CLEVELAND — Health care talent clusters in Cleveland. Among America’s 40 largest regions, the Cleveland region is second to Pittsburgh in the concentration of skilled health care workers. That talent is particularly concentrated in Cuyahoga County, which has the seventh most hospital employees in the nation, despite being the 35th largest by population.
Given Cleveland’s status as a world-class health care provider, one could surmise those resources would translate into good local population health. But that’s not the case. According to the University of Wisconsin’s Population Health Institute figures, Cuyahoga County ranks 75th out of 88 counties for health outcomes in Ohio. Ohio’s Appalachian counties make up the majority of counties that rank below it.
This incongruity is present at smaller geographies. The city of Cleveland’s Health-Tech Corridor is a 2.87- square-mile stretch running from downtown to University Circle. That stretch contains nearly 40% of Cuyahoga County’s health care jobs. Yet the corridor is also home to neighborhoods with the worst health outcomes. An analysis of the census tracts that are most vulnerable to COVID-19 complications — as gauged by the concentration of residents with the highest prevalence of chronic disease — revealed that two of the top five most vulnerable census tracts in Ohio were within the health corridor’s boundaries.
So, what’s going on here?
Education and health care, or “eds and meds,” have become a globalized industry. Hospitals and universities have taken on the air of worldwide headquarters — or a place in a city, not necessarily of the city. In the case of hospitals, the quality of care is important, but so is a path to more profit. The organizational missions that don’t create a beeline to that end can be overlooked. A global hospital, then, can become divorced from its local community, with population health becoming a no-brainer that few people think about.
“That’s a good direction to go,” said former Cleveland Clinic CEO Toby Cosgrove in 2017 when asked by Politico reporter Dan Diamond what the Clinic can do to reduce health disparities locally, before Cosgrove wondered, “But how much can we do in population health?”
Fast forward to April 2020 and Cosgrove attempted to answer his own question in a co-authored Politico piece. Cosgrove explained that the double whammy of COVID-19 and unemployment could be an opportunity to build a public health workforce he dubbed the “Health Care Ready Reserve.” Consider it an “army” of people whose skills are repurposed toward protecting public health, not unlike President Franklin Roosevelt’s Works Progress Administration (WPA) that retooled the underemployed, pivoting their labor toward infrastructure and cultural development.
Cosgrove argues that good health could be fostered by putting money in people’s pockets as they tended to the health needs in their communities. Moreover, resiliency can get baked into an increasingly strapped health care labor force, with reserve workers freeing up caregivers for direct care as they’re trained to administer COVID-19 tests, contact-trace people who’ve been exposed to the virus, and perform logistical tasks such as disinfection.
Even after this novel virus has passed, participation in the reserve force “could provide a steppingstone for workers to transition from shrinking parts of the economy to those, like home health care, that are growing,” notes Cosgrove. It would also allow a level of preparedness for the arrival of the next novel virus, which is less a question of “if” but “when.”
While Cosgrove was strategizing nationally, it’s likely his experience in Cleveland influenced his worldview. Plainly, the Cleveland Clinic is a global health care system enmeshed among neighborhoods of poor health. But there’s untapped potential in those neighborhoods, making it a perfect proving ground in changing how the economics of health works. Consider it the localization of globalization — or the retethering of what we gift globally to what we need locally.
If accomplished, Cleveland could change the world by changing Cleveland.
Richey Piiparinen is the director for urban theory and analytics at Cleveland State University’s Maxine Goodman Levin College of Urban Affairs.
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