Public Health Communications, Division of Policy, Information &
Rhode Island Department of Health
Where we live directly impacts our health. The toxins in our
water, our access to fresh and nutritious food, our exposure to air pollution, and
the safety of our neighborhoods all matter.
Families living just blocks away from each other may have drastically
different health outcomes, and their health has more to do with where they live
than the choices they make or the quality of their genes.
In Rhode Island, we believe that everyone should have a fair
and just opportunity to be healthy.
Rhode Island’s Health Equity Zone initiative emerged from data
on financial investments in health care and health outcomes. Although the U.S. spends much more than other
developed countries on health care, health outcomes are worse here, and life
expectancy is declining. Eighty percent
of health outcomes are determined by factors outside the doctor’s office. Instead,
health outcomes are determined by social and environmental conditions inside
our homes, in our schools, at our jobs, and in our communities. Therefore, we
need to shift our investments and do our public health work differently.
Traditionally, public health funding has been
directed at implementing specific programs or addressing health concerns. Rhode Island’s Health Equity Zone initiative is
a novel process to funding and delivering public health services. By braiding together funds from several
sources, the Rhode Island Department of Health invests in building capacity and
sparking community development. The place-based approach of the Health Equity
Zone initiative brings communities together to build the infrastructure needed
to achieve systemic changes for critical underlying issues, which include lack
of quality education, poverty, unemployment, discrimination, and social
isolation. These issues are root causes of disparities in health outcomes.
Equity Zones are identified geographic areas that historically have been under-resourced, where there are opportunities to address health inequities
through investment in the community. Health Equity Zones are contiguous
geographic areas that are small enough for the initiative to have a significant
impact on improving health outcomes, reducing health inequities, and improving
the social and environmental conditions of the neighborhood, yet large enough
to impact a significant number of people.
organizations and community members must work together to create healthier,
equitable places. Thus, each Health Equity Zone is led by a collaborative that
represents the diverse makeup of the community, including its residents. The Health Equity Zone approach recognizes
that different communities have different needs and assets. Through a community-led process, each Health
Equity Zone collaborative conducts an assessment to identify key priorities
within their community, and then develops a data-driven action plan to address
the unique social, economic, and environmental factors that prevent people from
being as healthy as possible. Community
leadership ensures that actions are culturally and socially relevant, and
History and Process
The first cohort of Health Equity Zones was solicited in
2015. The Rhode Island Department of
Health requested proposals from community-based organizations that demonstrated
the ability to convene and engage community partners in planning
processes. These community-based
organizations served as the “backbone agency” for each of the Health Equity Zones
and were responsible for building the organizational structure necessary to
organize the Health Equity Zone collaboratives.
This work involved providing or hiring staff, leveraging local resources,
and soliciting additional fiscal and in-kind financial support. Ten Health
Equity Zones were established, some defined by inner-city neighborhoods, some
defined by a municipality, and one that encompassed an entire county. An initial grant award of approximately three
million dollars was divided between the 10 Health Equity Zones.
five-step process was outlined for each Health Equity Zone to follow during the
award period. Each Health Equity Zone was
responsible for building and maintaining a strong, inclusive, community-based
collaborative in which a diverse group of residents have meaningful
participation; conducting a baseline assessment of the community to identify
and describe health inequities of interest and importance; developing an action
plan informed by the assessment process, which identifies key health priorities;
implementing interventions that address
the root causes of disparities in outcomes for those key health priorities; and
evaluating the structure, process, and outcomes of the Health Equity Zone
this process, the Health Equity Zones identified a variety of key health
priorities that reflected the unique needs of each community, including improving food access for its
residents, building substance recovery capacity in the community, addressing
public safety in their neighborhoods, supporting safe and affordable housing, increasing
civic engagement, improving transportation, and building resilience to climate
change. Four years since its launch, the
Health Equity Zone initiative is showing promising results. While changes in health inequities will
inevitably take more time to measure, research shows that the Health Equity
Zone initiative has created safer communities; improved health outcomes;
increased access to healthy, affordable foods; strengthened educational
outcomes; decreased social isolation; and linked people with substance use
treatment and recovery services.
Everyone, in every ZIP code, deserves the opportunity to
live a healthy life and achieve their full potential. The Rhode Island Department of Health is
working to make this vision a reality through its Health Equity Zone
For more information about Rhode Island’s Health
Equity Zones, visit http://health.ri.gov/hez.