The HEZ: Early Days
A Systems Changing Approach. In 2015, the Rhode Island Department of Health adopted a transformational way of approaching community health. Leaders were aware that health inequality based on zip code had persisted despite initiatives by the Department of Health to address community health disparities. Leaders in the Department of Health had seen community-led, placed-based inititives transform lives in communities struggling with safety, and they began the process of applying that philosophy to health equity. That year, Ana Novias, Deputy Director of the Department of Health together with Director Dr. Nicole Alexander-Scott, launched a pilot program to create a Health Equity Zone where residents, local leaders and community organizations would work together on issues that affected health. The goal was to create a network of organizations that would seek resident input to affect meaningful change.
That first year, the RI Dept. of Health launched a pilot project to create Health Equity Zones (HEZs) in communities with the greatest health outcome disparities. The structure created place-based, resident-led areas for each zone, and named a backbone entity to support the work. Backbone entities are trusted, local community organizations that facilitate communication among the residents, Community Based Organizations (CBOs), local leadership and with the Department of Health (RIDOH). It's this convening, and management of the collaborative, that prioritizes local voices that distinguishes the HEZ program from other community health modalities. The backbone entity conducts community assessments, facilitates community conversations, convenes collaborative meetings and reports back to the community and to the Department of Health. The backbone entity also raises and gathers resources that will positively impact community-led projects and initiatives. The program builds communications channels based on trust and a proven history of collaboration.
The theory of change for the HEZ was that if Rhode Islanders worked together to develop a sustainable infrastructure of mission-driven residents and local providers, and aligned resources and targeted investments to address the needs that had been identified by the community, that this will produce a positive impact on the social determinants of health, and result in improved population health benefits. In other words, if the community helped develop the plan, they would help deliver the results.
Getting Started: LISC convened local Community Based Organizations (CBOs), local community representatives, municipal departments, Mayors and Councilmembers, religious organizations and resident advocates to ask one question: how can your life be made better?
The focus groups, town halls, community meetings and feedback sessions were kept open-ended so that residents could share the topics and concerns that they had. The goal was to collect community feedback and then categorize the issues using the social determinants of health and then work with residents and CBOs to work through solutions. LISC listened to thousands of engagements, analyzed the responses, and then presented an action plan to the community.
During the next 5 years, significant progress was made to check off the action items, but more importantly, deep relationships based on trust and accountability had been forged with residents, leadership and local CBOs. The HEZ formed a "Collaborative" comprised of both residents and partners, which met monthly, engaged in capacity building trainings, worked together to overcome challenges and forward the collective mission of advancing community health in the PCF HEZ catchment area.