Community Health Analysis: Columbus Hilltop & Franklinton Area

Identification and History of Franklinton and Hilltop

The Franklinton/Hilltop area of Columbus, Ohio is located on the west side of the greater metropolitan area. Franklinton sits in a river valley adjacent to the Scioto River, while the Hilltop area lies just west of it on an elevated rise. The Hilltop area is defined as the area between I-70 to the north, the B&O Railway to the east and south, and the I-270 outerbelt to the south and west (Greater Hilltop Area Commission, 2011). Its main thoroughfare is West Broad Street, otherwise known as U.S. Route 40. Welcome signs mark the area near Mound Street and Hague Avenue. Franklinton is bordered by the Scioto River to the north and east, Hague Avenue to the east, Stimmel Road and Greenlawn Avenue to the south, and I-70 to the west. West Broad Street also serves as the main street for Franklinton. Although the two areas are technically separate, many locals consider them a single community because they share the same main street and are culturally similar. Both communities share resources, and residents do not regard themselves as distinct from one another.

The history of Franklinton began in 1797 and was shaped by Lucas Sullivant, a Virginia land surveyor. Franklinton is the oldest community in Central Ohio (Franklinton Development Association, 2011). It began as a farming community that took advantage of the rich, fertile bottomlands along the river. Originally separate from Columbus, it was eventually surrounded and absorbed by the city. Located on a flood plain, it is now protected from the Scioto River by a flood wall (Franklinton Development Association, 2011). Frequent flooding historically made the area a poor choice for business development, and it remains an impoverished and economically depressed part of the city.

Hilltop was originally known as Sullivant's Hill and was gradually sold off in sections by the Sullivant family. Lucas Sullivant received the land in recognition of his service to the federal government at the end of the 18th century (Greater Hilltop Area Commission, 2011). Franklinton and Hilltop were originally interconnected, and their shared geography allows them to remain culturally and socially linked today. Sullivant Avenue is a major secondary street running through Hilltop.

The population of Franklinton is approximately 11,529, with roughly 3,517 people per square mile (City-Data.com, 2011a). The Greater Hilltop Area is slightly larger, with a total population of 58,628 and a density of 3,605 people per square mile (City-Data.com, 2011b). By comparison, Columbus as a whole has a population density of 3,384 people per square mile (City-Data.com, 2011b). Both Franklinton and Hilltop share a common history of low income and widespread poverty. Flooding and geography have discouraged major corporate investment in the area since the communities' earliest days.

Both areas are ethnically diverse. Their proximity to major highways and the bus system, with easy access to downtown, allows residents to work outside the community. Major employers are scarce within these neighborhoods, and most employment opportunities are located elsewhere. Both communities have been slated for redevelopment and are currently undergoing change. For the purposes of this study, the Franklinton and Greater Hilltop areas will be referred to collectively as "Franklinton/Hilltop."

Windshield Survey Findings

Stanhope and Knollmueller (2001) outlined a technique for characterizing the health needs of a community. Their approach divides the assessment into an examination of place, people, and community function. The community health assessment also includes the health status of the community, available structures, and the processes in place to keep citizens healthy.

The windshield survey of the Franklinton/Hilltop area begins with a drive down the main street through both neighborhoods. Traveling along West Broad Street tells the story of an area that has been economically depressed for quite some time. Buildings in the Franklinton area are largely one-story storefronts dating to approximately 1900. The Hilltop area has few businesses along Broad Street and is predominantly residential. The businesses along Franklinton's main street are in a significant state of dilapidation, with many boarded up and graffiti visible in plain sight. Older Black men were observed standing on the street smoking or sitting by buildings reading newspapers. Franklinton is literally in the shadow of downtown Columbus.

Continuing west along Broad Street into the Hilltop area reveals a gradual transition into a more residential setting. Hilltop appears to have been built largely between the 1950s and 1960s, with numerous duplex housing units throughout. Many homes are small, one- or two-story structures. The neighborhood has the feel of a family community, with children riding bikes along the streets. It appears to be a mixed community with a high percentage of African-American residents and a generally working-class character. Driving down side streets tells a more complex story: one house will be very well kept, while the one directly beside it may be in a state of disrepair with trash in the yard. In the Franklinton area, side streets revealed a deeply depressed community in continued decline. Housing stock consisted of single-family homes, duplexes, and small apartment buildings of up to six units. Teenagers were observed on street corners smoking.

