Cleveland Clinic is a world-class hospital, but despite the quality of care it provides, residents in the mostly poor neighboring community have little trust in the facility.
The hospital is an oasis of wealth in the midst of Cleveland’s Fairfax and Hough neighborhoods, which are low-income and have dwindling populations, according to an article from Politico. The surrounding communities are also unhealthy; more than a third of residents in the Census tract around Cleveland Clinic have diabetes, and the rates of other preventable chronic conditions, like heart disease and high cholesterol, are above the national average.
“You have one of the best global brands in healthcare, but some of the worst healthcare disparities” are right next door, Richey Piiparinen, who studies urban planning at Cleveland State University, told the publication. “That’s the impact of not being connected to the neighborhoods.”
One initiative that has caused particular friction with local residents is the Opportunity Corridor, a state transportation program backed by the hospital that involves tearing down parts of the neighborhood to help staff and patients reach the hospital faster. Some local residents see this as catering to a majority white or international patient and physician base at the expensive of the majority-black neighborhoods (Fairfax and Hough are 95% black, according to the article).
Cleveland Clinic CEO Toby Cosgrove disputed these concerns in an interview, telling the publication that the hospital has completed its three “obligations”: providing high-quality healthcare, creating jobs and supporting education. It invests in health and wellness programs in the surrounding community, he said, like the Langston Hughes Community Health and Education Center, located a mile from the main campus.
Another Politico report found that under the Affordable Care Act, nonprofit hospitals have been able to fatten their wallets as insurance coverage gains decreased uncompensated care spending. But the country’s best hospitals haven’t reinvested those savings in charity care or community projects, instead reducing spending on charity care.
As population health initiatives grow in importance, research shows providers must address social issues to improve health on a wide scale. The ACA does push for increased emphasis on population health, but many hospitals view community health initiatives as something that's outside of their traditional mission. Cosgrove told Politico that Cleveland Clinic is invested in population health, but there’s a limit to what it can do, and “society as a whole” must take a look at ways to tackle the social determinants of health.