CLARK-FULTON/METROHEALTH ECODISTRICT IMPERATIVES COMMITMENT

Adoption Date: February 21, 2019 Submittal Dates: March 1, 2019, for preliminary review; April 22, 2019, for final review Adoption Method: The Imperatives Working Group and key stakeholders provided and incorporated comments into the document that follows in two phases, an outline followed by full draft format. Upon review of the final full draft, each member of the District Team confirmed consensus that the Imperatives Commitment that follows is complete, accurate and ready to be submitted for review and endorsement.

Preparers: Imperatives Working Group: Keisha Gonzales* Victor Ruiz For MetroHealth System Pastor Joe Abraham Sarah Hendrickson CouncilRep Jasmin Santana* Greg Zucca* Rita Andolsen Latisha James Isaac Smith Sarah O’Keeffe* Beverly Burtzlaff Robert Koonce Jacob van Sickle Greg Bieler Bill Callahan Ricardo Leon* Linda Warren Kathy Plummer Sandra Chappelle Tania Menesse* Andrew Watterson Charity Chelangat Samantha Metcalf Chris Whitmore For ReThink Advisors Freddy Collier* James Mizak, MD R. Christopher Widdowson Mark Mykleby Janese Contreras Sean McDermott *indicates District Team Michael Peters Maribeth Feke Erika Meschkat Michael Fodor Mike Foley Tom O’Brien Irwin Lowenstein Kim Foreman Jane Platten Grace Gallucci Jill Rizika

INTRODUCTION The Clark-Fulton/MetroHealth District Team (the “District Team”), a diverse set of cross-sector, forward thinking visionaries convened under the auspices of the MetroHealth System, the healthcare anchor institution that has cared for the Clark-Fulton neighborhood on ’s near west side and the wider community for over 180 years, desires to work collectively and collaboratively towards a healthy, sustainable and just district. Recognizing that EcoDistricts represents a new way of building community, one in which the relationship between the health of people and the planet is deeply considered, and that the neighborhood is the most important scale to implement change, the District Team is committed to the EcoDistricts Protocol and to certification. Strong, new ward leadership in City Council and the local Community Development Corporation that serves the neighborhood, each with the desire to plan collaboratively with a focus on equity, makes EcoDistricts the ideal framework for collective impact and a unified theory of change.

The District Team engaged a stakeholder body representative of the Clark-Fulton neighborhood to contribute their expertise and experience towards accomplishing this goal. A self-selected sub-set of the District Team joined an Imperatives Working Group that worked over a period of five months to create this collectively written commitment statement intended to be representative of district residents, businesses and stakeholders. The District Team drafted this Imperatives Commitment with leadership by and input from Imperatives Working Group and with assistance from ReThink Advisors, Inc., the EcoDistricts Consultant, after five, two-hour in-person work sessions with imperative presentations and collaborative group exercises to determine a census of local imperative measures as well as various homework assignments preceding each workshop.

The District Team seeks to capitalize on the $1B commitment toward a Transformation Plan launched in 2016 by MetroHealth, a plan that commits to not just a transformation of the hospital campus but also the surrounding Clark-Fulton neighborhood and wider community. MetroHealth is one of America’s Essential Hospitals1, vital to its community, providing primary and trauma care, disaster response, health professional training, research, public health programs and other services. Like other leading innovating hospitals across the nation, MetroHealth believes that creating impact at scale and reaching population level outcomes requires an alignment of system level initiatives and especially openly partnering with local community benefit organizations, a process that, to date in other health systems regionally and nationally, has been piecemeal. MetroHealth has reconceived its role in a rapidly transforming healthcare sector starting by focusing on the community’s understanding of its health, the social determinants of health and policy and systems change toward health equity. A focus on equity is evident in MetroHealth’s longstanding mission to serve its community. With over 100 community-based programs and a commitment to the most vulnerable since 1837, MetroHealth fundamentally views health in its community as much more than the “absence of sickness,” and it recognizes and appreciates that various definitions of “health” – peoples’ own assessment of their health may differ from their healthcare provider’s and feeling healthy can be just as important as actually being healthy – likely exist within the community. Additionally, MetroHealth’s mission not only includes the health of the local residents, but also those who work in the neighborhood and those who deliver social and health services in the neighborhood.

The Clark-Fulton neighborhood in Cleveland, , is one of the most diverse but also one of the poorest in the city with all races and ethnicities sharing in economic hardship. The neighborhood was settled in the mid-1800’s primarily by Central and Eastern European immigrants, the majority of whom were Germans, Czechs, Italians, Slovaks and Poles, who chose the area to be close to the employment opportunities to be found in Cleveland’s nearby factories. Some of their descendants still reside in this neighborhood, and a large and growing Hispanic community and an

1 https://essentialhospitals.org/

increasing number of African-Americans join them today. The physical development of the neighborhood dramatically changed during the 1960’s and 1970’s with the construction of I-71 and I-90, both of which act to isolate the Clark-Fulton neighborhood from the surrounding neighborhoods to the north, east and south.

