Moving Beyond Disease-Specific Approach, Health Equity Zones give Rhode Islanders Opportunity to Improve Quality of Life

‘The value of HEZs is undeniably proven… We hope to be the ripple that makes that change. It’s intentional disruption that’s necessary. That’s what we are doing collectively.’

Across Rhode Island, fourteen “health equity zones,” or “HEZs,” are engaging residents and stakeholders to improve the social, environmental, and economic conditions of their communities. These HEZs are part of Rhode Island’s Health Equity Zone Initiative, created in 2015 under the Rhode Island Department of Public Health (RIDOH).

The program, which takes an innovative approach to public health, is now recognized as a national best practice with several states actively replicating the program. However, the McKee Administration’s fiscal year 2025 budget did not include any of the $3.5 million needed for the program’s operations – a concern for organizers and residents.

Ana Novais, Assistant Secretary of the Executive Office of Health and Human Services, is the originator of both the model and term “health equity zones.” With a lengthy background in community and minority health, it became clear to her that the disease-specific approach to health in Rhode Island wasn’t working.

“We needed to shift away from this model and invest in improving overall quality of life and quality of neighborhood,” Novais says. “You can say eat vegetables, walk 30 minutes every day, but if in some communities you don’t feel safe walking outside or you don’t have access to healthy food, what good does it make?”

This is why the HEZ model focuses on Social Determinants of Health. These are the conditions in one’s community that impact health outcomes, such as access to healthy food, healthcare, affordable housing, quality education, and employment, as well as racial inequities and other barriers. “Health equity” ensures everyone has an equal and fair opportunity to achieve their most optimal health. In other words, by addressing these factors, public health improves.

To achieve this, the HEZ design is place-based and people-driven. Christopher Ausura, HEZ Initiative Director, explains that traditional public health has been oriented to demographics, which often misses key needs. “People in communities know what their community’s challenges are. It’s not about just the who – but where. So, how do we work with these individuals to create strategies for meaningful change?”

Each HEZ, therefore, conducts its own needs assessment producing community-specific data and priorities. Those same communities then come up with ideas and solutions, which HEZ and RIDOH support.

One of the very first HEZs in the state is Central Providence Opportunities CPO-HEZ (formerly the Olneyville HEZ). Central Providence contains approximately 70,000 residents across nine neighborhoods – just under half of the population of the city.

Residents and stakeholders convene to discuss what will become the Central Providence Roadmap – Photo courtesy of Nine Neighborhood Fund

“It’s a diverse and vibrant area,” says Dominique Resendes, former program manager and now Associate Director of Community Infrastructure at ONE Neighborhood Builders, CPO-HEZ’s backbone organization. Within the CPO-HEZ, health equity is approached through a lens of economic opportunity. “We understand that this is central to a lot of challenges: housing affordability, displacement, food insecurity, access to quality jobs. We really want to support people with drivers of mobility and equip them with opportunities,” Resendes says.

As part of its numerous efforts, CPO-HEZ engaged in the Nine Neighborhood Fund – a participatory budgeting initiative which allows residents to decide how funds are spent. Through the HEZ, Medicaid and private matching funds resulted in an allocation of $1 million. Residents were then asked: How would you use $1 million to improve health in your neighborhood?

Voting takes place for Nine Neighborhood Fund’s $1 million participatory budget program – Photo courtesy of Nine Neighborhood Fund

“We collected over 300 ideas from the community,” Resendes says. “And these ideas really reflected how the health of a community isn’t just putting up a doctor’s office. It’s much bigger.” Nearly 1,200 residents voted on eight projects. Bathroom access in parks expanded, over 2,000 Brita water filters were distributed for lead concerns, and a peer mental health model was implemented to support youth. Other projects included increased shelter at bus stops, planting food-bearing trees, youth life skills classes, bike distribution, and expanding youth soccer.

“Participatory budgeting is a really good example of the HEZ work,” says Resendes. “It really highlights what resident-led, place-based change looks like.” Expanding this even further, CPO-HEZ unveiled the Central Providence Roadmap in March of 2023 – a comprehensive plan for the area defined by residents, civic leaders, and 60 community organizations. (Editor’s Note: See previous story on participatory budgeting in Providence.)

Elsewhere in Rhode Island, The Pawtucket Central Falls Health Equity Zone (PCF HEZ) also engaged in a $385,000 participatory budget program, which led to the creation of a “splash pad”, the commission of two anti-stigma murals, peer-to-peer mental health training, and NARCAN® kit distribution.

