The Cleveland Clinic Approach to Achieving Health Equity

Speaking at the recent symposium on health equity held at Cleveland Clinic, Vickie Eaton Johnson, MPA, senior director of Community and Economic Development and Local Government Relations at Cleveland Clinic, described an ambitious multipronged plan she has helped spearhead for the health system: promoting health equity in Cleveland’s Fairfax neighborhood, where the institution’s main campus is located. The seeds of the plan were sown in 2018, when Tomislav Mihaljevic, MD, joined Cleveland Clinic as the new CEO, explained Johnson. With Mihaljevic’s arrival came a shift toward recognizing the importance of care and health equity among everyone involved: patients, caregivers, clinic employees, and community members.

This recognition led to broader community engagement. When Mihaljevic began his tenure, he walked with Johnson through the Fairfax neighborhood to speak directly with residents who were underrepresented and underserved; these individuals have barriers to care and lack access to health systems. This simple act laid the groundwork for Cleveland Clinic’s larger mission to integrate itself within the community, and ongoing engagements have enabled the staff of the Cleveland Clinic to better understand and address health disparities within the community.

Hospitals can heal communities. “But it cannot happen in the hospital,” said Johnson. “It has to happen in the [surrounding] communities.” Equity can be achieved only when factors other than the delivery of health care are addressed, she explained. These factors include social determinants of health (SDOH) such as economic stability, education and job opportunities, safe housing and neighborhoods, access to nutritious food, and literacy skills.¹

One of several major projects undertaken by Cleveland Clinic was a 3-year pilot study, funded with a $3-million grant, in which community health workers (CHWs) supported underserved community members who had experienced barriers to health—bureaucratic, governmental, commercial, and social. The CHWs connect these individuals to care offered within Cleveland Clinic. Johnson said, “I cannot emphasize enough that this work is done for people who may not be patients of Cleveland Clinic.” CHWs engage with people, because, “they’re our neighbors, and because we want to get the population help.”

Promoting access to nutritious food among community members was another focus for Cleveland Clinic. The Fairfax neighborhood has an overwhelmingly Black resident population (92%), and, although Fairfax is centrally located in Cleveland, Johnson described the neighborhood as a food desert with insufficient healthy and affordable food available to its residents.² Given their realization of the importance of good nutrition in achieving better health, Johnson and her colleagues sought out a grocery purveyor that would be both willing and able to meet the needs of the community. They found an ideal partner in the Meijer grocery chain. Johnson and colleagues mitigated their concerns by providing Meijer with data on Cleveland Clinic’s 20,000 employees—all potential customers. Ground was broken for a 40,000-square-foot grocery market in December 2021. The structure will additionally include 196 apartment units, and it will provide 50 new jobs.^3,4

Another Fairfax neighborhood project that Johnson described is an 80,000-square-foot apartment building consisting of 82 1- and 2-bedroom units; 30% of these will be available to people earning $35,000 to $40,000 a year and who would not normally be able to afford this kind of housing at market rates.^5,6 Cleveland Clinic has provided a $10-million low-interest loan for the project, which is being developed in conjunction with local partners, including the city of Cleveland; it is part of a larger development program to revitalize the Fairfax neighborhood.⁵

Finally, Johnson emphasized the importance of philanthropy as part of the multipronged effort to support health equity. A donor was recruited to provide funding for patients with temporary lost income to pay their bills while recovering. She noted that Black women face an elevated risk for losing their housing after a cancer diagnosis. “At Cleveland Clinic, we’re going to do all we can to remove that burden so that a person can get to a place of health and then wellness,” said Johnson. Health equity must include the principle that a person, or a family, should not have to sacrifice their financial health to achieve their physical health.

REFERENCES

1. Social determinants of health. The US Department of Health and Human Services. 2022. Accessed December 15, 2022. https://health.gov/healthypeople/priority-areas/social-determinants-health
2. Fairfax neighborhood factsheet. The Center for Community Solutions. 2021. Accessed December 4, 2022. https://www.communitysolutions.com/wp-content/uploads/2021/09/Fairfax-1.pdf
3. Community partners break ground on $52.8 million grocery market and apartment complex in Cleveland Innovation District. News release. Cleveland Clinic. December 14, 2021. Accessed December 3, 2022. https://newsroom.clevelandclinic.org/2021/12/14/community-partners-break-ground-on-52-8-million-grocery-market-and-apartment-complex-in-cleveland-innovation-district
4. DeNatale D. Groundbreaking held for $52.8 million Fairfax Market in Cleveland’s Innovation District. WKYC Studios. December 14, 2021. Accessed December 3, 2022. https://www.wkyc.com/article/news/local/cleveland/groundbreaking-held-fairfax-market-cleveland-innovation-district/95-9563b23a-030f-45d9-98d4-704476b71044
5. Groundbreaking kicks off construction of $26.9 million Innovation Square apartments in the Fairfax neighborhood. News release. Cleveland Clinic. September 19, 2022. Accessed December 3, 2022. https://newsroom.clevelandclinic.org/2022/09/19/groundbreaking-kicks-off-construction-of-26-9-million-innovation-square-apartments-in-the-fairfax-neighborhood
6. Heisig E. Cleveland planning commission to review proposed apartment building set for ‘Innovation Square’ in Fairfax neighborhood. Cleveland.com. February 18, 2021. Accessed December 3, 2022. https://www.cleveland.com/realestate-news/2021/02/cleveland-planning-commission-to-review-proposed-apartment-building-set-to-be-part-of-innovation-square-in-fairfax-neighborhood.html

VICKIE EATON JOHNSON, MPA

Senior Director

Community and Economic Development & Local Government Relations

Cleveland Clinic

Cleveland, OH