We’re working in ways we’ve never worked before.
London Roth, leader of Louisville's Bold Goal effort
2016 RWJF Culture of Health Prize Winner
Health Equity Is Their Compass
When poet Hannah Drake drives through her Smoketown neighborhood and past the little white house where her father was born and raised, a discussion of health disparities feels real and personal.
His death, caused by congestive heart failure at age 64, fits a pattern for people in this historically black section of Louisville, Ky. They live, on average, nine years less than residents of many of the city’s other neighborhoods and have higher rates of drug and alcohol use, diabetes, heart disease, HIV-AIDS and death from homicide. Poverty, racism and unemployment weigh heavy, and transportation options and healthy foods are elusive because of institutional policies that have widened the gap between rich and poor, black and white.
Drake knew none of the bleak statistics about her neighborhood until she began working with Louisville-based artist innovation company IDEAS xLab after her father’s passing. “It all kind of made sense when I thought about my family,” she says. Four weeks after her father died, a stroke took his twin brother. Cancer later claimed two of her aunts. Until their deaths, all four of Drake’s family members had lived just a few blocks from a swath of buildings that house the highest concentration of hospitals and doctors’ offices in the state.
Louisville’s civic leaders and health institutions recognize that in the face of generations-deep disparities, proximity to health care services is only part of the story. Good health for all citizens requires so much more—such as having a job, a safe place to live and walk, a place to buy healthy affordable food, a good education, clean air to breathe and a strong social network.
We’re working in ways we’ve never worked before.
London Roth, leader of Louisville's Bold Goal effort
The city’s efforts to right historical wrongs and combat the conditions too familiar to Drake’s family, and so many others, led to Louisville’s recognition as an RWJF Culture of Health Prize winner. Among the things that distinguish Louisville’s expansive efforts is the way the city’s arts, business, health, education, law enforcement and social service sectors have come together. They’ve turned statistics and data into tools to rectify health inequity, respond to neighborhood violence and make the city’s impressive health resources available to everyone.
Louisville’s agenda for bringing the community together and dissolving disparities was born out of the city’s 2003 merger with surrounding Jefferson County—a voter-backed move meant to increase government efficiency and spur economic development. Civic leaders in the newly combined metro area knew they needed to boost development in the core urban communities, which lagged behind the suburbs in many measures of health and well-being. The year of the merger, 13 foundations planted the seeds of change by creating the Greater Louisville Project. This initiative is designed to improve education, jobs and quality of place.
“‘How do we create a competitive city for everyone?’ was at the heart of the creation of the Greater Louisville Project,” says Ben Reno-Weber, its director. “We took something everyone knew, for example, ‘kids are dropping out of school at unacceptable rates.’ And we asked, ‘How do we marry the intuition we have—our schools are unequal—to data in a way that makes people want to act?’”
That question led to the creation of a cross-sector partnership now known as 55,000 Degrees, an effort to boost the number of Louisville residents who have higher degrees. The use of data to tackle injustice also undergirds innovative programs across Louisville’s health, education and violence prevention sectors. KentuckyOne Health is using data to identify “familiar faces”—who often use emergency and hospital services because they can’t afford preventive care—and keep them from coming back. Today, when those patients are discharged, they are connected to in-home preventive health services, such as nutrition and exercise counseling.
RWJF is working to create change at every level of society by engaging leaders who represent every sector and discipline, and who recognize that health is greatly influenced by complex social factors, not just by health care.
Data also underlies Louisville’s Bold Goal initiative, the health and well-being company Humana’s collaborative effort to make the city 20 percent healthier by 2020, as measured by the Centers for Disease Control and Prevention’s Healthy Day's tool. Input came from both insurance claims data and the Robert Wood Johnson Foundation’s social determinants of health framework, in-depth interviews and focus groups with community members and a clinical town hall. Based on what the collaborators learned, they will focus on three conditions (diabetes, behavioral health, upper respiratory health) and three barriers (healthy food access, awareness of community resources, transportation) they believe will have the most impact on improving the city’s health.
“We’re working in ways we’ve never worked before,” says London Roth, who leads Louisville’s Bold Goal effort. She says Humana and its more than 50 community collaborators want to use data to impact the health of Humana members and Louisville residents, as well as the environments in which they live. That may mean, for instance, planting trees in an area with high asthma rates and little tree cover rather than just covering inhaler prescriptions, since research has linked an abundance of trees to lower asthma rates.
