Duluth’s Hillside neighborhoods face some of the worst health outcomes in the city — and the medical district aims to change that
The developing medical district is located in an area that struggles the most with health in Duluth.
Duluth’s medical district is growing rapidly. Leaders of the hospitals say the developments will improve the nearby neighborhoods — which face some of the worst health outcomes in the city — but not all residents are convinced.
St. Luke’s and Essentia Health both say they have a responsibility to improve the health of those living in the Central and East Hillside neighborhoods — and that they have already taken steps to do so. To do this effectively, experts say hospitals need to be intentional with investments and partnerships when working to uplift nearby neighborhoods.
Both hospitals have been in the Hillside neighborhoods for decades, and are investing millions to redevelop their medical campuses in that same community.
St. Luke’s approximately $250 million investment includes a new emergency room, catheterization lab, helipad, parking ramp, hospital tower and more. Essentia’s $800 million Vision Northland development looks similar: It includes a 12-story hospital tower, larger surgical suits and updated clinic space.
The developments are happening in and near neighborhoods that have significant health needs. Data from the Centers for Disease Control and Prevention show that these residents face some of the worst health outcomes in the city.
The census tract including a portion of the Central Hillside neighborhood has an average life expectancy of 66 years — falling well below other Duluth neighborhoods and the state’s average of 80.8 years, according to the CDC.
Life expectancy is the average age of death of people born in that area, according to Alysha Alloway, a graduate student researcher with the Smart Community Health project at the University of Minnesota.
Lower life expectancy may point to greater hardships, and are understood to be strongly associated with higher rates of income inequality, she wrote in an email. But the lower rate may be skewed by the presence of hospital facilities in the neighborhood as more people die there.
To combat this, as well as other health outcomes such as high obesity and smoking rates, Essentia and St. Luke’s say they’ve launched numerous community programs and investments.
Serving the neighborhood ultimately helps St. Luke’s patients, said Michael Boeselager, St. Luke's vice president of support services.
“We are trying to become much better at managing the health of a population versus just those in need of our specific services,” he said. “No longer do we have to wait for people to come to us, right, we can provide those services in a much different way.”
Life in Hillside
Hillside residents know their neighborhood struggles with numerous health issues.
To Jeremiah Stegner and Melissa Domena, both residents of Tri Towers, mental health issues and addiction are Hillside’s primary problems.
“Half the people out there in this neighborhood are freakin’ nuts. They’ve got no mental health care. And they’re worried about expanding and spending for what? That doesn’t help us,” Stegner said.
Data backs up their observations about neighborhood health. Numerous health measurements indicate poor health outcomes in the Hillside neighborhood when compared to city, state or national averages.
Nearly one in three Hillside residents over the age of 18 near the medical district is obese, according to 2016 CDC data of nearby census tracts. This was slightly above the national and Minnesotan obesity rates from that same year of around 30% and 28% , respectively.
The percentage of neighborhood residents over 18 years who reportedly smoked was among the highest in Duluth. The average percentage of people who reported themselves as smokers was between approximately 22-24%. Except for a handful of western Duluth neighborhoods, rates are lower in the rest of Duluth.
With the health of the medical district communities falling below average, both hospitals say they have a responsibility to improve the neighborhoods.
Debbie Welle-Powell, Essentia’s chief population health officer, called the statistics “sobering.”
“Essentia … has had a long history of investing in population health and community wellness. In fact, our mission is to make a healthy difference in people's lives. And we believe, unequivocally, that ... steady investments in our community is just good medicine for our neighborhoods.”
Boeselager, of St. Luke’s, said serving the nearby community is rooted in its mission.
“We serve — this is why we exist. It's our mission,” Boeselager said. “We're a nonprofit healthcare provider system and the fact that we're essentially just located here (means that) I think we have an obligation to provide those services and make sure they're accessible.”
The hospitals don’t tackle health issues on their own. Every three years, they are required to complete a community health needs assessment. The two hospitals, along with St. Louis County Public Health and other organizations, collaborated on each of the past two assessments, including one completed this year.
“We did talk to more than 300 community members and interviewed 75 different partner organizations to come up with what we think is really a very high-quality product to identify what the biggest health needs are in the community,” said Emily Anderson, community health director for Essentia.