Current Conditions and Demographics for the Clark-Fulton neighborhood vs. the wider City of Cleveland are as follows (present/baseline conditions data provided by The Center for Community Solutions). Note the data for race and ethnicity, like the US census, counts Hispanic/Latinx as an ethnicity, not a race, so all people of Hispanic/Latinx ethnicity are also captured in the race data either as white, black or some other race:

Demographics (2010-2014 ACS 5-Year Estimates) Clark-Fulton City of Cleveland Count % Count % 7,451 392,114 Total Population Under age 18 1,901 25.5% 92,121 23.5% Age 18-64 4,804 64.5% 251,135 64.1% Age 65+ 746 10.0% 48,788 12.4% Race and Ethnicity White 4,733 63.5% 157,419 40.1% Black/African American 1,379 18.5% 204,249 52.1% Asian/Pacific Islander 68 0.9% 6,711 1.7% Other/More than one race 1,271 17.1% 23,735 6.1% Hispanic or Latinx (of any race) 3,586 48.1% 39,406 10.0% Household Makeup Families with own children 730 25.5% 40,180 24.1% Single-parent families w/ children 510 17.8% 28,154 16.9%

Health Coverage (2010-2014 ACS 5-Year Estimates) Clark-Fulton City of Cleveland

Note: Current uninsured rates are likely lower due to the implementation of the ACA Percent of people with no health insurance 21% 16% coverage

Employment and Income (2010-2014 ACS 5-Year Estimates) Clark-Fulton City of Cleveland Count % Count % 3,040 52.0% 182,834 58.9% Labor Force Participation, age 16+ Median Household Income $21,983 $26,179 Public Benefits Income

Households w/ Social Security Income 827 29.6% 46,237 27.7% 342 12.3% 11,977 7.2% Households w/ Cash Public Assistance Income Households that received SNAP 1,368 49.0% 57,501 34.5% Poverty (2010-2014 ACS 5-Year Estimates) Clark-Fulton City of Cleveland Count % Count % Persons living below poverty 3,434 46.6% 136,860 35.9% 1,127 61.6% 48,267 53.5% Children (Age 0-17) living below poverty Families w/ children living below poverty 504 58.3% 21,622 46.3% Seniors (Age 65+) living below poverty 171 25.0% 9,819 21.0% Persons in deep poverty (under 50% of 1,797 24.4% 68,532 18.0% poverty) Persons in or near poverty (under 200% of 5,335 72.4% 233,518 61.2% poverty) Education (2010-2014 ACS 5-Year Estimates) Clark-Fulton City of Cleveland Count % Count % Persons (Age 25+) w/ High School diploma or 3,466 71.1% 141,855 55.6% less Persons (Age 25+) w/ Bachelor’s degree or 305 6.2% 38,705 15.2% higher Youth who are high school dropouts 15 - 2.045 - Housing Affordability (2010-2014 ACS 5-Year Estimates) Clark-Fulton City of Cleveland

Unaffordable housing: Housing costs are more than 30% of household income Owner-occupied households in unaffordable 36.6% 32.6% housing Renter-occupied households in unaffordable 69.0% 52.8% housing Overall households in unaffordable housing 55.0% 44.0% Teen Birth (2010-2014 Ohio Department of Health, U.S. Census Bureau) Clark-Fulton City of Cleveland Rates are per 1,000 Females 5-Year Rate 5-Year Rate Total Total 177 126 4,172 59 Teen Births

Sources: 2010-2014 ACS 5-Year Estimates for Cleveland neighborhoods were calculated by NODIS at Cleveland State University. Because geographies are small, margins of error may be high, and differences between geographies should be interpreted with caution. 2010-2014 Teen Birth Rate data are from Ohio Department of Health, complied by The Center for Community Solutions. Rates are calculated using U.S. Census Bureau population data.

Consistent with national trends, life expectancy has, over the last four decades, increased for middle- and high-income Clevelanders but has stagnated and even declined in Cleveland’s poorest neighborhoods including Clark-Fulton. MetroHealth knows this is unjust and, as Cleveland’s public safety-net hospital, seeks to reverse that trend starting in its own backyard. As required by the Affordable Care Act of 2010, MetroHealth completed, most recently in 2017, a Community Health Needs Assessment (CHNA) to focus on improving community health outcomes and deepen its understanding of the needs of its community and how those needs impact the overall health of the community. MetroHealth realizes that it cannot improve community health outcomes alone and needs to partner with other community-based organizations around a common agenda. The priorities of the 2017 CHNA include the following:

• Reducing infant mortality: This effort to reduce infant mortality will utilize clinical programs, outreach initiatives and community partnerships, like First Year Cleveland (of which MetroHealth is a founding member), and it affirms MetroHealth’s existing commitment and leadership on this issue. • Addressing the opioid epidemic: Through its Office of Opioid Safety and the Know the Risks campaign, MetroHealth is a leader in addressing this epidemic through education, advocacy, risk management and treatment. Naming this as a community health priority underscores MetroHealth’s commitment to save lives and reduce the burden of this epidemic. • Eliminating the racial and ethnic disparities in chronic disease outcomes for MetroHealth patients: With support from Better Health Partnership, MetroHealth has made significant progress toward the elimination of racial and ethnic disparities in the standards of care provided to its patients, particularly those with diabetes and hypertension. Despite this, disparities in health outcomes persist, and MetroHealth will explore new ways to improve outcomes, with an emphasis on bridging clinical care and community programs. • Community building in the Clark-Fulton neighborhood: As MetroHealth transforms its main campus, an anchor institution on West 25th Street in Cleveland, it aims to positively influence the surrounding community. This commitment to Community Transformation includes ongoing support for the many initiatives already underway in the Clark-Fulton neighborhood as well as additional opportunities for community health improvement and economic development. • Addressing community trauma in East Side neighborhoods: As an emerging area of focus, MetroHealth will partner with faith-based leaders and communities to develop ways to address adverse community conditions and experiences in an effort to build community resilience

These five vitally important priorities including – in particular – a commitment to the health and development of the Clark Fulton neighborhood will form the basis of MetroHealth’s overall institutional strategy for the next three years.

EQUITY COMMITMENT

VISION AND SCOPE The District Team defines equity as “full and equal access to housing, employment, health and healthcare, safety, mobility, political representation, technology, and a clean environment”. The District Team understands that the process of achieving equity is ongoing and requires honest and explicit dialogue about the issues of social and economic injustice, structural racism, and historical power imbalances that have caused inequity, and a commitment to a transparent and collaborative agenda moving forward.

Motivated by MetroHealth’s guiding values of service to others, teamwork, accountability, respect, inclusion and diversity, and excellence and its mission to realize a healthier you and a healthier community, the District Team is committed to advancing procedural, structural, distributional, and cross-generational equity in all district activities.

