • To what extent is input from diverse resident groups reflected in the initiatives championed by Louisville’s leaders?

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