At the Newport HEZ, housing became a major focus ultimately leading to the creation of the 2022 North End Equitable Development Strategy. The year prior, the HEZ also helped pass the “Green and Complete Streets Policy” for pedestrian safety. These efforts not only preserve neighborhoods but transform public policy — another vision of the HEZ model: long-term systemic change.  Director of Prevention, Sydney Ormerod said, “We have residents who never felt comfortable being in City Hall, let alone running for office or joining a committee. There’s a real sense of belonging from the HEZ’s work.”

Contributions by residents, partners, and Newport HEZ staff led to the creation of the “Newport HEZ Shared Vision,” designed by local artist, Holly Spence Fisher – Photo courtesy of Newport Health Equity Zone

OneCranston Health Equity Zone (OCHEZ)’s weekly farmer’s market, offers free produce to residents. “We partner with five mostly BIPOC local farmers and we have a group from Johnson & Wales that comes every week to hand out recipes based on that week’s produce. It’s almost a mini health resource fair every week,” says Andrea Champagne, Initiative Director.

OCHEZ also empowers residents through small “community builder” grants. “We’ve seen neighborhood cleanups, enhancements to schools, playground efforts,” says Champagne. For youth, OCHEZ hosts a book and media club and offers career exploration opportunities, plus numerous other initiatives. “The success of being able to gather community stakeholders around the table is a really exciting and big win. We’re a convener to connect residents to different services,” Champagne says.  Like other organizers, she also worries about funding.

The Washington County Health Equity Zone has focused on Health Bodies, Healthy Minds (HBHM), which, since 2015 has built a robust network of over 100 partners. “These partnerships have allowed us to implement a range of innovative programs that address mental health, early childhood development, and access to nutritious food,” says Program Manager Melissa Sigua.  For example, from July 2022 to June 2023, more than 20,000 pounds of healthy food were distributed to residents. Then there’s “Man Therapy,” a humor-based program that empowers men to address their mental and emotional health.

“The HEZs today are so much more than we ever dreamed,” says Assistant Secretary Novais. This past April, LISC Rhode Island, the backbone organization of PCF HEZ, was invited to present at the National Network of Public Health Institutes on best practices learned during the pandemic. Here, they discussed the instrumental role HEZs played in the state’s response. For example, when National Guard pop-up clinics were confoundedly vacant, HEZ organizers learned from residents that it was because people were in uniform. The information was forwarded, workers returned in street clothes, and the testing and vaccination centers were busy. This, organizers say, is a testament to HEZ and the role of resident input.

Despite what Novais calls a “tremendous deficit” from RIDOH for fiscal year 2025, some funding sources have been identified to sustain the program for now. This includes USDA Forestry, Department of Education, Department of Housing and Urban Development, and other philanthropic partners.

“The issue for me is that there’s a need to support the infrastructure for those local initiatives,” says Novais. This covers staff who implement programs and training and technical assistance for community partners. Initiative Director Ausura adds that change also requires time and capacity-building, and thus, a commitment to funding. Additionally, he says, HEZ supports Rhode Island and Rhode Islanders.

“The more we react, the more it’s going to cost. We are set up to do short term interventions, but the data shows this has not improved the demand for resources. These ongoing inequities are the primary driver of costs — whether that’s healthcare or missing days of work. It’s also how we retain people. As we improve community conditions and connectivity, it enhances that feeling of opportunity and growth which is important for any economy to grow. Those things impact well-being and prosperity. If you don’t have transportation to a job, or your kids can’t get food, how do you thrive?,” he says.

“The value of HEZs is undeniably proven,” concludes Novais. “But it’s a change in how public health is funded. We get comfortable with success that reaches a majority, but we forget that we systematically leave behind our more vulnerable people. That cannot be okay. We hope to be the ripple that makes that change. It’s intentional disruption that’s necessary. That’s what we are doing collectively.”

For more information and a complete list of all Health Equity Zones, visit https://health.ri.gov/programs/detail.php?pgm_id=1108

Copyright © 2023 Salve Regina University. Originally published by OceanStateStories.org, a publication partner of The Providence Eye.

This version has been edited for brevity and the original can be found here.

 

Ashley Bendiksen is a National Speaker, Award-Winning Activist, and Valedictorian graduate of Salve Regina University with a degree in Administration of Justice. She was also granted the SRU Mission Award as a distinguished alumni for her work to drive social and global change. As a subject matter expert and Top Youth Speaker®, Ashley offers speaking and consulting services on the issues of domestic violence, sexual assault, teen dating violence, youth mental health, and resilience. She has been a contributing expert for major news media, is a published author, and was featured in an 8x award-winning documentary. She is also the co-founder of the Blue Hearts Project, a global storytelling platform for survivors of abuse. Ashley has been a freelance journalist for more than a decade plus serves as editor of two Aquidneck Island magazines. Additionally, Ashley is the co-founder of Island Youth Coaching which specializes in life coaching for teens and young adults. Learn more at www.ashleybendiksen.com.