The District Team will serve as connectors, conveners and collaborators rather than merely representatives. The District Team commits to inclusive and authentic engagement of local residents and the diverse community benefit organizations that serve the vulnerable populations of the Clark- Fulton neighborhood and the surrounding neighborhoods, including, but not limited to, the following: • The MetroHealth System • Regional Transit Authority (GCRTA) • The Office of Councilwoman Jasmin Santana (Ward 14) • Towards Employment • The Cleveland Foundation • Cleveland Neighborhood Progress • Metro West Community Development Corporation • Esperanza • Scranton Road Ministries • Boys and Girls Clubs • Hispanic Business Center • Cuyahoga County Equity Planning

The District Team commits to transparent decision-making that fully considers historic inequities that may have subordinated vulnerable populations in the past. Finally, the District Team commits to fair distribution of the burdens and the benefits of district projects and programs across all populations and both current and future generations, as well as equity in all programs and health in all policies.

CURRENT CONDITIONS The Clark-Fulton neighborhood is a community of color, 48% Hispanic or Latinx (compared to a city wide average of 10%), and, as such, the District Team recognizes that any conversation about equity must occur within the existing framework of race and class. The District Team believes it is supremely important that, to build a brighter future, we need to reckon with the past by explicitly addressing issues of social and economic injustice and structural racism. As well, it is necessary to fully understand and acknowledge the power dynamics at play within this context and the historical imbalances that exist primarily along racial and economic lines. The District Team will facilitate and support the means for sharing power and building the capacity to use it, and it will spend time understanding the differences in context, goals, and power.

The District Team commits to employing a community development approach to engagement and to especially connect with people at the margins, those who don’t typically have a seat at the table. As one of the most socially and ethnically diverse neighborhoods in the City of Cleveland, the Clark-Fulton neighborhood is also home to many vulnerable groups who have been historically subordinated – we see conditions similar to those of many post-industrial, legacy cities – and who are likely to be affected by district activities.

The following list of vulnerable groups and conditions have been organized in descending order based on group size and level of vulnerability with additional vulnerable groups included at the end of the table. This format is intended to inform the work of the district by highlighting those most at risk and identifying the most impactful areas for the District Team to focus their attention:

Primary Vulnerable Groups Context and Historical Conditions People of Color Comprising roughly 37% of the Clark-Fulton neighborhood overall, people of color have historically been subjected to structural racism, redlining, discrimination, strained police-community relationship, lack of community trust, lack of sustainable capital investment and other conditions

Primary Vulnerable Groups Context and Historical Conditions People of Hispanic/Latinx heritage (of any Comprising roughly 48% of the Clark-Fulton neighborhood overall (compared to roughly 10% city race) wide), people of Hispanic/Latinx heritage have historically been subjected to xenophobia, discrimination, strained police-community relationship, lack of community trust, lack of sustainable capital investment and other conditions Immigrants and migrants, including those Roughly 25% of Clark-Fulton residents overall were born outside of the United States and this for whom English is a second language population has been subjected to xenophobia, discrimination (based on language, race, ethnicity, religion, etc.) and other conditions People with low-Income and people Roughly 47% of Clark-Fulton residents live in poverty, and this population has been subjected to experiencing homelessness classism, job dislocation, education disparities, no protection for affordable housing and other conditions Senior citizens Comprising roughly 10% of the Clark-Fulton neighborhood overall, senior citizens have been subjected to health and education disparities, lack of multi-modal transportation options, inferior housing, poor food access and other conditions Youth Comprising roughly 26% of the Clark-Fulton neighborhood, youth in the community have been subjected to health and education disparities, lack of multi-modal transportation options, inferior housing, exposure to lead, poor food access and other conditions Renters Roughly 60% of the Clark-Fulton neighborhood are renters, many of whom have been subjected to Inferior housing, presence of lead, and no protection for affordable housing and other conditions

Additional Vulnerable Groups Context and Historical Conditions LGTBQ A relatively small group in the Clark-Fulton neighborhood, the LGBTQ community has nevertheless been subjected to historic discrimination, lack of economic opportunities, health and education disparities and other conditions Small, local businesses Lack of sustainable capital investment Unemployed or underemployed Roughly 52% of the Clark-Fulton neighborhood is currently participating in the labor force, and the entire community has been subjected to job and skills dislocation, education disparities, poor access to economic opportunities and other conditions Disabled persons, survivors of trauma, These groups are subjected to health and education disparities, lack of multi-modal transportation users of mental health services, chronically options and other conditions sick and frail Gang Members A subset of Youth, gang members are subjected to many of the same conditions Formerly incarcerated A relatively small group in the Clark-Fulton neighborhood, nevertheless formerly incarcerated individuals are subjected to discrimination and limited economic opportunities in addition to many of the same conditions facing other vulnerable groups in Clark-Fulton

There exists a substantial number of state and local equity policies and programs that are applicable to the district. The following list has been organized in descending order based on likely impact on the district. This format is intended to inform the work of the district by highlighting those most at risk and identifying the most impactful areas for the District Team to focus their attention:

