When Brittney Lange-Maia, PhD, an epidemiologist at Chicago’s Rush University Medical Center, assessed community health needs on the city’s West Side using the Child Opportunity Index (COI), the results surprised her.
The areas of greatest need for health and lowest opportunity for health were right in the hospital’s backyard.
“We could see life expectancy of younger than 70 years old in one neighborhood and then 85 years old in one not far from it,” she says. “You could physically see this difference just by riding the L train a few stops. Importantly, the differences in life expectancy follow parallel patterns in the Child Opportunity Index.”
Rush used the COI data to produce its community health needs assessment, which hospital systems nationwide are required to produce every three years as mandated by the IRS, and integrated community feedback to inform its implementation plan. The resulting community programming focused on the neighborhoods surrounding Rush, where the need was greatest.
Lange-Maia says the influence of the COI data is reflected in the questions her team members now ask: “What neighborhoods should we focus our community services on? Where are we sending our volunteers? Are they servicing the right neighborhoods, based on what we know?”
The Child Opportunity Index comes to Chicago
Rush’s introduction to the COI came about because of the success the Chicago Department of Public Health’s (CDPH) Office of Epidemiology had using the COI to inform the city’s five-year community health improvement plan, Healthy Chicago 2.0: Partnering to Improve Health Equity. The plan, for 2016 through 2020, was the product of a collaboration between the public health department and 130 stakeholders to build stronger communities where all residents enjoy equitable access to resources, opportunities and environments that maximize their health and well-being. The COI gave the planning team a deep and detailed understanding of which neighborhoods were best resourced with high opportunity for children and which neighborhoods had the fewest resources with low opportunity for children.
The COI told the story of racial inequity in opportunity for children in Chicago; it quantified the overall burden of low opportunity, finding that nearly 300,000 children were growing up in areas of low opportunity. Furthermore, it revealed that nearly 1 in 2 black and Latino children lived in areas of low opportunity, compared to 1 in 50 white children. Perhaps the most powerful aspect of the Index was its ability to assess child opportunity not at the city or ZIP code level, but at the census tract level. This hyper-local view supported place-based implementation strategies. For example, the public health department’s ReCAST (Resiliency in Communities After Stress and Trauma) Program used the COI to identify neighborhood blocks where programming was most needed.
"Lange-Maia says the influence of the COI data is reflected in the questions her team members now ask: “What neighborhoods should we focus our community services on? Where are we sending our volunteers? Are they servicing the right neighborhoods, based on what we know?”"
Community seed grants as a result of Healthy Chicago 2.0
In 2019, CDPH and Public Health Institute of Metropolitan Chicago (PHIMC) launched a seed grant program, aligned with Healthy Chicago 2.0, awarding community partners that will help make areas around transit stations safer, more accessible, and welcoming. The seed grant program also considered low child opportunity level of a neighborhood as a criterion by which to evaluate community development proposals and make its awards. Its awards included: Foundation for Homan Square to transform a vacant lot that will encourage walkability, and South East Chicago Commission to fund environmental improvement efforts near a few transit stops, among others.
Ways to use the Child Opportunity Index scale throughout Chicago
Because Chicago's Healthy Chicago 2.0 team was so successful in using the COI, the Index is now used throughout Chicago by other stakeholders, policymakers, and health care professionals.
Elevated Chicago, which collaborated with CDPH and PHIMC on the seed grant program, “launched in 2017 to present collaborative, community-led solutions to neighborhood displacement and inequities” using Chicago’s public transit system. The group used Healthy Chicago 2.0’s COI data to identify disinvested and gentrifying neighborhoods in African American and Latino communities served by transit. Today, Elevated Chicago works with community-based organizations to finance equitable transit-oriented projects and engage neighborhood residents in major development project planning within the half-mile of train stations. They also advocate for equitable policy plans so development near transit does not displace legacy residents and businesses, and co-fund climate and cultural resilience and walkability programs near transit stations.
The COI has been incorporated into the Chicago Health Atlas, the premier website for population health data in Chicago. Users of the Atlas can examine indicators, like teen birth rates, at various levels of child opportunity as measured by COI. The overall COI is also available for each Chicago community area profile page, allowing for an at-a-glance look at resource inequities across all 77 community areas of Chicago.
"Because Chicago's Healthy Chicago 2.0 team was so successful in using the COI, the Index is now used throughout Chicago by other stakeholders, policymakers, and health care professionals."
Rush Medical Center and Lurie Children’s Hospital make data-driven health services decisions
Rush University Medical Center is not the only hospital in Chicago to use the Child Opportunity Index. Its neighbor on the East Side, Lurie Children’s Hospital, also uses the COI to inform and change the services they provide to their communities, as the CDPH has championed it as a common tool to address disparities city-wide.
Lange-Maia of Rush credits the COI as a “game changer and turning point” in identifying priority neighborhoods that need more resources, and informing Rush’s development and implementation of intervention and prevention strategies in these neighborhoods as part of a nationally mandated process.
Lurie Children’s Hospital uses the COI in similar ways. The COI informed Lurie’s 2016 and 2019 needs assessments, and the hospital uses it regularly to better understand causes of morbidity and mortality in many Chicago neighborhoods. COI data showed health care professionals at Lurie that obesity, asthma, and behavior health concerns were more concentrated in low-opportunities areas, and therefore, they put in place many prevention strategies. For example, as reported in TIME Magazine, in 2019 “researchers at Lurie Children’s Hospital of Chicago incorporated the data in an analysis of car accident injury records. They found that injured children who weren’t properly secured in a car seat were more likely to live in neighborhoods that rank low on the scale for childhood opportunity. This spurred the hospital to ramp up services that offer free car seats and car safety education to families in those areas.”
Health care institutions collaborate to help make the under-resourced West Side stronger
Rush and Lurie shared their learnings and banded together with other four other major health care systems, the Illinois Medical District, community residents, education providers, the faith community, businesses, government, and other organizations, to form West Side United, a community health and wellness collaboration that addresses social factors that affect health to raise life expectancy and make West Side neighborhoods healthier and more vibrant. Building on existing West Side community and institutional capacity, the collaboration was formed to address life expectancy disparities that are highly correlated with childhood opportunity.
West Side United has taken a multi-sector approach to addressing health with initiatives in health and healthcare, economic vitality, neighborhood and physical environment, and education. They have worked closely with community members to define, develop, and refine priorities. Since 2018, accomplishments include:
- Providing grants to expand community health workers and mental health services
- Awarding two rounds of micro grants totaling $585,000 to 36 small businesses
- Investing in community development projects
- Increased summer high school internships
- Developed career pathways for hospital employees
- Held a joint hiring fair
- Developed a food access strategy
For example, Rush now holds job fairs in neighborhoods on the West Side, so they are helping to alleviate economic hardship that some areas experience by recruiting its residents for jobs.
Transformations of the health of Chicago are thoughtful, carefully planned, and innovative, in large part because of the Chicago Department of Public Health, which has helped organizations, policymakers, and institutions across the city work from a consistent dataset—the COI--and language as a result of learnings from the COI. Their efforts are collaborative, complement one another, and only keep getting stronger.
"The COI is a "game changer and turning point" in identifying priority neighborhoods that need more resources, and informing Rush’s development and implementation of intervention and prevention strategies in these neighborhoods. "