How Can Cleveland Hospitals Address Racism As a Public Health Crisis?

Ideastream Public Media’s health team is connecting the dots on how racism contributes to poor health outcomes in the Cleveland area. As government and health agencies have declared racism is a public health crisis, officials at Cleveland Clinic tell us what they have been doing to target structural barriers at the root of health inequities.

Cleveland Clinic is known internationally for its medical care and research and generates billions of dollars for the state and local economies each year.

But, just a few blocks away are neighborhoods plagued by decades of poverty – like Fairfax, where dilapidated homes and abandoned, boarded-up businesses line some streets.

Many residents here experience poor health outcomes such as asthma and diabetes, and the average life expectancy is 66 years of age.

In 2019, life expectancy at birth was 78.8 years for the total U.S. population, according to the Centers for Disease Control and Prevention.

“Health is not a state of being that all who live in Northeast Ohio have equal access to,” said Dr. Adam Myers, chief of population health at Cleveland Clinic.

These poor outcomes, he added, are tied to racist policies of the past, such as redlining, when banks denied loans to Black homebuyers and declared majority Black neighborhoods like Fairfax as undesirableto live in.

As a result, companies and organizations didn’t invest there, leading to low employment, high poverty, and poor health outcomes still to this day.

That’s why many health experts consider racism a public health crisis, Myers said.

“We've known for a long time that these health disparities existed as a country, but we haven't done, as a country, that much about it,” he said. “Our hope is that we can take this moment of awakening and turn it into a movement that will have impact for the future of our Black and brown partners in the community.”

Click on this image to find out more about how you can partner with Ideastream Public Media to help connect the dots between racism and health. [melitas / Shutterstock]

In June 2020, Cleveland Clinic joined other health systems and organizations to support Cleveland City Council's resolution to address racism as a public health crisis.

It is no longer enough for hospitals to simply focus on the medical care they offer, Myers said, because so much of a person’s health depends on what goes on outside the doctors’ office – such as whether someone has a safe place to live, access to groceries and healthy food, and a job.

Factors like these are called social determinants of health, Myers said.

“That’s what impacts 80 percent of health outcomes. Traditionally, health care organizations haven’t really felt that that was their sweet spot,” he said .

By declaring racism as a public health crisis, Cleveland Clinic is committing to putting more effort into the 80 percent, Myers said.

To improve housing in the surrounding areas of the hospital, the Clinic is spending $6.1 million and partnering with a development corporation to build a mixed-use affordable apartment complex in Fairfax later this year, he said.

Hospital officials are also working with grocery chain Meijer to build a grocery store to address food insecurity in Fairfax, as well as Hough, another neighborhood near the campus, he added.

“Much of the food that was available to people in Fairfax and Hough wasn't necessarily the highest quality from a health standpoint. Lots of processed food, limited access to produce. All that's going to change when the Meijer grocery store comes in,” Myers said.

The Meijer grocery store will be built where this empty parking lot currently stands at the corner of East 105 St. and Cedar, just down the street from Cleveland Clinic. [Anna Huntsman / Ideastream Public Media]

Efforts like these are a good start, said Michellene Davis, who spearheaded similar initiatives as vice president of RWJBarnabas Health in New Jersey.

But, simply putting a grocery store in a food desert does not mean residents will immediately flock to it, she added.

While at RWJBarnabas, Davis orchestrated plans to build a greenhouse in a vulnerable neighborhood, but there was low uptake at first. After examining the issue, hospital officials realized there was another barrier keeping residents from shopping there: the store did not accept food stamps, even though 5,000 residents there used the Supplemental Nutrition Assistance Program (SNAP).

“We literally took the additional effort of ensuring that we made policy changes so that a hospital-affiliated greenhouse can be a SNAP verifier,” she said.

Going the extra mile for policy changes like these is what is needed for hospitals to get to the root of structural issues, Davis said.

Another way to do this is for hospitals to examine their own internal practices, she said, and hire people from the poorer areas they serve.

“And not just hiring people into those first-rung ladders, but making certain that they have both outside in and then inside up opportunities. What are we doing to invest in ensuring that individuals are not remaining at entry-level positions over a 30-year period of time, but are really helping to fight generational poverty?” Davis said.

From an employment standpoint, Myers said Cleveland Clinic does look to hire people from its surrounding neighborhoods, primarily high schoolers through a scholarship and training program that exposes students to the health care field.

Davis also recommends hospitals invest in their communities by incorporating local businesses in their supply chains.

Cleveland Clinic is already planning to do this, Myers said, by doubling its spending on products from women and minority-owned businesses in Cleveland to $160 million by 2025, in an effort to increase the wealth in its surrounding neighborhoods, he said.

Another major way for hospitals to address racism, Davis said, is to work with lawmakers on legislation and policy changes.

“By virtue of the size of a hospital system and often times the respect that it carries with it in the legislature, you have the ability of access and opportunity to speak with legislators, to speak with the governor's office about things that are not just important to you - like charity care or reimbursement rates or, you know, Medicaid expansion,” she said. “You have the opportunity also to bring with you things that are really incredibly important to the local communities, especially in vulnerable communities, like food insecurity, like housing, like community violence, et cetera.”

Cleveland Clinic officials primarily advocate on legislation pertaining to housing, transportation, and broadband access, Myers added.

The hospital system also signed on to be part of a working group with Cleveland City Council as part of the resolution declaring racism a public health crisis - but one year later, they’re still waiting for more details from public officials, Myers said.

Officials have offered up a representative from the health system for the committee, but to Myers’ knowledge, no meetings or ongoing efforts have been planned yet, he said.

“We eagerly await traction on the city and county side so that we can engage with that in other meaningful ways as advocates,” he said.