Entity Program/Policy Policy Description Relation to CF/MH EcoDistrict City of Cleveland Planning City of Cleveland Equity Planning Effort to place equity at the center Ensuring equity is at the center of Commission of the planning process by City planning initiatives will aid providing resources to economic CF/MH in its goal to strive for development organizations, equity in the district elected officials and government agencies City of Cleveland Planning Connecting Cleveland 2020 Comprehensive plan for Improving connectivity at the city Commission Citywide Plan Cleveland; seeks to create level will aid CF/MH in its goal to connections between people, strive for equity in the district places, and opportunities City of Cleveland Mayor Frank G. Mayor’s Neighborhood Initiative to invest in Clark-Fulton’s proximity to the Jackson’s Office Transformation Initiative (NTI) disadvantaged neighborhoods neighborhoods of Ohio City and just outside growth zones and Tremont, both of which are encourage private market to experiencing growth and return to these areas without the investment, makes it a logical need of public incentives target for this initiative Mayor Jackson, Cleveland City Lead Safe Cleveland Coalition Plan to reduce childhood lead 19% of children under 6 years old Council, Local Stakeholder exposure rates by addressing in Clark-Fulton had elevated lead Organizations leaded paint in homes. Goal to levels (greater than or equal to 5 becomes lead safe city by 2028 ug/dl) in 2017 Cleveland Neighborhood Racial Equity and Inclusion Intensive workshops designed to 36% of Clark-Fulton’s resident Progress introduce participants to population is people of color while historical, institutional, and the majority of the employees and systemic racism, challenge administrators of the local anchor deeply-held assumptions, and institutions including MetroHealth reveal the devastating impacts of are white. persistent racial inequality Brookings Institution, The Kresge Shared Prosperity Partnership Convenes leaders in select 47% of Clark-Fulton’s population Foundation, Urban Institute, communities across the U.S. to is living at or below poverty level Living Cities discuss challenges to inclusive and only 52% are currently growth and provide data, employed research, and access to national resources. Collaborative Planning Effort of West 25th Corridor Plan Effort to identify and leverage West 25th is one of the main West Side Anchor Institutions development opportunities along commercial and transit corridors (City of Cleveland Planning West 25th Street based on current in Clark-Fulton and provides Commission, Cleveland City plans and proposed investments, access to the MetroHealth Council, MetroHealth, CNP, particularly around the campus GCRTA, Various Community MetroHealth campus and other

Entity Program/Policy Policy Description Relation to CF/MH EcoDistrict Development Corporations, Ohio key areas along the corridor Dept. of Transportation, among others) MetroHealth System Employee Housing Initiative Employer assisted housing Initiative to increase affordable program created to encourage housing options for MetroHealth eligible employees of local anchor employees in Clark-Fulton institutions to live near work. Case Western Reserve University Center for Reducing Health Mission to reduce health 21% of Clark-Fulton residents do and the MetroHealth System Disparities disparities through research, not have health insurance education, and partnerships with coverage community organizations and government agencies MetroHealth System and over 100 Health Improvement Partnership Mission to inspire, influence, and 21% of Clark-Fulton residents do additional government, academic, (HIP Cuyahoga) advance policy, environmental, not have health insurance nonprofit organizations and lifestyle changes that foster coverage health and wellness for everyone who lives, works, learns, and plays in Cuyahoga County National organization working Nurse Family Partnership Nurses visit homes of first-time 71% of Clark-Fulton residents with MetroHealth in Cuyahoga mothers living in poverty. have a high school diploma or County Beginning during pregnancy and less and 62% of children in Clark- lasting until the child is two, Fulton (0-17) are living in poverty nurses visit homes to educate mothers on parenting, share resources, and perform health checks City of Cleveland, Greater Community Benefits Agreements Standards designed to encourage Labor Force Participation Rate in Cleveland Partnership, the use of local labor and local Clark-Fulton is 52% Cleveland’s contractors and contracting firms, particularly building trades unions minority and female workers and firms MetroHealth System School-Based Health Program Basic health care services offered 21% of Clark-Fulton residents do through 9 Cleveland Metropolitan not have health insurance School District schools bringing coverage health services directly to each school MetroHealth and YWCA of Open Table National faith-based model to Important program for at-risk Greater Cleveland create a family of support around adults, families and youth living in young people leaving foster care Clark-Fulton neighborhood homes. Table members help to

Entity Program/Policy Policy Description Relation to CF/MH EcoDistrict broaden opportunities for young people who may not have received the guidance that they needed growing up Opportunity CLE (City of Opportunity Zones Created as part of the 2017 Portions of Clark-Fulton are Cleveland, Cuyahoga County, federal tax legislation, there are 48 located in designated Opportunity Greater Cleveland Partnership, designated opportunity zones in Zones Cleveland Development Advisors, Cuyahoga County that are eligible the Fund for Our Economic to receive investment from Future, Cuyahoga Land Bank) investors’ unrealized capital gains. These opportunity zones are intended to spur investment in low-income communities La Villa Hispana Steering La Villa Hispana Mission is to be the economic and 48% of Clark-Fulton’s population Committee ( cultural center of the Latinx is of Hispanic/Latinx ethnicity (of Hispanic Chamber of Commerce, community in Greater Cleveland any race) Hispanic Business Center, by engaging residents, local Hispanic Alliance, MetroHealth elected officials, businesses and System, Metro West Community institutional partners, and Development Office, other nonprofits stakeholder groups) Greater Cleveland RTA, Rotary Redline Greenway Planning Nearly three mile multi-purpose Redline Greenway located near Club of Cleveland, LAND Studio trail and greenspace corridor Clark-Fulton neighborhood, running parallel to the Red Line adding much needed green space rapid transit tracks for local residents to enjoy while enhancing connectivity City of Cleveland Scranton Road Bike Infrastructure New striping and signs, including Important transit corridor for local exclusive bike lanes on Scranton residents to utilize via an Road alternative transit option

WORK PLAN The District Team will incorporate and integrate the following tasks and actions into the planning, implementation, and certification processes during each phase to endeavor to remove inequalities and strengthen equitable outcomes:

Equity in the Formation Phase • Procedural Equity o Task 1: Utilizing an authentic Community Engagement Process to explain Formation steps and participation opportunities, including but not limited to: Town Hall Meetings, Equity-Centered Design Process, Racial Equity and Inclusion Training (REI, Black and Latinx tracks) and the Racial Equity Screening Tool (Cleveland Climate Action Plan), reach out to identified vulnerable groups (including all appropriate language translations).