The most recent assessment , under the banner of Bridging Health Duluth, identified mental health, youth substance abuse and food insecurity as the top needs.
Regardless, not all neighborhoods residents believe the hospitals will impact the health of their community.
Joel Heller has lived in the Central Hillside neighborhood for around 30 years. While he supports the healthcare improvements that will come with the developments, he doesn’t believe the hospitals effectively communicate with residents.
“Right now, if St. Mary’s reached out and said, ‘Neighborhood, we want to care about you,’ a lot of people are going to say, ‘We don’t trust you because you’ve never done nothing for us. You’re going to build a multi-million dollar thing, and we support that part of it,” Heller said. “But ... once it gets built, we’re still going to be left to the side.”
Although critical of the claimed neighborhood impacts, Hillside resident Stegner said he’s happy the hospitals are located nearby.
“In spite of how they’ve treated me, if something bad happens, I’m glad they’re there, especially in this neighborhood where you can get stabbed or shot over nothing,” Stegner said.
Violet Scharp, a Tri Tower resident, chose to live in the area because it’s only a two-block walk to Essentia. “I have good doctors, good nurses. If I have a question they do anything they can to answer,” she said.
Revamping the neighborhoods
Both hospitals have launched numerous initiatives to address health in the neighborhoods, as well as across the region.
St. Luke’s sits on the Mayor’s Affordable Housing Taskforce, is working with the Duluth Transit Authority to ensure smooth transportation around the campus, provides cooking and nutrition educational courses, partners with and supports local nonprofits, among numerous other initiatives.
It is also figuring out pedestrian paths through St. Luke’s new campus, to ensure it doesn’t cut off the Hillside community’s access to Lake Superior.
“We want to make this neighborhood (a place) where people want to work, where they want to live, where they can recreate,” Boeselager said.
In the future, his hope is that the campus is integrated into the neighborhood and becomes more attractive to all types of residents.
Shawna Mullen, community development director for Zeitgeist Duluth, said St. Luke’s mindset shows interest in population health.
“They want their campus to not be a bubble that people go around. They want people to be able to go through the campus and use the campus and have public amenities that serve the community and not just their patient base," Mullen said.
St. Luke’s reached out to the nonprofit arts and community development organization, which has been active in working with the Hillside neighborhoods. Mullen said the hospital was trying to better understand its neighbors and communicate better.
Essentia’s initiatives look similar. It has invested millions in charity care, research, education and community contributions; supports food banks and farmers markets in the Hillside neighborhood; donates to the local grocery store; partnered with the Northland Foundation on a mental illness campaign; supports access to dental care, among numerous other programs.
“We have a long-standing commitment to this community that really gets back to the decisions we make tied back to our mission and our Benedictine values around justice and stewardship,” said Welle-Powell, of Essentia.
Pam Kramer, executive director of Duluth LISC , supports the ongoing medical district development, as the city has seen the hospitals work with numerous entities to improve the city. She listed various contributions that have impacted numerous aspects of Duluth life, including housing, education, stimulating development, improving access to quality education and more.
“LISC values the commitment that both Essentia Health and St. Luke’s have made in the Hillside and Downtown neighborhoods and looks forward to continuing to bring new funding, training, technical assistance and capacity building support to work,” she wrote in an email.
David Zuckerman, director of healthcare engagement for the Democracy Collaborative , studies how major entities, like hospitals, impact their nearby communities.
The most effective way for hospitals to positively change their neighborhoods is by purchasing from local businesses owned by women or people of color; establishing hiring pipelines in the community; and investing in ventures or portfolios that then invest back into the communities, he said.
“It's not about shifting everything. It’s about (how) can we be more intentional with a portion of our resources to create more inclusive and equitable impact in our communities,” Zuckerman said.
Additionally, he said it’s in organizations’ interests to have explicit mission statements that direct the organization to focus on the well-being of the community.
“They're increasingly recognizing that health is outside of their four hospital walls. And that in those communities with the greatest health disparities … they're seeing that the things that are driving those poor health outcomes are really things like housing and lack of good-paying jobs and other types of root causes of poor health,” Zuckerman said.