Targeting the places where disparities have the greatest impact makes sense in a city that is taking as wide a view of health as possible, says Susan Barry, president and CEO of the Community Foundation of Louisville, the largest charitable foundation in Kentucky and a leader in the Greater Louisville Project.
“Let’s say you have 10 stacking blocks,” she says, and each block represents an element of health. “If in three neighborhoods 90 percent of people have six blocks missing, let’s focus on those neighborhoods. And if you can intervene and keep those blocks in place [from the start], then people will thrive.”
I don’t think art in and of itself can do anything,” says Theo Edmonds, artist and co-founder of IDEAS xLab, an artist innovation company in Louisville, Ky." But I think artists can change the world.”
More specifically, the former healthcare executive says artists can impact health in surprising ways. He’s found believers across Louisville, from the mayor’s office and local foundations to the area’s healthcare institutions and the University of Louisville. Together, they’re out to do transformative things across the city:
In these projects and others, art has become a vehicle for change.
“The power is in the people,” says Hannah Drake, a poet and lead artist for Project H.E.A.L. “But sometimes you have to show people they have the power to change anything they want to.”
Young people at YouthBuild Louisville do their daily chores, picking weeds in the garden and courtyard of their LEED-certified green campus—just one beat in the rhythm of this 16-year-old vocational training, education and community service program.
“It’s part of the garden,” says YouthBuild graduate and now intern Brittany Carson, 25, of the need to weed. “You gotta do it every day.”
Based on a national model with the dual mission of training young people in construction and building affordable housing, Louisville, Ky.’s YouthBuild teaches participants not only what they have to do, but also what they can do. Not just for themselves, but also for their city and neighborhoods. Program participants—many of whom are young parents—earn high school diplomas and acquire the skills to work in one of four career tracks: construction, environmental design, nursing assistant and culinary arts. What’s more, they learn valuable skills—such as showing up on time, being a team player and solving problems—that translate to any field.
“We’re making the connection between service, urban design, environmental issues and public health issues,” project manager Josh Poe says.
During her time with the organization, Carson has worked on low-income housing construction, planted 40 trees around the city to bring shade to the city’s “heat islands,” helped build a playhouse for a blind child, and this summer she even traveled to France’s Potager du Roi, or King’s Kitchen Garden, near Versailles. There she learned urban gardening techniques and other wisdom that seem to apply equally to plant life and to the budding young adults being nurtured at YouthBuild, such as harvesting every day so the plant can continue to grow.
“It’s really important to us, when we choose a young person for the program, that we take them on for the long haul,” says Executive Director Lynn Rippy. “That means we prepare them educationally, we prepare them vocationally and we prepare them socially to be really active members of this community and advocates for themselves and their children.”
Waaswaaganing Anishinaabeg (Lac du Flambeau) Tribe, Wis., reclaimed its culture for health and healing in the community.
We’re making the connection between service, urban design, environmental issues and public health issues.
Josh Poe, project manager of YouthBuild Louisville
In Louisville, compassion is in the air.
It’s in the air when young moms recovering from substance abuse gather at a Louisville park with their children to enjoy a summer evening and support each other.
It’s in the air when young professionals come together to pool their dollars into a $25,000 gift for a worthy nonprofit’s field trip program aimed at empowering at-risk children and youth.
It’s in the air when an evicted veteran is quickly able to obtain a Section 8 low-income housing voucher in a city that has, in effect, eliminated veteran homelessness and the backlog of vets waiting for a place to live.
In these scenarios, the concept of compassion—truly caring for and taking care of one another—becomes real. Louisvillians have long been thinking about, discussing and practicing what it means to be “compassionate.” The concept became an intrinsic element of the city’s policy agenda when Mayor Greg Fischer made it one of his three top priorities—alongside job creation and health promotion—when he took office in 2011.
“We must create an even more compassionate city,” he said in his inaugural address. “Where neighbor cares for neighbor, friend for friend, stranger for stranger.”
Fischer’s declaration brought Louisville into a global movement of individuals and communities committed to putting the Golden Rule into action by signing a "Charter for Compassion" that thousands of people helped author online. Other “Compassionate Cities” in the U.S. include Cincinnati, Houston, Las Vegas and Seattle.
The Prize honors and elevates U.S. communities working at the forefront of advancing health, opportunity, and equity for all.
