Treating a Neighborhood as a Patient to Benefit Children
Health care providers historically have been ineffective at changing outcomes for children living in neighborhoods marked by extreme poverty. The children suffer from neighborhood effect syndrome, including housing blight, segregation, violence, poor schools, exposure to pollution and lack of community.
Through the Healthy Neighborhoods Healthy Families (HNHF) initiative, Nationwide Children’s, Community Development for All People and partners have treated a Columbus neighborhood as a patient instead of the traditional health care model of treating one child at a time. They report early outcomes in Pediatrics.
“The Southern Orchards neighborhood, right by the hospital, was one with gun violence, high infant mortality rates and high asthma rates in children,” says Kelly J. Kelleher, MD, director of the Center for Innovation in Pediatric Practice at Nationwide Children's and lead author of the publication. “Houses were boarded up and vacant. You didn’t see kids playing outside.”
When the program began, the diverse district was home to 4,300 residents. Half the children lived in poverty, local school populations were highly transient and one in three residents 16 or older were employed full time.
After identifying safety associated with the loss of residents and a surge of vacant and abandoned properties as the neighborhood’s chief concern, HNHF invested $23 million to upgrade more than 300 homes.
Early results of the initiative and related programs show:
- Investments have transformed housing stock in the area and reduced blight.
- The vacancy rate declined from more than 25 percent to 6 percent.
- Youth who have participated in area development programs have shown progress in emotional health and academic performance.
- The high school graduation rate has risen from 64 percent in 2013 to 79 percent in 2017.
- Homicides have declined; zero were reported in the immediate neighborhood in the last year.
“The community-level approach allows the integration of epidemiology approaches, business resources and neighborhood development to support a mixed income community,” says Dr. Kelleher. “Our next challenges will be to continue growth with new partners and to measure outcomes on children’s health in the neighborhood.”
Kelleher K, Reece J, Sandel M. The healthy neighborhood, healthy families initiative. Pediatrics. 2018 Aug 3. [Epub ahead of print]