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A mosaic of health is coming to life in Louisville, KY. The materials (art, collaboration) are surprising.

This feature was produced by Robert Wood Johnson Foundation, and does not reflect the opinions or point of view of Vox Media or Vox Creative. Vox Media editorial staff was not involved in the creation or production of this content.

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 heavily, 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. Explore the links throughout this story to learn more about Louisville's work.

Community health workers Mary Squire and Rhonda Whooten pay a visit to Martin Trice in his Louisville home.

[The surprising ways artists impact health in Louisville]

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.

Mohammed Arwan (left) and Jonathan Clement (right) participate in Louisville’s YouthBuild program.

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.

[A vocational program for youth like you've never seen before]

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, the project's 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?'"

[How compassion feeds the movement toward better health]

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.

[The connection between health and a college degree might surprise you]

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.

[Uprooting the deep norms that contribute to youth violence]

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."

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This feature was produced by Robert Wood Johnson Foundation, and does not reflect the opinions or point of view of Vox Media or Vox Creative. Vox Media editorial staff was not involved in the creation or production of this content.


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