Photo credit Louisville Center for Health Equity


African Americans in Louisville, Kentucky, as in the rest of the U.S., experience greater health inequities compared to other racial and ethnic groups. This population, in particular, disproportionately experiences illness, violence-related injuries and premature death. In response, the Louisville Metro Department of Public Health and Wellness's Center for Health Equity (CHE) is tracing the pathway from illness and injury to the community conditions, norms and root factors that lead to poor health and inequity in the first place. By building capacity among historically disenfranchised neighborhoods, CHE is leading an urban movement to promote equal opportunities for health and safety.

Established in 2006, CHE's mission is to "eliminate social and economic barriers to good health, reshape the public health landscape, and serve as a catalyst for collaboration between communities, organizations and government entities through capacity building, policy change and evidence-based initiatives." CHE determines "what types of institutional and social changes are necessary to prevent poor health outcomes." To answer these questions, CHE uses Geographic Information System (GIS) mapping of local areas to measure differences in rates of disease and violence. Public Health and Wellness has also begun to overlay social determinants of health and safety, such as housing stock and educational attainment, to further illustrate their profound effect on community safety and wellness. Taken together, these efforts inform project planning, draw attention to the social determinants of health, facilitate community engagement, and make the case for an investment in disease and injury prevention. The next goal is to use GIS mapping to show impacts of policy change.

Reframing the conversation on health and safety inequalities

The backbone of CHE's work is empowering community members and policymakers to realize that health and safety have less to do with individual choices and more to do with opportunities for health based on socioeconomic status, race and geography. CHE began this work by exploring strategies for educating community members and decision-makers about the causes of inequities in health and safety. CHE commissioned Cultural Logic, an applied cognitive and social science research group, to identify "the discrepancies between what public health experts want people to understand and what the public currently believes about health and health disparities." Cultural Logic conducted in-depth interviews with a sample of Louisville residents and also analyzed the content of news media reports. Their research found that people think that some populations are less healthy than others because of their individual choices and decisions rather than due to their neighborhoods conditions.

To change the public's misperceptions, CHE convenes community groups and government officials to discuss how inequities are created and where prevention efforts are most effective. Communities watch and react to a seven-part documentary series that explores racial and ethnic inequalities in health called Unnatural Causes: Why Inequality is Making Us Sick. Episode One features Dr. Adewale Troutman, CHE Founder, who presents the stark differences in life expectancy based upon their neighborhoods conditions and years of education.

In 2010, CHE awarded $10,000 grants to five community-based organizations to facilitate community dialogue on the community conditions that lead to poor health. The grant entails recruitment of 3 to 5 community residents to complete a two-day Health Equity Dialogue Facilitator Training. CHE trains facilitators with the Health Equity Dialogue Facilitator's Guide, developed in part by Prevention Institute, a national non-profit in Oakland, California. The Guide prepares facilitators to lead Louisville community residents in a dialogue about elements of the social and community environment that can be addressed to enhance quality of life and improve health behaviors and outcomes. After being trained, the facilitators host 3 to 5 health equity dialogues in their communities. Community residents coalesce to share their stories of how inequities affect them, and with assistance from CHE, the facilitators work with neighborhood residents to conduct community assessments, convene an action planning team and develop an action plan to address a related health equity topic.

Promoting Equity by Impacting Multiple Determinants of Health

Robert Wood Johnson Foundation selected Louisville as one of nine cities to be awarded a a Healthy Kids Healthy Communities (MHHM/HKHC) grant through their Mayor's Healthy Hometown Movement (MHHM). The purpose of this grant is to create community-wide environmental and cultural changes that encourage and support healthy lifestyles and removes barriers to physical activity and healthful eating. The grant requires CHE and the MHHM to engage 12 neighborhoods in projects to improve neighborhood conditions in which people live, work, play and learn. For instance, residents have conducted walkability assessments. CHE is also working with youth from West Louisville and East Downtown to use digital storytelling and photo voice projects as a way of identifying barriers to living a healthy life. Through digital storytelling and photo voice projects, young people record and reflect their community's strengths and challenges. These photojournalist techniques can be used to engage policymakers by providing a method for describing the community from the viewpoint of those who live there as opposed to those who govern it.

