Overview
Across the U.S., Health Equity Zones (HEZs) and similar place‑based models designate specific geographic areas with stark health inequities and invest in community‑led, multi‑sector solutions to address root causes of health outcomes. Unlike traditional public health programs tied to topics or departments, HEZ initiatives tie funding to places and give communities the power to identify priorities, govern investment, and design solutions that reflect local realities. This approach has been adopted or piloted in a growing number of states and localities, including Rhode Island, Maryland, Washington, and Illinois.
Rather than delivering one-off programs, HEZ initiatives build lasting community infrastructure for health, equity, and local decision-making. There are multiple HEZ models, and this resource aims to generalize components, while sharing some specific examples
Ideal adopters include state and local health departments, Medicaid agencies, health systems, and philanthropic or civic collaboratives that are prepared to serve as or support a backbone entity for multi‑sector, community‑led coalitions.
Unique Value
HEZs represent a shift from program-based public health to place-based community governance. Traditional public health funding often flows through categorical, topic‑specific programs that are designed and administered at the state or federal level, which can limit local flexibility.
HEZ models fund geographic communities rather than topic areas, center community voice and leadership, create long-term health equity infrastructure, and coordinate multiple programs and sectors within a stable, shared container
HEZ models create a structure that can enable communities to braid different funding streams — such as Medicaid dollars, public health grants, local government budgets, and philanthropy — toward locally identified priorities like housing, nutrition, childcare, safety, or economic mobility.
Origins
Rhode Island is widely recognized as the first state to operationalize the Health Equity Zone model statewide. Rhode Island’s HEZ model grew out of evidence that neighborhood‑level factors such as poverty and older housing stock were strongly associated with health inequities. The Rhode Island Department of Health (RIDOH) shifted from disease-specific funding toward place-based investment using the HEZ model, and developed and published the Health Equity Zones Toolkit to support replication of the model in other communities.
Maryland pioneered an earlier place‑based model—Health Enterprise Zones—providing incentives and resources in five zones with documented disparities, with goals that included reducing preventable hospital utilization and costs. Independent evaluations and state reports found improvements in access to primary care and better management of chronic conditions. Maryland later created Health Equity Resource Communities (HERC), expanding to more funded communities and explicitly including social determinants of health and community‑based organizations as core partners.
Following Rhode Island and Maryland, states such as Washington and Illinois, and cities such as Chicago, have adopted HEZ‑like frameworks, reflecting growing interest in place‑based approaches to health equity.
Methodology
Conditions
The following conditions make HEZs successful and sustainable:
- Clear disparities documented by local data
- State willingness to invest flexible, multi-year funds into place-based collaboratives
- A policy environment that incentivizes prevention and community-governed solutions
- Commitment to equity, power-sharing, and community voice
- Several state HEZ initiatives explicitly require that funded collaboratives align interventions with statewide health improvement plans while centering community voice in identifying priorities
Process
The generalized HEZ process includes the following steps:
- Define and Select Zones
Use data to identify geographies with high disparities and set criteria for eligibility. - Design Governance & Backbone Structures
Select a backbone organization and establish resident-led advisory groups. - Provide Seed Funding & TA
Offer multi-year implementation funding and technical assistance. - Conduct Community-Led Assessments
Use participatory processes to identify local priorities and root causes. - Develop an Action Plan
Community partners select a portfolio of strategies aligned with state priorities and local needs. - Implement & Braid Funding
Deploy solutions while aligning Medicaid, public health, and community development investments. - Monitor, Evaluate, and Adapt
Track clinical outcomes, community metrics, and process indicators using participatory evaluation. - Scale, Sustain, or Sunset
Use evidence to expand, refine, or sunset zones as conditions evolve.
