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Case Study: “The Eastview Health Equity Gap—Applying SDoH and Community Assessment”

Aligned to Chapter 11

Scenario

The city of Eastview (population 324,000) recently completed its Community Health Assessment (CHA). While overall health indicators appear stable, the CHA revealed significant disparities between Eastview’s west and east districts.

Key Findings from the CHA

West District (higher income):

• Life expectancy: 82.4 years
• High school graduation: 94%
• Home ownership: 78%
• Primary care access: 1 PCP per 1,300 residents
• Unemployment: 3.2%

East District (lower income):

• Life expectancy: 74.1 years
• High school graduation: 68%
• Home ownership: 42%
• Primary care access: 1 PCP per 2,800 residents
• Unemployment: 12.7%

Additional SDoH Data

• East District has limited public transit and only one grocery store.
• Childhood asthma rates in the East District are 3× higher than the West.
• Violent crime rate is 2.5× higher in the East District.
• 27% of Eastview’s immigrant population resides in three East District neighborhoods.
• Rent burden has increased 22% in five years.

Community feedback:
Residents in the East District report lack of trust in health institutions, minimal outreach, and language barriers.

Student Tasks (4–5 pages)

1. Conduct an SDoH Analysis Using Chapter 11 Frameworks

Identify which SDoH domains are most strongly influencing disparities (economic stability, education, neighborhood environment, social context, access to care).
Explain the causal pathways from these determinants to:

• Life expectancy
• Chronic disease patterns
• Behavioral health
• Health service utilization

2. Identify Priority Populations

Using the CHA data, determine two priority populations that the city of Eastview should target first.
Justify your selections using population health reasoning.

3. Evaluate the City’s CHA Process

Assess whether the CHA reflects:

• Adequate community engagement
• Use of both quantitative and qualitative data
• Cross-sector collaboration
• Cultural competence
• Identification of root causes vs symptoms

What elements were missing?

4. Develop an Upstream Intervention Strategy

Propose three upstream interventions (housing, transit, language access, education, environmental safety, etc.).
For each intervention, explain:

• The determinant it addresses
• The expected impact on health outcomes
• Which partners must be involved (public health, housing authority, schools, nonprofits, city planners)
• Barriers to implementation