Community Context 

New Haven is located in south central Connecticut, about halfway between New York and Boston. The city saw economic and population declines between the mid- and late-20th century. It later underwent urban economic revitalization efforts and experienced population growth, particularly among populations of color, and resulted in a racially/ethnically diverse community. 

Yale is a significant cultural and economic driver in the city, though “town-and-gown” relationships remain complex. The university is a major source of employment and funding and the leader of many important health initiatives. It does not pay taxes on earnings from its $42.3 billion endowment, though in 2021, Yale committed to increasing its payments in lieu of taxes (PILOTs) to the city of New Haven. There are many nonprofits and community-based organizations concentrated in a relatively small city, which results in competition for funding.

New Haven’s residents have historically been politically engaged, which has motivated these values among leaders. The city has seen two Democratic mayors over the past five years, both of whom prioritized health and equity with signature issues. 

Connecticut’s expansion of Medicaid has allowed New Haven’s FQHCs and Yale-New Haven Hospital (YNHH) to expand services for many residents with low incomes. The community’s proximity to New York City meant it saw early COVID-19 impacts that disproportionately impacted communities of color.

Community violence has always been a top concern, and in 2021, gun violence was at its highest rate in years. 

The state minimum wage has been increasing since 2019 and is set to reach $15 per hour in 2023. However, there continue to be large disparities in health and well-being outcomes for communities of color and with low incomes.

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

Five years into the Sentinel Communities Surveillance Project, New Haven’s capacity to promote health, well-being, and equity is led by the local health department, Yale University, and YNHH.

Others are also involved, including healthcare organizations, educational institutions, city departments, a robust nonprofit sector, workforce development organizations and coalitions, and local foundations. New Haven continues to take steps toward better health, well-being, and equity with significant grassroots activity and institutional initiatives on topics such as community safety and trauma, reimagining healthcare delivery, meeting basic needs in combination with upstream efforts, and engaging in equitable economic and workforce development. Many of these initiatives have been in place before 2017, though new investments and commitments have been made since then. New Haven’s history of confronting various social determinants of health and health inequities has shaped stakeholders’ broad definition of health, which incorporates education, poverty, violence and trauma, and housing, in addition to physical and mental health. Some community members are concerned that the dominant narratives in the community still emphasize downstream approaches and individual responsibility. New Haven’s approach to health equity has evolved over the past five years, from some discussion of equity by various stakeholders to rethinking funding, empowering grassroots leaders, and creating new structures with racial equity as a cornerstone.

Lessons Learned: Where is New Haven Five Years Later?

New Haven’s journey to promote health, well-being, and equity shows how a community can capitalize on both institutional and grassroots capacity, but it also sheds light on how acute community challenges may inhibit collaboration and action on long-term systems transformation. 

Other communities can learn from New Haven’s approaches and challenges to inform their own journeys. And as COVID-19 recovery continues, with New Haven receiving historic funding through the American Rescue Plan Act, future research could consider the ways in which the community’s established track record for considering health and equity influences community health narratives and decisions moving forward.

New Haven has funding, capacity, and grassroots energy to address longstanding factors that influence health, equity, and well-being outcomes. Yet, instability in local leadership, a top-down approach to community health from many large institutions, and a lack of coordination present barriers to addressing significant unmet needs in the community.

Facilitators

  • Funding and capacity from large institutions

  • Culture of community engagement

  • Cultural diversity contributing to sense of community and vibrancy

  • Willingness to think collectively across sectors

Barriers

  • Leadership turnover

  • Top-down approach to funding allocation

  • Small tax base limits funding to city government

  • Many acute priorities results in disjointed effort