Photo credit Louisville Center for Health Equity

Photo credit Louisville Center for Health Equity

As part of their comprehensive efforts to breakdown contextual barriers to residents living safe and healthy lives, the Health Department has a specific focus on preventing violence. Violence is a serious health threat, and the social impacts to families and communities are severe and costly. Further, rates of homicide deaths are more than sevenfold greater for African Americans than for Whites. Louisville is a member of the UNITY (Urban Networks to Increase Thriving Youth through Violence Prevention) City Network. UNITY is a Centers for Disease Control and Prevention (CDC)-funded initiative, co-chaired by Prevention Institute, Harvard School of Public Health, and University of California at Los Angeles, which works with city representatives to develop sustainable strategies for building community resilience and preventing violence in the first place. Louisville has implemented Youth Print, which is a comprehensive plan to prevent violence that was developed by local leaders and guides local prevention efforts. The City Department of Youth Development has also coordinated a unique data sharing agreement with the Jefferson County School System. Local community based organizations can access data on a number of educational indicators, including academic achievement, attendance and suspensions. Having access to these data enables organizations to measure outcomes of the programs they implement. In addition, the city hosts "An Afternoon of Youth Development", for anyone in the community interested in learning more about youth development. Over 400 participants attended the quarterly training series in one year. In partnership with the Muhammad Ali Center, the training series is also available for people and organizations that work with youth. In addition, the city is partnering with the University of Louisville to develop youth service curricula that complement a monthly youth service worker training.

Photo credit Louisville Center for Health Equity

Further, Louisville's efforts to prevent community violence intersect with their approaches to prevent chronic disease. Violence or the fear of it makes it harder for Louisville residents to eat healthful food and be active and also undermines efforts to create and sustain health-promoting food and activity environments. Louisville is one of six national pilot sites funded by the Convergence Partnership to develop multi-sectoral collaboratives to reduce violence and improve healthy eating and activity in their neighborhoods. Louisville is implementing environmental change strategies in the Shawnee neighborhood. In this predominantly African American neighborhood, 39% of residents 25 years and older have not earned a high school diploma. The median household income is $21,906, compared to Louisville's $40,793. Because alcohol abuse contributes to violent assaults in the neighborhood, the Louisville partnership intends to decrease alcohol consumption with policies that limit alcohol promotion (i.e., eliminating alcohol and tobacco promotion signage). The team is also adding lighting in the neighborhood to increase neighborhood safety and encourage physical activity. Forthcoming activities include decreasing graffiti and restoring the Shawnee neighborhood so that residents feel safe walking to grocery stores and accessing spaces for physical activity.

Photo credit Louisville Center for Health Equity

CHE and its city partners have also taken major strides to achieve a number of related policy goals to improve health and safety for all. Some of these achievements include:

  • The Food in Neighborhoods Committee is proposing a "Buy Local" policy, which the Department of Public Health & Wellness is piloting.
  • The City is working to develop and implement a policy to promote breastfeeding.
  • CHE is providing Electronic Benefit Transfer machines for Farmer's Markets.
  • The Planning Department has developed a policy that requires walkability issues to be addressed in all neighborhood plans.
  • The Planning Department is developing a policy requiring that all new construction projects conduct Health Impact Assessment, which is a cross-disciplinary strategy for assessing the potential population health impacts of a proposed project, policy or other development decision.
  • The Healthy in a Hurry Corner Stories Initiative provides equipment, façade improvement and training for corner stores to stock and sell fresh produce.

Photo credit Louisville Center for Health Equity


By engaging residents and decision-makers to identify and intervene on the root causes of health inequities, the Louisville Metro Department of Public Health and Wellness's Center for Health Equity is changing the conversation, the community, and the context when it comes to good health. The culmination of CHE's efforts will help to increase the odds that all Louisville residents, regardless of their race/ethnicity, years of education, or neighborhood, will have many healthy and safe years of life.


This profile would not have been possible without funding from the W.K. Kellogg Foundation. We also wish to acknowledge Lisa Tobe, Director of the Center for Health Equity, for sharing her time and expertise.

For more information, visit http://www.louisvilleky.gov/Health/equity/