An Innovative Approach to Health Equity
UIC School of Public Health researchers help the Chicago Department of Public Health address health disparities from the ground up and build the city’s health equity muscle.
Intro
Genese Turner and her colleagues at the Chicago Department of Public Health’s (CDPH) Office of Community Planning and Equity Zones (CPEZ) knew the numbers all too well.
In the nation’s third-largest city, a diverse metropolis of 2.6 million people, Black residents lived over a decade less than their white peers while the city’s Latinx population also trailed behind white residents in life expectancy. Fueled by a lengthy list of preventable social, environmental and economic determinants of health, the race-based life expectancy gap of the city’s residents troubled CDPH staff – and prompted an earnest pursuit for solutions. Combining inspired action with an innovative public health approach, CDPH unveiled Healthy Chicago Equity Zones (HCEZ) in 2022. The novel, grassroots effort invites community organizations to the table to drive collaboration, independence and neighborhood-centric solutions to improve population health.
“We wanted to move deeper into the health equity and health disparities worlds by sharing power and co-developing solutions with communities,” said Turner, CDPH’s director of health equity and strategic partnerships. To solidify the upstart initiative’s foundation and propel its future, CDPH leaned on a familiar ally: the UIC School of Public Health (SPH). Carried out over two years, the participatory, mixed methods evaluation work of researchers from SPH’s Division of Community Health Sciences has helped to strengthen CDPH’s innovative HCEZ initiative and advanced the health equity zone model as a viable strategy to combat health disparities and promote health equity.
Pursuing health equity
In public health circles, and even dinner table conversations, the COVID-19 pandemic increased broad awareness of significant gaps in the nation’s public health and health care landscape, including the accessibility of care for vulnerable populations, such as low-income families, rural communities, people living with disabilities and communities of color. While public health agencies like CDPH had been building up equity-focused programs for decades, the visible differences in pandemic-era care and outcomes across different communities intensified movement toward health equity and clearly demonstrated to non-public health sectors the fact that some communities simply needed more resources. By and large, public health knew it wanted – and needed – an increased commitment to health equity.
In Chicago, specifically, CDPH had continued working to expand upon their approaches and craft new strategies putting health and fairness at the center of the agency’s efforts. For example, in 2017, the Health in All Policies Task Force in the City of Chicago released a report of recommendations on how City departments and sister agencies could collaborate to improve health based on Healthy Chicago 2.0’s plan to achieve health equity. However, an inspiring model from Rhode Island offered a new opportunity: a collaborative approach directly investing in community-based organizations to address health challenges and reduce disparities.
The Rhode Island Department of Health’s innovative approach to address health disparities – building so-called health equity zones – featured a system of community-led collaboratives providing insights and plans to ensure public health investment matched specific community needs. Rather than focusing on a one-size-fits-all solution across the state, the Rhode Island agency shared power with individual communities to identify needs and priorities and then distributed resources accordingly.
“The goal wasn’t new, but the approach was,” said Ben Shaw, professor and director of SPH’s Division of Community Health Sciences. Back in Chicago, Rhode Island’s work captured the attention of CDPH leadership. The health equity zone approach seemed a sharp way for CDPH to expand its neighborhood networks and share power, establish and implement thoughtful health equity action plans alongside community partners and create evidence-based systems addressing barriers to community health and well-being.
Creating Healthy Chicago Equity Zones
Initially supported by COVID emergency funding and later bolstered by a $30 million health disparities grant from the Centers for Disease Control and Prevention (CDC), CDPH and CPEZ launched the HCEZ initiative in summer 2022.
Modeled after Rhode Island’s novel effort, HCEZ relies on hyper-local assessments performed in tandem with community organizations in six regions across Chicago. Together, the partners identify public health priorities at the neighborhood level as well as the factors contributing to health and racial inequities. Thereafter, CPEZ and its community partners craft solutions and execute action plans designed to advance health and close health disparity gaps.
“We talk a lot in public health about the social determinants of health, and HCEZ is an example of trying to help communities address social determinants in their specific area by focusing on factors that are indirectly but powerfully linked to community health, like employment opportunities, access to schools, green spaces and crime,” Shaw said. HCEZ focuses on trust building and shared learning. The initiative uses culturally and linguistically tailored practices to reach disproportionately affected populations. It also heightens capacity through technical training so community organizations can assess their own needs and devise pragmatic solutions.
“This program puts the resources and supports in place to let people already connected with neighbors discover what’s needed,” said Tiffany Ford, assistant professor of community health sciences at SPH.