• Structural Equity o Task 2: Recruit and develop community leaders from historically underrepresented or oppressed groups, (e.g. African American, Latinx, people with low-income, immigrants and refugees, trauma survivors)

Equity in the Roadmap Phase • Procedural Equity o Task 3: Enable and encourage participation of vulnerable groups in Roadmap development, including language translation, process orientations and workshops • Structural Equity o Task 4: Choose performance indicators that reflect a commitment to equity and address historic inequities that may have subordinated vulnerable populations • Distributional and Cross-Generational Equity o Task 5: Evaluate the distributional and cross-generational impacts of project and program proposals during strategy ranking

Equity in the Performance Phase • Procedural Equity o Task 6: Continued education of stakeholders and allies who are in positions of power on issues of systemic oppression and practices in equity and inclusion o Task 7: As part of biennial progress reporting, prepare an evaluation of Equity results to date and recommend strategy adjustments to improve outcomes o Task 8: Ensure district performance is transparent and accessible to ensure the results can be used to adjust and strengthen the Equity commitment. Report out via website, social media, community meetings, newsletters and any additional methods deemed appropriate, meaningful and effective for the district o Task 9: Meet with vulnerable groups to review the equity of burdens and benefits from Roadmap execution, creating an indicator feedback loop that gauges progress made, highlights persistent inequalities and recommends strategy adjustments • Structural Equity o Task 10: Utilize selected performance indicators to evaluate the degree to which decision-making is transparent and historic inequities have been addressed; recommend strategy adjustments to improve outcomes, strengthen the Equity commitment, implement adjustments and report on progress. • Distributional and Cross-Generational Equity o Task 11: Utilize selected performance indicators to evaluate the degree to which the benefits and burdens of district projects and practices are distributed fairly across all populations and current and future generations; recommend strategy adjustments to improve outcomes, strengthen the Equity commitment, implement adjustments and report on progress.

RESPONSIBILITIES AND SCHEDULE Task 1 (Equity in the Formation Phase) • Organization(s) with primary responsibility: District Team with assistance from Cleveland Neighborhood Progress (REI). • Process: Community outreach, engagement, REI Trainings • Schedule/Timetable: Target completion for December 2019 Task 2 (Equity in the Formation Phase) • Organization(s) with primary responsibility: District Team with assistance from Neighborhood Connections

• Process: Leadership development and community organizing • Schedule/Timetable: Target completion for December 2019 Task 3 (Equity in the Roadmap Phase) • Organization(s) with primary responsibility: District Team with assistance from Neighborhood Connections • Process: Leadership development and community organizing • Schedule/Timetable: Target completion for December 2020 Task 4 (Equity in the Roadmap Phase) • Organization(s) with primary responsibility: District Team with assistance from Center for Healthcare Research and Policy, Center for Community Solutions, School of Social Work and Medical School at CWRU. • Process: Data design and research • Schedule/Timetable: Target completion for December 2020 Task 5 (Equity in the Roadmap Phase) • Organization(s) with primary responsibility: District Team with assistance from Center for Healthcare Research and Policy, Center for Community Solutions, School of Social Work and Medical School at CWRU. • Process: Data analysis, evaluation and research • Schedule/Timetable: Target completion for December 2020 Task 6 (Equity in the Performance Phase) • Organization(s) with primary responsibility: Backbone Organization with assistance from Cleveland Neighborhood Progress (REI). • Process: Community outreach, engagement, REI Trainings • Schedule/Timetable: Ongoing Task 7 (Equity in the Performance Phase) • Organization(s) with primary responsibility: Backbone Organization with assistance from Center for Healthcare Research and Policy, Center for Community Solutions, School of Social Work and Medical School at CWRU. • Process: Data analysis, evaluation and research • Schedule/Timetable: Ongoing Task 8 (Equity in the Performance Phase) • Organization(s) with primary responsibility: Backbone Organization with assistance from Neighborhood Connections • Process: Leadership development and community organizing, data analysis and evaluation • Schedule/Timetable: Ongoing Task 9 (Equity in the Performance Phase) • Organization(s) with primary responsibility: Backbone Organization with assistance from Neighborhood Connections • Process: Leadership development and community organizing, data analysis and evaluation • Schedule/Timetable: Ongoing Task 10 (Equity in the Performance Phase) • Organization(s) with primary responsibility: Backbone Organization with assistance from Neighborhood Connections • Process: Leadership development and community organizing, data analysis and evaluation • Schedule/Timetable: Ongoing Task 11 (Equity in the Performance Phase) • Organization(s) with primary responsibility: Backbone Organization with assistance from Neighborhood Connections • Process: Leadership development and community organizing, data analysis and evaluation • Schedule/Timetable: Ongoing

INDICATORS The following indicators of equity developed to date by the District Team are illustrative and not meant to be exhaustive. However some indicators are more meaningful, relevant and available than others and the District Team understands that too many indicators can be confusing. The four or five indicators most relevant and meaningful to the neighborhood will be confirmed in the Formation and Roadmap Phases: • Wealth Distribution by Race and Ethnicity • People of Color on Boards and Decision-making Committees • Employment rates by Race and Ethnicity • Number of REI Workshops • Poverty Rates by Race and Ethnicity • Percent Affordable Housing Units • Median Income by Race and Ethnicity • Percent of Monthly Income Spent on Housing • Population receiving Social Assistance • Local Eviction Rate • Rates of Diabetes, Hypertension by Race and Ethnicity • Educational Attainment Rates/Graduation Rates • Rates of Obesity by Race and Ethnicity • Access to Vocational and Technical Training (Measured by • Healthy Food Access number of financial aid programs, financial aid made • Premature Mortality by Race and Ethnicity (Deaths before available, availability of transit) Age 75) • Graduation to Employment Rates • Morbidity Rates by Race and Ethnicity • Access to Formal Banking Services/Percent Un-Banked • Percent Eligible Voters Registered

EVALUATION AND ADJUSTMENT Equity conditions are regularly updated as new data become available (using, for example, the REAL and Racial Equity Tool), and the findings inform program and project prioritization for ensuing work plans. Biennial performance report used as feedback to be cross-referenced for adaptation and adjustment within each Performance Phase Work Plan.

