Cross-sector partners join forces to make Cleveland home of the first hospital-anchored certified EcoDistrict

Government, philanthropy, and resident leaders teamed with The MetroHealth System in the creation of the Clark-Fulton/MetroHealth EcoDistrict, implementing a paradigm shift in neighborhood revitalization that focuses on health equity and community well-being.

By adopting the EcoDistricts Protocol and seeking certification to help guide a two-year community master plan process, the partners in Clark-Fulton have achieved both a local vision and something genuinely transformational and potentially of national importance. 

Earlier this month, MetroHealth and its partners received their EcoDistrict certification, marking the first certification in the nation by a major health care system.

Collaborators included MetroHealth, the City of Cleveland, Ward 14 Councilwoman Jasmin Santana, the Metro West Community Development Organization, the Cleveland Foundation, and a cohort of eight resident ambassadors. Together, this group aligned around a shared vision and bold goals for the neighborhood. 

Clark-Fulton, a neighborhood just west of Downtown Cleveland, is a proud but marginalized community — a hardscrabble, largely Latinx and Black neighborhood.

As outlined in the EcoDistricts Protocol, the District Team focuses on addressing root causes of inequity. The objective is to reduce unjust health and socioeconomic disparities in this neighborhood and thereby create a model for enhancing the overall health and wellbeing, and resilience of Clark-Fulton.

EcoDistricts, a framework 20 years in the making, is a growing movement of thousands of urban and community development leaders across North America and worldwide who, like the partners in Clark-Fulton, are making neighborhood-scale commitments to equity, resilience, and climate protection. The 

EcoDistricts Protocol, a rigorous urban development framework and certification standard, was created to foster a new model of urban regeneration, one that puts people at the center.

The District Team’s first significant collaboration resulted in the Clark-Fulton Together Master Plan, the first-ever comprehensive master plan for the neighborhood. Recently approved by Cleveland’s Planning Commission, the master plan proposes many visionary long-range projects. The plan seeks to strengthen community places and mixed-use corridors, create new open spaces, preserve existing historic homes, build new ones without displacing residents, and provide equitable access to the internet, among many other things. 

The Clark-Fulton Together Master Plan was developed alongside the EcoDistricts certification process.  The master plan outlines “what” the community wants to see, including fostering more excellent health and more significant health equity. The EcoDistricts Roadmap outlines “how” to make the vision achievable.

It is evident that health disparities vary widely across racial, ethnic, and class lines in Clark-Fulton, and many communities like it nationwide. In an often-cited study, the life expectancy of a baby born in Glenville, a predominantly Black neighborhood in Cleveland, is 12 years shorter than one born in Lyndhurst, a primarily white suburb only 10 miles away. And most paradoxically of all, the poorest health outcomes by race and class in Cleveland often occur in neighborhoods directly in the shadows of world-class hospitals. That’s the case with all three major healthcare systems in Cleveland.

There is a growing body of research and evidence about the relationship between health outcomes and poverty; substandard housing; food deserts; unaffordable and inaccessible nutrition; poor early childhood support; inferior educational programs and opportunities; difficult working conditions; inadequate neighborhood and community networks; remoteness of safe green spaces; and structural discrimination based on race and other attributes. These factors are what healthcare stakeholders have long recognized as the social determinants of health. These non-clinical factors play a much more significant role in health outcomes than medical care itself.

But these factors, the social determinants of health, are parts of a highly complex system of interlocking and interdependent parts. Systems-level challenges require systems-level solutions. The methods of change pursued so far, primarily one-time siloed project-based initiatives, haven’t worked. MetroHealth and the District Team partners recognized the EcoDistricts Protocol represents a systems-level theory of change, particularly well-suited to address the social determinants of health at the neighborhood scale. 

Like the Protocol, the District Team sees health and wellbeing as highly interdependent with other priorities and imperatives. 

MetroHealth, an active member of the national Healthcare Anchor Network, is unique among its sister healthcare systems in its mission and commitment to shrink the health gap between whites and people of color in Cleveland. MetroHealth is keenly aware of the connection between zip code and health outcomes and is eager to play the long game of neighborhood development to achieve better health for all. A recent index released by the Lown Institute places MetroHealth in the top 98th percentile of 3,300 hospitals and health systems for community health, equity, and inclusion. The health system’s current projects in the neighborhood focus on the social determinants of health including investments in affordable housing, digital equity, and workforce development and readiness.

The timing is ripe. The Clark-Fulton neighborhood is already benefitting significantly from the Neighborhood Transformation Initiative (NTI) championed by Cleveland’s Mayor Frank G. Jackson. This bold initiative aims to provide healthy, sustainable, and equitable opportunities to build wealth and stabilize historically fringed neighborhoods. Through NTI, the city and its partners offer districts like Clark-Fulton new tools and resources to build wealth and stabilize communities.

Clark-Fulton also benefits from the MetroHealth Transformation and its $1billion investment in its main hospital campus. The once-in-a-generation project is the cornerstone of a broader neighborhood revitalization effort concurrent with the launch of the Institute for HOPE (Health, Opportunity, Partnership, and Empowerment) which uses a coordinated, collaborative, and strategic approach to help patients with non-medical needs such as healthy food, stable housing, and job training. 

MetroHealth has anchored Clark-Fulton for 150 years and is delivering on its promise to lead the community toward better health outcomes for all, especially the most vulnerable among us.

Under the leadership of MetroHealth President and CEO Dr. Akram Boutros, the hospital system has garnered national attention proposing that the healthcare sector change from a treatment to a prevention mindset. The Clark-Fulton/MetroHealth EcoDistrict will serve as a proof of concept for innovation around this ongoing transition. MetroHealth is already a national leader in value-based care, population health, and addressing the social determinants of health.

The health system is also a national leader in clinical and basic research. The MetroHealth Research Institute is translating innovations and discoveries to improve health and quality of life, especially for vulnerable populations. The Institute rejects more common exploitative research study approaches and instead involves the community in research design, implementation, and analysis.

While the master plan is now complete, the long-term plan implementation and performance measurement through data aggregation are just beginning. As a collective, the EcoDistrict project partners will continue the robust collaboration and neighborhood engagement started during the development of the master plan and the EcoDistricts Roadmap. 

Thanks to the EcoDistricts certification process, Clark-Fulton is ready for collective action and deliberative democracy. Better health and more wealth for all is the North Star and the journey continues.

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