When officials at Eskenazi Health look at a map of central Indiana, a few numbers jump off the page.
In Fishers, an upscale suburb in Hamilton County, people have a life expectancy of 84 years. But in the less-affluent Martindale-Brightwood neighborhood near downtown, people have a life expectancy of just 68 years.
That’s a difference of 16 years just a dozen or so miles apart. And it’s a driving force behind the health care system’s latest push to figure out what can be done to narrow that gap.
In March, Eskenazi Health, one of the nation’s largest safety-net hospital systems that serve mostly uninsured or under-insured patients, launched a $60 million fundraising campaign to help it move the needle on health disparities.
“Where you live shouldn’t determine how long you live,” said Ernest Vargo, president and CEO of the Eskenazi Health Foundation, the system’s fundraising arm.
As of last month, the foundation had raised $57 million, bolstered by two large gifts: $5.5 million from the Regenstrief Foundation to evaluate initiatives aimed at decreasing inequities and $3 million from the Richard M. Fairbanks Foundation to address substance abuse disorder, including the high rate of tobacco use and youth nicotine use.
The goal of the campaign is to improve life expectancy across the city. Eskenazi is aiming to do that by coupling its assets—its downtown hospital, 14 primary-care centers and five mental-health centers—with community and neighborhood partners.
Together, they want to address issues that affect a person’s health and longevity. That includes not only quality of care in hospitals and clinics but also “upstream” factors, such as neighborhood walkability, parks, tobacco use, diet, exercise and community safety.
That is likely to be a tall order. Indiana is ranked among the least healthy states in the nation by several national groups or publications, and life expectancy in Indiana is two years below the national average.
Forbes magazine this fall ranked Indiana 40th in the nation for health care, based on a study of access, cost and outcomes. America’s Health Rankings, published annually by United Health Foundation, ranks Indiana 35th, based on such measures as drug deaths, food insecurity, and air and water quality.
And Eskenazi is not the only health system trying to address the problem. In October, the Indiana University Health Foundation, the fundraising arm of IU Health’s adult hospitals, launched a $200 million fundraising campaign called “All the Difference,” with the goal of helping Hoosiers with health needs, including patient programs, housing, education, employment, and access to healthy food. As of the kickoff, the foundation already had raised $125 million.
Community Health Network’s annual “Giving Gig” banquet raises millions of dollars, much of it going to help cancer patients. Ascension St. Vincent’s fundraising arm last year raised nearly $15 million, which the system earmarked for patient programs, research and resources.
But for all the millions of dollars raised for programs inside and outside hospital walls, central Indiana’s health-disparities gap remains wide enough to drive a few ambulances through.
Officials at 164-year-old Eskenazi Health, however, think their latest campaign, called Beyond Barriers, could make a breakthrough because of the way it is being structured and studied.
“We have the infrastructure of our Eskenazi Health centers that are actually within the communities that we’re trying to impact,” Vargo said. “So we have a greater reach and a greater model that we’re trying to deploy. Of course, I’m biased.”
Eskenazi plans to set up three “health-equity zones” in low-income areas of Marion County with neighborhood leaders and residents to increase access to health care, mental-health care, nutritious foods and more.
The zones are defined as geographic areas where multiple organizations can work together to address obstacles to healthy living, including poverty, physical disabilities, mental-health problems and substance abuse.
Eskenazi said it will set up its health-equity zones by 2025. They will be known as Eskenazi Health Center West 38th Street International Marketplace, Eskenazi Health Center East 38th Street Northeast Corridor, and Eskenazi Health Center Grassy Creek/Far Eastside.
In each zone, Eskenazi is teaming up with a large, primary partner that can help identify needs and act as an outlet for services.
The goal is to work with other organizations, such as the Gleaners Food Bank of Indiana, to provide food assistance to people so they eat well and stay healthy.
“We partner a lot with Gleaners already,” said Tedd Grain, vice president of social determinants of health for the Eskenazi Health Foundation. “It’s a wonderful organization that does food assistance and may already be doing so in some of these neighborhoods. … We want to make sure that we are partnering with them and not re-creating that activity.”
The health-equity models are designed to link Eskenazi Health with community-based organizations, businesses, small not-for-profits and other groups. “We want it to leverage what they do well with what we do well,” said Kimberly McElroy-Jones, Eskenazi’s director of community partnerships for community health.
Eskenazi has found some key supporters to help with the big job ahead. The Regenstrief Foundation’s donation of $5.5 million will allow Eskenazi to evaluate what works and what doesn’t and to expand those findings across its 12 community health centers in Indiana.
The Indianapolis-based Regenstrief Foundation said it looked around the nation for organizations documenting health inequities because it wanted to support those trying to make health care more efficient and accessible.
“And what we found was that the best of the breed is in our own backyard with the activity going on at Eskenazi,” said Dr. Craig Brater, the Regenstrief Foundation’s president and CEO and former dean of the Indiana University School of Medicine. “And our community should really be proud of that.”
The other large gift, $3 million from the Indianapolis-based Fairbanks Foundation, will help set up the three health-equity zones, where Eskenazi will work with neighborhood partners to address community safety, diet, exercise and unhealthy behaviors, such as tobacco use.
Claire Fiddian-Green, the Fairbanks Foundation’s president and CEO, said her organization was intrigued by Eskenazi’s model of connecting clinical care and non-clinical care, especially for people in low-income neighborhoods.
The Fairbanks gift will also help underwrite community health workers, who deliver food and supplies to needy people in the neighborhood, as well as make sure people have their medicines and are going to physical therapy and health care appointments.
It will also fund a network of “community weavers,” people in the neighborhoods who are making residents aware of all the services available to them, through either Eskenazi Health or other providers.
“So it’s an exciting vision of how you can help people have better health outcomes and decrease rates of disease and death in those areas,” Fiddian-Green said.
Eskenazi said it was inspired to set up the health-equity zones, in part, by the state of Rhode Island, which has created 15 such zones in recent years at a cost of $30 million. The state claims it has created safer communities, improved health outcomes, increased access to healthy foods, decreased social isolation and helped people with substance use treatment and recovery services.
Eric Beane, former secretary of health and human services in Rhode Island, said the benefit of health-equity zones is that the government doesn’t decide what programs need to be set up to correct health disparities.
“You’re bringing together people in neighborhoods, in communities,” Beane said in a video on the state’s website. “You’re creating an infrastructure for them to tell us what the community needs for education, for transportation, to address health needs. So when you have these bottom-up, grassroots initiatives, you can be sure the government is going to do smarter things.”
Eskenazi Health can claim it has tried to address health disparities for more than a century. It was founded in 1859 as City Hospital, which opened at West 10th Street and Indiana Avenue, first to treat a smallpox epidemic and then as a Civil War military hospital. The hospital is now near West 10th Street and West Michigan Street, near the IUPUI campus.
Eskenazi Health is home to a Level 1 trauma center, a regional burn center, a patient tower, teen and adolescent programs, health and wellness centers, a mental health center, and a network of primary care clinics.
“If we expand what we are doing with our patients into the neighborhood as a whole and really start to address more than just what is presented to us at the clinic,” Grain said, “I think it could have a tremendous impact.”•
Correction: The original version of this story incorrectly reported that the Regenstrief Foundation is the fundraising arm of the Regenstrief Institute. The foundation is a separate organization and does not do fundraising. It supports various programs, including the institute.