LETTERS OF SUPPORT FOR THE EQUITY IMPERATIVE • Pastor Joe Abraham, Scranton Road Ministries • India Pierce Lee, Cleveland Foundation

RESILIENCE COMMITMENT

VISION AND SCOPE The District Team defines resilience as “the capacity of district residents, business owners and stakeholders to survive, adapt, and thrive when confronting the economic, environmental, and social stresses and shocks they experience”. Stresses such as unemployment, aging housing stock, or crime, weaken a district on a chronic basis, while shocks such as heat waves, winter storms, or the foreclosure crisis, are sudden, single-event disruptions that threaten a district. Through the supportive activities of informal social networks, community and faith-based organizations, and other local actors, the most vulnerable among us are better equipped to overcome these stresses and shocks.

The District Team is committed to building resilience knowledge and expertise that empowers action through effective organizations and networks, enabling people and places to thrive in the face of social, economic, and environmental stresses and shocks. Great care must be taken to protect and strengthen the local culture and cultural history while amplifying support for local resident leaders, institutions, businesses and the arts.

The District Team, commits to leadership and governance that empowers residents, businesses and stakeholders, integrates resilience into the Roadmap and effectively manages current resilience initiatives such as the Climate Ambassador Project, Block Clubs, etc. The District Team will include social groups and economic structures that provide collective identity, social stability and security, and financial resources such as HBC, ECDI, HFLA, County Emergency Management and Disaster Preparedness. Finally, the District Team will strive to mitigate existing and potential social, economic and environmental shocks and stresses and seek varied and authentic means to build wealth in the community.

The District Team seeks holistic community transformation and, given the core mission of MetroHealth, that transformation includes a special emphasis on improving the health and well being of the community and health equity in the community. This process occurs during an era of seismic transitions in healthcare nationwide, a transition toward health management and a preventative medicine approach. With an emphasis on value-based healthcare and risk sharing, MetroHealth has embraced new thinking about the relationship between community development and community health and well being. The District Team acknowledges the importance of cross-sector collaboration between healthcare systems, public health and social service/community service, and it recognizes the need to move from isolated projects and programs to systems of programs and projects that are deeply interrelated and mutually reinforcing.

The District Team acknowledges that a primary but seldom-acknowledged risk factor driving poor health in disadvantaged neighborhoods is a lack of agency or a feeling of control over one’s choices or the ability to effect change. A personal sense of agency extends to and impacts a group’s collective agency and, therefore, impacts the ability of the community to come together to create change. Hospitals and public health agencies have important messages for the community, but these messages often fail to resonate with community members primarily focused on the day-to- day realities of their own lives. Similarly, the District Team knows that building trust with and among community stakeholders can only be accomplished through authentic, personal connections developed over an extended period of collaboration and conversation, and the District Team envisions the transformed hospital campus and new public park as an open, accessible civic commons, one means to realize this aspiration.

Finally, the District Team understands that there is a difference between a resilient hospital and a resilient neighborhood. Resilience for the hospital addresses factors such as risks to energy, water, air, patient room services, employee health and wellness. A resilient neighborhood shares many of the same risk factors, including risks to energy, water, and air. That said, disadvantaged neighborhoods also risk exposure to loss of human connectivity and community connections that erode public trust and a sense of collective agency. Neighborhoods benefit from authentic community engagement at various levels leading to a process neutral, redundant design approach seeking smaller, hyper-local economic systems for necessities such as healthy food, clean water, reliable energy, affordable energy-efficient housing, efficient and inexpensive mobility and high- quality education.

CURRENT CONDITIONS Place-based, mission-driven local neighborhood institutions have a long-standing history of supporting the Clark-Fulton community during shocks and stresses. These local community benefit organizations include Scranton Road Ministries, Merrick House, Jones Home, Lincoln West High School, the Second District Police Headquarters and, of course, MetroHealth Hospital. The MetroHealth campus has historically provided resilience through its Level I Trauma Center, its disaster-readiness, and its presence as a place of refuge for members of the community. It has already launched a Live Local employer assisted housing program to encourage MetroHealth employees to live in the nearby communities, an initiative which has the added benefit of allowing rapid mobilization in times of emergency and crisis. MetroHealth has also launched a Trauma Informed Community Response Institute, an initiative designed to be a mitigation-focused, comprehensive response to the impact of chronic complex trauma in our community. Furthermore, MetroHealth supports its employees and community residents through its own robust internal and external health and wellness programs.

The Clark-Fulton neighborhood and its residents, especially the most vulnerable groups, are subject to the chronic stresses and potential shocks, impacts that hit low-income and disadvantaged communities the hardest. The vulnerable groups who are likely to be affected by district activities include, but are not limited to, those mentioned in the foregoing Equity Imperative. The following list of chronic stresses that impact the community has been organized in descending order of magnitude. This format is intended to inform the work of the district by highlighting those most at risk and identifying the most impactful areas for the District Team to focus their attention:

