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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