Tapping SPH for support
To fulfill the requirements of its CDC grant, CPEZ needed to develop an evaluation system and publish a final report detailing its early HCEZ efforts. To perform that assessment, CPEZ turned to a longtime CDPH partner: UIC’s School of Public Health.
Over the years, CDPH and SPH had collaborated on numerous endeavors, from establishing the nation’s first academic health department to share public health research, education and data-analysis projects to COVID contract tracing and community response to the award-winning Chicago Health Atlas, a free resource featuring neighborhood-level health data for all of Chicago’s 77 community areas. While CDPH’s familiarity with SPH was certainly a plus, even more attractive was the school’s experience collaborating with community-based organizations and its ongoing work evaluating health disparity efforts at Cook County Department of Public Health as part of that agency’s own CDC health disparities grant.
“[UIC’s School of Public Health] had the manpower and subject matter expertise to do evaluative work with both us and community partners,” said CDPH project coordinator Stephanie Salgado BA ’18, MPH ’22 with a concentration in Community Health Sciences.
In fall 2022, Shaw, a new UIC faculty member whose research focuses on social and behavioral determinants of health, met with CPEZ leadership to learn about the project’s scope and its early implementation. He then began building a team of colleagues – Ford, Kelechi Ibe-Lamberts, Alisa Velonis, Jeni Hebert-Beirne, Eve Pinsker, and Diana Ghebenei among them – and students to complete the evaluation. The layered, real-time effort would include investigating everything from the program’s setup and execution to the public health department’s collaboration with community organizations.
“And ultimately, our task was to provide feedback for improvements on this long-term project, so it could be a more successful program,” Shaw said.
A thorough and thoughtful evaluation
The SPH team’s evaluative work began with the development of a program theory and logic model representing a comprehensive shared understanding of the HCEZ initiative – its blueprint of what, precisely, SPH needed to study. Guided by conversations with various CPEZ staff and partners and a thorough review of HCEZ informational resources, the model explained how the HCEZ intervention sought to address structural racism as well as how the program would connect intervention activities with desired outcomes. “They put into a model what we knew in our heads,” Turner said of the SPH researchers.
“They had the expertise to get us over that hump.” (At the same time, it’s worth noting, the SPH researchers also began studying activities of the Health Equity in All Policies (HEiAP) team funded by the same grant activities. The HEiAP initiative focuses on promoting health equity within local government decision making.) With the logic model in hand, SPH then steered the development of evaluation questions alongside CPEZ leaders and an SPH-formed advisory group comprised of academic, government and community partners. Following deep discussion around the most important, innovative and potentially impactful elements of the HCEZ program theory as well as a review of the data available and a review of the data that could be reasonably obtained, the SPH team established a list of seven evaluation questions.
“How do you evaluate elements like trust building and power sharing? That’s what our SPH partners helped us figure out,” Turner said. To drive a detailed investigation, the SPH team employed a participatory, mixed methods evaluation approach to inform potential HCEZ improvements and promote the initiative’s long-term sustainability.
Rather than a traditional independent, third-party evaluation resulting in a score or grade, Shaw’s group worked closely with CDPH and community partners to design the evaluation, collect data and assess results. SPH researchers met every Wednesday with their CPEZ peers to share updates, troubleshoot problems and define next steps.
“It’s a bit like embedded journalism,” Shaw said of the participatory evaluation. “If we’re going to find the places that need further investment, we need to work in close conjunction with the people involved and better understand what’s going on, so we can ask the right questions.” The mixed methods analysis, meanwhile, combined both qualitative and quantitative methods. It included in-depth interviews with key collaborators from CDPH and community partners, survey results, a review of documents related to HCEZ activities and monthly data tracking supplied by community organizations.
“The value of the mixed methods approach is that you’re integrating different sources of data to tell a richer, more cohesive story,” said Ford, a mixed methods researcher with a history of community-engaged work studying structural racism and policy. After collecting the data from multiple sources, the SPH team then guided an interpretation of findings, which included engaging the advisory group in an interactive “Community Café” exercise and developing a joint data display presenting key qualitative and quantitative results.
Positive findings
The SPH-led evaluation stirred positive takeaways, including widespread agreement that the hyperlocal HCEZ initiative was generating positive results. In its final evaluation report, SPH researchers credited CPEZ and the HCEZ initiative with helping Chicago build its health equity muscle at the grassroots level and said the effort was better preparing the city to protect its most vulnerable residents from both emergent and chronic health challenges.