Stresses Relative Magnitude Vulnerable Groups Structural Racism & Discrimination High People of color, people of Latinx heritage, immigrants and migrants – especially those for whom English is a second language, LGBTQ Poverty/Lack of Community Investment High People of color, people of Latinx heritage, immigrants and migrants, people with low income, people experiencing homelessness, unemployed or underemployed Job Dislocation High People with low income, people experiencing homelessness, unemployed or underemployed Lead Poisoning High People with low income, youth Health Disparities High Senior citizens, youth, disabled, survivors of trauma, users of mental health services, sick and frail, people without access to health insurance Public Safety High People of color, people of Latinx heritage, Immigrants and migrants, people with low income, people experiencing homelessness Xenophobia High Immigrants and migrants Aging Housing Stock High People of color, people of Latinx heritage, Immigrants and migrants, People with low income, senior citizens, youth, renters Car Dependency & Urban Sprawl Medium Small, local businesses, people with low income, senior citizens, youth Built Environment & Surrounding Land Use Medium Small, local businesses Police Violence Medium People of color, people of Latinx heritage Food Insecurity & Lack of Healthy Food Medium People of color, people of Latinx heritage, Immigrants and migrants, people with low income, people experiencing homelessness Loss of Tree Canopy Medium People experiencing homelessness, sick and frail Reduced Air Quality Medium Senior citizens, youth, people experiencing homelessness, sick and frail Gentrification and Displacement Medium Renters, people with low income Deteriorated Social Cohesion & Social Medium Senior citizens, LGTBQ Isolation Political Disenfranchisement Medium People of color, people of Latinx heritage Poor Sidewalk Conditions Low Senior citizens, youth, people experiencing homelessness

In addition to these persistent challenges, vulnerable residents of the neighborhood face a number of potential shocks to the status quo including:

Shocks Relative Magnitude Vulnerable Groups Climate Related Heat Waves & Extreme Cold High Senior citizens, youth, disabled, sick and frail, people experiencing homelessness Extreme Rainfall & Flooding High Senior citizens, youth, disabled, sick and frail, people experiencing homelessness Sudden Economic Downturns including High People of color, people of Latinx heritage, Immigrants and Foreclosure Crisis migrants, people with low income, people experiencing homelessness, small, local businesses Crime and Violence incl. Gun Violence High People of color, people of Latinx heritage, Immigrants and migrants Health Trauma Medium People of color, people of Latinx heritage, Immigrants and migrants, people with low income, people experiencing homelessness, senior citizens, youth, disabled, survivors of trauma, users of mental health services, sick and frail, people without access to healthcare Businesses or Local Stores Closing Medium Small, local businesses Power Outages Medium Small, local businesses, senior citizens, youth, disabled, survivors of trauma, users of mental health services, sick and frail Immigrants and migrants, people experiencing homelessness, Migration & Climate Refugees Medium renters Unemployment Medium People of color, people of Latinx heritage, immigrants and migrants, LGBTQ, people with low income, people without access to health insurance

In response to these challenges, the District Team commits to supporting and fostering current local/state resilience policies and programs applicable to the district including the following:

Entity Program/Policy Program/Policy Description Relation to CF/MH EcoDistrict MetroHealth System MetroHealth Medical Center New central utility plan (CUP) to Reliable, uninterrupted power Campus Central Utility Plant be built as part of campus source for MetroHealth campus, transformation which serves as a community shelter during emergencies and disasters MetroHealth System MetroHealth Police Headquarters New headquarters for New police facility demonstrates on West 25th St. MetroHealth Police Department commitment to public safety of on West 25th Street (to be located the MetroHealth campus and across the street from the Clark-Fulton neighborhood MetroHealth Campus) Greater Cleveland RTA, West 25th Street Bus Rapid GCRTA consolidated existing Goal to provide reliable public

Entity Program/Policy Program/Policy Description Relation to CF/MH EcoDistrict MetroHealth System Transit (BRT) routes to begin transition to BRT transportation for patients, MH on West 25th St. MH supports employees, and community public transit in the neighborhood residents, spur economic (via naming rights to BRT line in development, and reduce carbon 2017) emissions MetroHealth System MetroHealth System’s Arts in Embed visual, performing, and Goal to promote healing, Medicine Program therapeutic arts throughout MH wellness, and increased System and into the community engagement among patients, families, caregivers, and the greater community City of Cleveland, Cuyahoga First Year Cleveland Effort to mobilize the community Connected to both the healthcare County, Case Western Reserve through partnerships and a unified mission of MetroHealth but also University, MetroHealth System, strategy to reduce infant deaths relevant given the racial and , University and, more specifically, reduce ethnic composition of the Clark- Hospital, Saint Luke’s Foundation, racial disparities, address extreme Fulton neighborhood Mt. Sinai Health Care Foundation, prematurity and eliminate sleep- among other partners related infant deaths Ohio Department of Health, Project DAWN (Deaths Avoided Community-based opioid drug Cuyahoga County has MetroHealth System With Naloxone) overdose education and naloxone experienced rise in overdose distribution program fatalities attributable to abuse of opioids in recent years City of Cleveland, Cleveland West 25th Street Corridor Planning effort to increase Development would make Clark- Neighborhood Progress, Development mobility, population density, Fulton a stronger, more resilient Cleveland Foundation, Enterprise investment and economic neighborhood if achieved in an Community Partners, MetroHealth development on 3.8-mile corridor equitable manner System along West 25th Street DigitalC Digital Divide Non-profit dedicated to making 47% of Clark-Fulton’s population Cleveland’s digital future more is living at or below the poverty equitable and achieve success level, digital access to healthcare through technology, innovation, improves outcomes and lowers and community costs City of Cleveland Office of Grid Resilience Efforts to diversify power grid, Impacts resilience initiatives of Sustainability, Cuyahoga County including Cuyahoga County Solar MetroHealth campus and Clark- Office of Sustainability Co-op, Solar farm on Brooklyn Fulton neighborhood landfill site, Downtown microgrid MetroHealth System, Local Faith MetroHealth System’s Community MH coordination with local Focus on resilience at the level of Community Trauma Initiative churches to ensure those the individual trauma survivor experiencing trauma, such as victims of violent crimes, receive the mental health and support