There did not appear to be a significant number of community resources in either Franklinton or Hilltop. Both areas are within a short distance of main bus routes, giving residents access to the rest of the city. The most significant structure in the area is Mount Carmel Hospital and its large, sprawling campus, which is easily accessible from all parts of the community by foot, taxi, or bus. This facility appears to be the primary provider of health care services to these communities.

Outside of Mount Carmel Health, few private physician or dental offices were observed in the area. Most services appear to operate in and around the main medical campus. Several free food pantries and social service providers were noted within the community, with conspicuous advertising.

Both areas clearly have significant unmet needs in terms of community health access. While Mount Carmel Health occupies a somewhat renovated section, much of the surrounding community remains in a state of dilapidation. The community appears to have numerous resources available but also has a great demand for them. It does not appear that all citizens have access to the services they need. Homelessness was visibly present in the area, more so in Franklinton than in Hilltop.

The community's greatest weakness appears to be that the need for services exceeds the capacity to provide them. There does not appear to be sufficient employment in the area, and many businesses have apparently been closed for years. The Hilltop area's relatively better standard of living suggests that residents must be traveling elsewhere to work. The Franklinton area presents greater challenges. The greatest overall weakness of these communities is the lack of resources adequate to meet the needs of their citizens.

The area also has several key strengths, though these are not immediately apparent from the windshield survey. The most significant is the presence of a major health facility accessible to the entire area. Although Franklinton and Hilltop were among the last neighborhoods to receive funding for community development projects in Columbus, both have now been designated for renovation.

Until recently, the frequency of flooding in the Franklinton area prevented it from being targeted for revitalization, with many land-use restrictions in place. Now that the flood wall has been completed, the city has a plan to renovate the area and attract businesses to promote economic development and employment (City of Columbus, 2003). The plan includes expansion of manufacturing and single-family residential housing, as well as construction of a bike trail along an old abandoned railway to increase recreational opportunities (City of Columbus, 2003). The Greater Hilltop plan includes a major facelift focused particularly on residential areas (City of Columbus, 2010). These current development plans represent the greatest assets possessed by these two communities, promising to raise the standard of living, attract higher-income residents, and support the establishment of more services for all.

Community Resources and Service Gaps

An assessment of community resources for helping families achieve an optimal level of wellness centers on Mount Carmel Health System, one of the largest hospital systems in Central Ohio. Few services — general or specialty — cannot be found on its campus. Residents who have health insurance or who receive Medicare or Medicaid benefits have relatively easy access to care at this facility. The following discussion focuses on resources available to those who lack access to Mount Carmel Health due to absence of insurance, transportation limitations, or inability to pay.

Citizens in both Franklinton and Hilltop have access to numerous resources throughout the greater Columbus area. The public transportation system provides easy access to other parts of the city, which has a wealth of not-for-profit, government, and private resources available to support health and wellness. Columbus literally has thousands of such organizations. In terms of neighborhood-level resources, however, Mount Carmel Health System remains by far the largest asset.

Because the west side of Columbus is a depressed area, it has become a priority for the Columbus Public Health Department. The Columbus Health Department's main facility is located near downtown, on the opposite side of the Franklinton and Hilltop neighborhoods. It is not within walking distance of either area but is accessible by public transportation.

The Columbus Public Health Department takes an active role in promoting public health across all city neighborhoods. Its programs include infectious disease tracking and prevention, environmental health services (animal control, food safety, lead control), emergency preparedness outreach, and education to help citizens take responsibility for their own health and that of their families. The department also offers many citywide health programs, but the most relevant to this study is the Healthy Neighborhoods program, which reaches out to individual communities within Columbus. Through the Columbus Neighborhood Health Center, Inc. — a federally qualified health center — the department operates five health centers providing primary care services to local residents (Columbus Public Health, 2011b).

Community Neighborhood Resource Centers not only offer health services themselves but also partner with other local resources to address what their residents need. They concentrate on services for low-income individuals who may not otherwise have access to community health resources. They serve many culturally diverse populations, including Asian-American community members through Ohio State University Hospital. The closest free clinics to the Franklinton and Hilltop areas are located at least a 35- to 40-minute bus ride away. Some clinics see only a limited number of patients or maintain very restricted hours (Columbus Public Health Department, 2011c). They are not readily accessible to low-income patients in the area.