In addition, SPH researchers saw community organizations – empowered by the HCEZ initiative and growing trust in CPEZ and CDPH overall – incorporating health equity goals into their long-term work plans. Groups once leery of government and institutions designed action plans and expressed confidence in the long-term prospects of the city’s health equity work. “There’s definitely strong evidence this program was forming a foundation for success and developing capacity in communities,” Shaw said.
The initiative’s collaborative, grassroots nature also highlighted community health needs that a traditional, topdown public health approach may have overlooked. During its evaluation, for instance, Shaw said every community completed an assessment of its unique health priorities. From that, the HCEZ team discovered the top health priorities across the city were neighborhood safety, chronic disease and mental health.
“If you’re dictating priorities to people rather than asking them, you’d fail to learn what’s most important to them,” Shaw said.
Octavia Tyson, a public health administrator with CDPH, called the SPH research group “critical thought partners” who helped CPEZ refine the required reporting to the CDC and craft the proper narrative.
Keeping the pace
Today, the SPH team’s thoughtful, deep evaluation of HCEZ is informing CDPH’s work with the upstart initiative, one that enjoys promising momentum, yet faces lingering uncertainty around its long-term viability. In its final evaluation report, in fact, SPH researchers called the present “a critical moment for the sustainability” of HCEZ-related work.
“To continue progress in addressing health equity … there is an urgent need for continued investment in support of these initiatives,” the CDPH-UIC Health Disparities Grant Evaluation concluded. Turner called funding the biggest hurdle to capitalizing on the HCEZ project’s early energy. To counter that challenge, CDPH is helping community partners build grant proposals and identify local foundations who might support community groups’ action plans. Turner has also seen community partners band together to pursue joint funding and one community partner leverage the technical assistance CDPH provided to earn a federal housing grant.
“The question is how much can we resource this in the next couple of years to keep moving forward and putting power in the hands of the community to design and implement solutions,” Turner said, adding that CPEZ launched action planning in 2024 to address priority issues identified by the HCEZ evaluation.
A program analyst with CDPH’s Office of Chronic Disease Prevention and Health Promotion, Brian Edmiston knows it takes time to measure and demonstrate success with population health programming. He acknowledged it’s a challenge CPEZ leadership and its community partners must tackle to ensure the program’s long-term growth.
“It’s on us to show the importance of this work and its potential benefits to prospective funders,” he said. To that end, project leaders have publicly positioned the initiative as a potential model for others to follow – a move that could encourage funding to propel HCEZ’s continued maturation. An article published in the January 2025 issue of the American Journal of Public Health co-authored by Turner, Edmiston and others, for instance, highlighted Rhode Island and Chicago’s work using the health equity zone model to prevent health inequities and reduce downstream needs among vulnerable populations. The authors termed their article “a call to action for transformative health equity initiatives empowering communities to address systemic health inequities through expanded implementation and enhanced evaluation of health equity zone models.”
Months earlier in a 2024 article for the Journal of Participatory Research Methods, CPEZ and HCEZ collaborators described their participatory evaluation process and joint efforts to address structural racism and advance health equity. The group said their process could “inform ongoing and future participatory evaluation efforts and contribute to the establishment of best practices for partnering across institutions to reshape systems and power relationships to advance health equity.”
“This can be a proof of concept,” Ford said of the HCEZ work. “This can be bigger than Chicago.”
Editor's Notes
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Editor’s Note: Throughout 2024, a team of Community Health Sciences (CHS) faculty and students worked with the Illinois Department of Public Health (IDPH) to conduct an environmental scan of ongoing HEZ projects in other states, and to engage communities throughout Illinois in the planning of a new statewide HEZ initiative. In January 2025, IDPH launched a HEZ pilot program under Heathy Illinois 2028 State Health Improvement Plan. IDPH awarded two HEZ pilot grants to programs in McDonough, Henderson, and Winnebago counties that will address historic health disparities in those regions. Building on the successful HEZ evaluation partnership with CDPH and their national research, the CHS team has now begun working with the IDPH grant awardees to provide technical assistance through monthly webinars and learning collaboratives.
The CPEZ team wants to acknowledge all their colleagues at CDPH and our internal and external partners who continue to work on providing resources to ensure every Chicagoan has the opportunity for optimal health and well-being. We also want to acknowledge the CDC for supporting our efforts through the National Initiative to Address COVID-19 Health Disparities Among Populations at High-Risk and Underserved, Including Racial and Ethnic Minority Populations and Rural Communities grant.