If we want compassion for ourselves, we have to help others excel and give that compassion back.
Natalie Harris, executive director of Louisville’s Coalition for the Homeless
Today, Fischer says citizens of Louisville resoundingly tell him they want to work together to make their city a better place. “It’s this notion that if we can live in a city where everybody is constantly learning from cradle to grave and we're healthy in all aspects and then we're looking out for each other and lifting each other up, everybody has got a chance to succeed,” he says.
Natalie Harris, executive director of Louisville’s Coalition for the Homeless, says compassion also has the potential to create a virtuous circle.
“If we want compassion for ourselves,” she says, “we have to help others excel and give that compassion back.”
Poverty and toxic stress are two of the biggest health risks that children face today. To overcome these challenges, a handful of communities are creating partnerships with schools and social services to support parents and keep children healthy.
What does a college degree have to do with health? Quite a lot, says Mary Gwen Wheeler, executive director of 55,000 Degrees. Her organization has an audacious goal: see to it that at least half of adults in Louisville, Ky., have an associate degree or higher by 2020.
People with college degrees enjoy higher average incomes, are less likely to have ever smoked or to be obese, have fewer divorces and are more likely to exercise compared to those without a degree.
“We set this goal because we saw it as a proxy for increasing quality of life,” Wheeler says.
The dozens of business, education and community-based partners that launched 55,000 Degrees in 2010 have witnessed significant progress. The number of high school students who graduate with the skills to attend college and start their careers reached 63 percent last year, compared with 45 percent in 2012. The number of college students completing degrees has gone up at 4-year institutions, even as enrollment has gone down.
“We’ve been able to move all populations, but we haven’t been able to close the gaps” between white and minority students, Wheeler says. “That led us to the mayor’s Cradle to Career initiative. We understood we needed to start much earlier.”
Now 55,000 Degrees is one of four organizations with lead roles in a continuum of programs that begin with preschool and bolster education and training for Louisville residents beyond their high school and post-secondary graduations.
Taken together, these efforts will ultimately give more Louisville residents a chance at obtaining a degree—and a better life.
One of the most sobering inequities in Louisville may be that its most dangerous neighborhoods have violent crime rates 35 times higher than the safest ones. This came into sharper focus in May 2012 when, on a single day, six people were shot and three died in the West Louisville neighborhood of Russell.
With West Louisville’s high unemployment, poverty, hunger, drugs, vandalism, abandoned homes, and violent crime, “a lot of risk factors for violence are just bubbling up,” says Rashaad Abdur-Rahman, director of the city’s Office for Safe and Healthy Neighborhoods, which was formed in the wake of the 2012 shootings. “Youth feel compelled to carry weapons even if they don’t intend to use them.”
That’s because for young people the consequences of not responding to violence with more of the same are extremely high, says Monica Wendel, a professor at the University of Louisville and director of the Youth Violence Prevention Research Center. Those who stand their ground face bullying, shaming, feelings of powerlessness, name-calling, and even more violence.
Wendel has hired West Louisville high school and college students to help uproot the underlying norms that support violence. In spring 2017, the group will launch a campaign to boost young people’s understanding of and pride in their African-American heritage and their individual power to be activists for good, while connecting them to social services such as mental health counseling and youth employment programs.
Since last year, Abdur-Rahman’s office and its partners have used quarterly meetings between youth and city officials to spark candid conversations and build bridges between the groups. The city is also promoting alternatives to the juvenile justice system for youth who’ve gotten in trouble with the law. They are matched with case managers and mentors who help them set and achieve academic and employment goals. Another project, launched this spring by KentuckyOne Health, the nonprofit Peace Education Program, the city’s health department, and the University of Louisville, employs caseworkers from West Louisville neighborhoods, many of whom have experienced street violence. They invite 18- to 34-year-olds—an age group at high risk of experiencing or perpetrating violence—who have come to the emergency room with gun or knife wounds to join a project called Pivot to Peace. The effort provides wraparound social and emotional supports to help participants move in a positive life direction, safe from retaliation.
“People say, ‘A rising tide lifts all boats,’ ” says Abdur-Rahman. “But how do we lift the boats that most need to be lifted”?
Kansas City is creating a safe, healthy environment for all its residents by addressing what impacts health. Over the past decade, life expectancy improved for all. The gap between white and African-American residents was reduced from 6.5 to 5 years.