The Franklinton and Hilltop areas have a range of resources available a short distance away. The problem is not necessarily the number of resources but the fact that the highly visible low-income population makes it clear that not all citizens are able to obtain the healthcare they need. Although the Columbus Public Health Department website suggests a large number of resources are available within individual communities, closer examination reveals a severe deficiency in resources accessible to low-income residents in these specific neighborhoods. Special populations and residents in certain areas of the city lack resources, and those that do exist are inadequate. This is particularly true for the Franklinton area.

The problem is twofold. First, sufficient resources must exist for low-income and special-needs populations within the Franklinton and Hilltop areas. Second, citizens must be able to actually access those resources. Transportation is the primary barrier to taking advantage of the city's low-income health care services. While bus routes provide citywide access, cab services may be cost-prohibitive. Free transportation services are available for the disabled, elderly, and veterans, but those who do not qualify for these programs may be prevented from accessing available services. Additionally, transportation programs themselves are limited and can only serve a fraction of those in need.

Outside of Mount Carmel Health System, few services were identifiable within neighborhood boundaries. In terms of school and occupational health services, mental health care, pharmacies, dental offices, private physicians, health department satellite locations, safety and protective services, support groups, or shelters — none could be located within the neighborhood limits. Neighborhood Watch signs were observed in both areas during the windshield survey, though the activity level of these groups could not be determined. Residents can access many city services through Ohio State University and major healthcare systems elsewhere in Columbus, provided they have transportation and the funds to do so.

Fire protection is provided by the Columbus Division of Fire, and police protection by the Columbus Police Department. Both services are assumed to be adequate and in compliance with city standards. Both Hilltop and Franklinton have a reputation as high-crime areas.

There is also a high level of drug addiction and homelessness in the area. Among drug rehabilitation programs in Columbus, nearly all — with the exception of Maryhaven — accept only patients who have insurance or the ability to pay. Maryhaven operates as a 501(c)(3) nonprofit funded by donations and maintains a long waiting list (Maryhaven, 2011). This single program is largely inadequate to serve the needs of the entire community, representing a significant unmet need identified during the study.

Meals on Wheels are provided by private contractors and local churches. Organizations such as Lifecare Alliance, based in downtown Columbus, serve the Franklinton and Hilltop areas. Elderly residents can access services by contacting the Franklin County Office on Aging (Franklin County Office on Aging, 2011). Senior Independence offers similar services with additional focus on adult education, day centers, hospice, and home healthcare, and also holds wellness clinics throughout the city (Senior Independence, 2011). There are 29 agencies in the Columbus area providing home healthcare services for seniors (YellowPages.com, 2011). Seniors appear to have a relatively wide range of accessible services, most requiring only a phone call. The primary barrier for seniors is not availability but awareness — getting information about available programs to the people who need them.

Welfare services including emergency food, shelter, and clothing are provided by private and civic organizations such as the YMCA. Faith Mission provides hot meals and overnight shelter for homeless individuals (Faith Mission, 2011). Four homeless shelters are located in downtown Columbus, but none are situated within Franklinton or Hilltop (Homeless Shelter Directory, 2011). Abused women can access Choice Women's Emergency Shelter as an emergency option. A persistent challenge across these services is that potential users must first know about them, then have transportation to reach them, and many services are at or near capacity much of the time. The Franklinton/Hilltop area is not alone — the entire City of Columbus is in need of expanded services.

Recreation

Recreation and relaxation are important components of a healthy lifestyle. Reducing stress and staying physically active benefits both body and mind, and it is important to have a variety of recreational activities available throughout the city. The Center of Science and Industry (COSI) is technically located within Franklinton's borders. It features a hands-on learning center for children of all ages and is a major attraction for the Columbus area. COSI is accessible by bus and within short walking distance of Franklinton, though general admission is priced beyond the reach of many area residents. Discounts are available for Medicare and Medicaid cardholders, and one day per year offers free admission.

Franklinton and Hilltop are also close to many downtown Columbus events such as the Jazz Festival and the Arts Festival. Many residents can see the Fourth of July fireworks from their homes, or join the celebration with a short walk. The Columbus Recreation and Parks Department maintains green spaces and runs programs throughout the area, including summer softball and soccer leagues, golf outings, and races. Two outdoor swimming pools in the Franklinton/Hilltop area are easily accessible and low-cost (Columbus Recreation and Parks, 2011). In terms of recreational opportunities, this is one area where these communities demonstrate a clear strength. Observations during the windshield survey suggested that many residents take advantage of city-provided activities and facilities.