Speaker 1: 180,000 children live in Hamilton County, Ohio, and Cincinnati Children's Hospital Medical Center wants them to be the healthiest kids anywhere. Even with its vast research and clinical capabilities, Cincinnati Children's realized that to truly improve the health of its children, care could not stop within the hospital walls. It also had to be integrated into its community.

Speaker 2: Community and population health is a strategic priority for us because we are really all about improving health for children.

Speaker 1: In 2010, Cincinnati Children's established the Community and Population Health Initiative as part of its strategic plan. It's a partnership between the hospital, community, and civic organizations in Hamilton County.

Speaker 3: I think what we've realized is there are tremendously effective community agencies out there. There's very committed individuals out there, and if we can work in partnership with them, we come with our health agenda, they come with their agenda around social determinants, that that leads to much more effective outcomes for kids.

Speaker 4: It's important in the long term for us to have healthy kids that can learn and go to school and be productive citizens, and it is a long term vision. It's not simply solving sort of the acute care problem.

Speaker 1: The initiative focuses on four primary areas, asthma, infant mortality, injury prevention, and obesity. Quality improvement methods, measurement, and mapping are used to track how well community interventions are working and to share progress with community partners. Here, Dr. Robert Kahn works with a team to cross-check neighborhoods with asthma and injury-related emergency department visits.

Speaker 3: What we're trying to do is sort of a quality improvement approach applied to community health where we try to pick two or three communities, set very clear goals and smart aims that the community can draw in collaboration with us.

Speaker 1: To start off, Cincinnati Children's is focusing in three urban neighborhoods, Avondale, Norwood, and Price Hill. In Price Hill, where social determinants can prevent access to care for pregnant women and children, the Cincinnati Children's Infant Mortality Team works to reduce preterm birth and improve infant outcomes. This work includes trying to ensure same-day access for entry into prenatal care. This is one way to ensure that women with high-risk pregnancies engage with as few barriers to care as possible. A key partner in the Price Hill neighborhood, Santa Maria Community Services, provides educational tools and resources to build strong families and promote a healthy lifestyle.

Speaker 5: We've been working very directly with Children's on a new project called Transforming Early Childhood Community Systems, or TECHS. Part of what we do is try to help families learn how to raise their kids in better ways. We know that parents want the best for their children, but sometimes they need an extra boost or an outside hand of support to make that happen.

Speaker 1: The message to parents is that raising a healthy child begins with a healthy infant, and that the first year of life is crucial for their growth and development. Community health centers like this one in Price Hill are critical points of contact for pregnant women. The Infant Mortality Team works closely with Price Hill Health Center to provide more accessible, affordable, and culturally sensitive prenatal care to promote healthy pregnancies and decrease infant mortality.

Speaker 6: We know that we're being successful, first of all, on multiple levels. One I would say is patient satisfaction, and that the patient can engage in care. That she feels comfortable with her care, that she engages in her care, and she has a voice in her care.

Speaker 1: Across town in the Norwood neighborhood, an effort to prevent childhood injuries is gaining momentum. Injuries cause more deaths in children over the age of one than all diseases combined, and Cincinnati Children's sees the opportunity to keep kids out of the emergency department.

Speaker 7: We're trying to focus first on the age one to four. We know that's a big part of that puzzle. It's also a big part of the puzzle that is preventable. Almost all those injuries happen in the home, which is why we're focusing on home safety.

Speaker 1: Preventing Injuries in Norwood, or PIN, is the partnership of Norwood organizations, leading the charge to prevent injuries in the home. Firefighters, EMS workers, and other volunteers visit homes throughout the neighborhood to install baby gates, cabinet locks, and smoke detectors. On this Saturday, volunteers were trained to conduct the next round of injury-preventing installations.

Speaker 3: Our injury team is increasingly finding their footing out in a town called Norwood, where they're really engaging the local community in improving home safety.

Speaker 8: In the time that, since we did the first one and today, which has been about five months, that kids that were in our initial offering have not shown up at the emergency room. Now that doesn't mean that nobody was injured, but it does mean that we're starting to see some little tiny progress.

Speaker 1: In the Avondale neighborhood, the obesity team is working to make progress in the field of childhood nutrition. With obesity rates among children soaring, the hospital is working closely with the Cincinnati Public Schools to improve young eating habits and understand why students like these were ignoring the healthy foods.

Speaker 9: We did kind of an observational analysis to see what students were eating and why were they or were they not eating healthy choices. And we observed that anywhere from 50 to 90 percent of fruits and vegetables were going in the garbage. We came up with a taste test program to allow children to actually sample fruits and vegetables. And one of the things that we learned is that, you know, over time, maybe not immediately on some things, that children would acquire, begin to acquire a taste for things like broccoli.

Speaker 1: The result?

Speaker 9: Instead of 70 percent of fruits and vegetables going in the garbage at lunchtime, 70 percent of children are eating fruits and vegetables.

Speaker 10: Cincinnati Children's Hospital has been a wonderful partner for our public school district because they've been able to provide a lot of the information that we've used to teach our kids about healthy nutritious choices.

Speaker 1: By starting small in three targeted neighborhoods, Cincinnati Children's is developing prototypes for improving population health on a larger scale.

Speaker 3: The key when you're working small is to always have the big scale in mind. We may be working with 500 kids in a particular community, but all the time we're saying there are 180,000 children in Hamilton County. What we build in Norwood or in Avondale ultimately has to be scalable countywide.

Speaker 4: If we're able to move the dial and we can visibly show healthier communities, I think it's applicable anywhere. What we bring to the table is, I think, resilience and willingness to stick with it. And so, we will stick with it until we get changes and when we get the results, then we'll be able to talk about it. Right now, this is just an early part of our journey.

Speaker 2: When the mission is so important, when the opportunity is so great to make a difference in the lives of children and generations of children, I know we've got the tenacity, I think our partners do, to really keep after this work.

Speaker 1: Learn more about the Population Health Initiative at CincinnatiChildrens.org CINCINNATI CHILDRENS.ORG