For many years, marginalized Cuyahoga County residents have experienced significant health inequities. Many of them are a direct result of racial segregation, particularly of anti-Black racism, but other impoverished individuals and people of color within the community suffer these inequities, as well.
Since 2015, Health Improvement Plan or HIP-Cuyahoga has been working with multiple community partners to resolve those challenges via direct action and collaboration throughout the county.
“We’ve been ‘admiring’ this problem for far too long,” said Heidi Gullett, MD, assistant professor, Center for Community Health Integration (CHI), CWRU School of Medicine, and co-chair of HIP-Cuyahoga. “We’re working on improving and increasing effective action and measurement, which is where we have fallen short.”
History of HIP-Cuyahoga
In 2009, Gullett explained, the Cuyahoga County Board of Health, along with Policy Bridge and the former St. Luke’s Hospital, worked together with Cuyahoga Place Matters, which was part of a national movement looking at place-based drivers of different inequities in health outcomes.
In 2013, Cleveland’s three local health departments – Shaker Heights, City of Cleveland, and Cuyahoga County Board of Health – partnered to perform a Community Health Status Assessment. That appraisal included primary data collection through thousands of quality-of-life surveys and available public health data such as life expectancy, infant mortality, and chronic disease measures. It also involved evaluating strengths and weaknesses of the public health infrastructure of the community.
In 2014, The HIP-Cuyahoga Consortium was created as a result of the Cuyahoga Place Matters movement, part of a national movement that evaluated place-based drivers of inequities in health outcomes. HIP-Cuyahoga maintains a direct partnership with the Cuyahoga County Board of Health, which serves as the “backbone organization” for the HIP-Cuyahoga Consortium..
“The movement promotes the fact that place matters more than genetics,” Gullett says. “Also, that residents of color in this community have disparate health outcomes because of racism. And we needed to begin to understand that, and that was before talking about structural racism was part of the national discourse.”
Addressing health priorities
The 2013 assessment led to the first Cuyahoga County Community Health Improvement Plan (CHIP). In 2015, after thorough analysis of the data and engagement with a variety of consultants such as District of Columbia Community Health Administration, the process led to establishing HIP-C’s four key priorities: eliminating structural racism, addressing chronic disease, promoting healthy eating/active living programs, and bringing public health and the hospital systems together. The latter collaborate on assessments of the health of the community and contribute money and resources to address the structural drivers of poor health.
Today, the Shaker Heights services are provided by the Cuyahoga County Board of Health. In 2018 and 2019, another Health Improvement Plan assessment was completed. Two priorities were added: mental health and substance abuse. The next community health assessment will be completed in 2022.
According to Gullett, the challenge now is how to address those six sizable priority buckets, each requiring “a lifetime of work.” Additionally, they are struggling to identify the best population health metrics to demonstrate effectively that their health equity efforts are impacting systems change.
“One success that is important for our community is we have declarations of racism as a public health crisis from the Cuyahoga County Council, the City of Cleveland, and multiple agencies like the ADAMHS Board and Cuyahoga County Board of Health and others,” she says. “But those are void if there is no action behind them.”
Currently, the county is implementing and refining a computer simulation mapping system to create a running simulation model of the criminal justice system, the diversion center, educational opportunities, quality-of-life metrics, perspective transformation, and racial trauma and healing. This system tracks the key metrics that the community has identified as leverage points to improve health equity initiatives.
But it’s not all bleak. Lots of people are taking action, proposing ideas. Some organizations such as HIP-Cuyahoga partner A Vision of Change (see The Land’s companion story) are taking solutions into their own hands, doing the work that needs to be done in the community.
One of HIP-C’s more than 100 community partners, A Vision of Change also provides academic empowerment, intervention, and prevention services. Founder Delores Collins’ goal is to break the cycles of illiteracy, poor health, high school dropouts, youth incarceration, and poverty.
“I’ve been at the table with lots of people and been involved in lots of conversations,” Collins said. “HIP-Cuyahoga is the first group that did what they said they said they were going to do. They allowed us to have a voice at the table. They valued our community voice, and it all just clicked.”
Christopher Johnston has published more than 3,000 articles in publications such as Christian Science Monitor, Scientific American and Time.com. His book, Shattering Silences: New Approaches to Healing Survivors of Rape and Bringing Their Assailants to Justice (Skyhorse) was published in February 2018.