Published in the journal Pediatrics, researchers from Nationwide Children’s Hospital presented a case study for treating a neighborhood as a patient.

Neighborhood effect syndrome, characterized by symptoms of extreme poverty including housing insecurity, racial segregation, trauma, violence, poorly performing schools, low social cohesion and environmental toxins, has debilitating consequences on child health. Health providers frequently encounter challenges to caring for children from affected neighborhoods, and these children often experience poorer outcomes compared to peers in unaffected neighborhoods. Historically, institutions have been largely ineffective in changing these outcomes with one-child-at-a-time tactics.

Fig. 1. Health Neighborhoods Healthy Families

Nationwide Children’s leaders with community partners decided to address neighborhood effect syndrome as a target for pediatric health care – treating the neighborhood as a patient. In 2008, Nationwide Children’s began collaborating with residents, government entities and social services agencies to develop the Healthy Neighborhoods Healthy Families (HNHF) initiative.

The hospital’s first patient neighborhood was Southern Orchards, a neighborhood of Columbus, Ohio, located adjacent to the hospital.

“The Southern Orchards neighborhood was one with gun violence, high infant mortality rates and high asthma rates in children,” says Kelly J. Kelleher, MD, MPH, vice president of Community Relations at Nationwide Children’s and lead author of the publication. “Houses were boarded up and vacant. You didn’t see kids playing outside much.”

In 2009, the neighborhood was characterized by the following:

• Residents totaled 4,300 with 23% being children
• 50 percent of children were living in poverty
• 50 percent of the children living in poverty were African American
• 25 percent of children in the area’s elementary school and 33 percent in the high school were transferring to other schools annually
• The elementary school was ranked 3,285 out of 3,311 public schools in Ohio
• Foreclosures exceeded 21%, more than three times the rate for the City of Columbus
• Abandoned, derelict or vacant properties peaked at 31.3% of all lots in the area

The chief concern uncovered through multiple sources of data and information was neighborhood safety associated with population loss and surge in vacant and abandoned property.

“Residents were deeply concerned about blight and gang/drug activity, including on vacant properties in proximity to the school,” says Dr. Kelleher. “Our primary target for intervention became housing. Our collaboration committed to renovating, building and developing mixed income housing to reduce crime, improve the vacancy rate and better family outcomes.”

The publication describes $23 million invested in upgrading more than 300 homes through the Healthy Homes Collaborative, which was formed with not-for-profit development corporation, Community Development For All People. The entity is owned by Community Development For All People with a board of directors selected by the two groups. To date, the investment has grown to more than $40 million.

The partnership, with collaboration from the Columbus Mayor’s Office, accessed Neighborhood Stabilization Program funds from the city, acquired properties from the city’s Land Bank program and gathered support from contractors and realty agents.

At the start, HNHF was mainly focused on the short-term goals of removing blight, developing relationships with community partners, and increasing safety. The housing element was just the beginning.  HNHF also has launched numerous initiatives to address social determinants of health such as access to educational opportunities, workforce development and neighborhood safety.

“By taking both short- and long-term views of community development, Nationwide Children’s and our partners have ambitious goals across many domains,” says Dr. Kelleher. “The community-level approach allows the integration of epidemiology approaches, business resources and neighborhood development to support a mixed income community. Our next challenges will be to continue growth with new partners and to measure outcomes on children’s health in the neighborhood.”

Kelly Kelleher
Abigail Wexner Research Institute at Nationwide Children’s Hospital and
The Ohio State University College of Medicine, USA

Publication

The Healthy Neighborhood, Healthy Families Initiative.
Kelleher K, Reece J, Sandel M
Pediatrics. 2018 Sep

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