Entity Program/Policy Program/Policy Description Relation to CF/MH EcoDistrict services they need MetroHealth System Trauma-informed Care Approach Organizational structure and Focus on resilience at the level of treatment framework that involves the individual trauma survivor understanding, recognizing, and responding to the effects of all types of trauma; emphasizes physical, psychological, and emotional safety MetroHealth System Employee Housing Initiative Employer assisted housing Initiative to increase affordable program created to encourage housing options for MetroHealth eligible employees of local anchor employees in Clark-Fulton institutions to live near work. Northeast Ohio Regional Sewer Project Clean Lake Consent decree led to Project Clark-Fulton is located within the District (NEORSD) Clean Lake, a 25-year program NEORSD service area and gets its that will reduce combined sewer drinking water from overflow discharging into Lake Erie via large tunnels, treatment plant improvements and expansion and green infrastructure City of Cleveland, NOACA City of Cleveland’s Complete and Ordinance passed in 2011 Related to West 25th Street Green Streets Ordinance requiring implementation of corridor development sustainable policies and guidelines in construction projects; emphasis on creating walking, biking and public transportation-friendly city while also incorporating green infrastructure City of Cleveland, MetroHealth BUILD Health 2.0 – Cleveland Healthy housing data system Asthma and lead poisoning have System, Environmental Health Healthy Home Data Collaborative grounded in neighborhood high prevalence rates in the City Watch, University Hospitals community engagement and of Cleveland and the Clark-Fulton Rainbow Babies & Children’s providing useful information to neighborhood address health disparities (focus on asthma and lead poisoning) City of Cleveland City of Cleveland’s Bikeway City’s commitment to improving Important transit corridor for local Master Plan conditions for bicycling through residents to utilize an alternative infrastructure, education transit option programs, and pro-bicycling policies

WORK PLAN The District Team will incorporate and integrate the following tasks and actions into the planning, implementation and certification processes during each phase to endeavor to minimize and avoid stresses and shocks when possible and, when unavoidable, mitigate their negative side effects:

Resilience in the Formation Phase • Knowledge/Expertise & Organizations/Networks o Task 1: Inclusive outreach and authentic engagement of stakeholders, particularly vulnerable populations and the organizations that serve them. • People & Place o Task 2: Recruit and develop community leaders from groups that are historically most vulnerable to stresses and shocks, (e.g. African American, Latinx, people with low income, youth, ESL).

Resilience in the Roadmap Phase • Knowledge/Expertise & Organizations/Networks o Task 3: Enable and encourage participation of vulnerable groups in Roadmap development, including language translation, process orientations and workshops • People & Place o Task 4: Evaluate the robustness of strategies to withstand anticipated stresses and shocks and the degree to which they possess the redundancy and diverse capacity to avoid overreliance on single assets

Resilience in the Performance Phase • Knowledge/Expertise & Organizations/Networks o Task 5: As part of biennial progress reporting, prepare an evaluation of Resilience results to date and recommend strategy adjustments to improve outcomes • People & Place o Task 6: Ensure district performance is transparent and accessible to ensure the results can be used to adjust and strengthen the Resilience commitment. Report out via website, social media, community meetings, newsletters and any additional methods deemed appropriate for the district o Task 7: Meet with vulnerable groups to review the burdens and benefits from Roadmap execution, creating an indicator feedback loop that gauges progress made and recommends strategy adjustments

RESPONSIBILITIES AND SCHEDULE Task 1 (Resilience in the Formation Phase) • Organization(s) with primary responsibility: District Team with assistance from Neighborhood Connections • Process: Leadership development and community organizing • Schedule/Timetable: Target completion for December 2019 Task 2 (Resilience in the Formation Phase) • Organization(s) with primary responsibility: District Team with assistance from Neighborhood Connections • Process: Leadership development and community organizing • Schedule/Timetable: Target completion for December 2019

Task 3 (Resilience in the Roadmap Phase) • Organization(s) with primary responsibility: District Team with assistance from Neighborhood Connections • Process: Leadership development and community organizing • Schedule/Timetable: Target completion for December 2020 Task 4 (Resilience in the Roadmap Phase) • Organization(s) with primary responsibility: District Team with assistance from Center for Healthcare Research and Policy, Center for Community Solutions, School of Social Work and Medical School at CWRU. • Process: Data analysis, evaluation and research • Schedule/Timetable: Target completion for December 2020 Task 5 (Resilience in the Performance Phase) • Organization(s) with primary responsibility: Backbone Organization with assistance from Center for Healthcare Research and Policy, Center for Community Solutions, School of Social Work and Medical School at CWRU. • Process: Data analysis, evaluation and research • Schedule/Timetable: Ongoing Task 6 (Resilience in the Performance Phase) • Organization(s) with primary responsibility: Backbone Organization with assistance from Neighborhood Connections • Process: Leadership development and community organizing • Schedule/Timetable: Ongoing Task 7 (Resilience in the Performance Phase) • Organization(s) with primary responsibility: Backbone Organization with assistance from Neighborhood Connections • Process: Leadership development and community organizing • Schedule/Timetable: Ongoing

INDICATORS The following indicators of Resilience developed to date by the District Team are illustrative and not meant to be exhaustive. However some indicators are more meaningful, relevant and available than others and the District Team understands that too many indicators can be confusing. The four or five indicators most relevant and meaningful to the neighborhood will be confirmed in the Formation and Roadmap Phases: • Educational Attainment by Race and Ethnicity (highest • Rates of Chronic Disease and Illness (including heart disease, degree of education) cancer, diabetes, stroke, arthritis, among others) • Language Proficiency (English and additional languages) • Transit Access (distance to stops and destinations accessible • Percent of Population with Health Insurance by transit) • Percent land area with Impervious Surface or Number of Rain • Small Business Formation Rates (applications for Employer Gardens Identification Numbers, EINs) • Local Employment Rate • Unbanked Population (adults without an account at a • Number of Climate Resilience Training Workshops Held financial institution) • Households Headed by a Single Parent • Crime Rate (number of crimes committed) • Number of Foreclosures • Poverty Rate (number of people whose income falls below • Number of Evictions the poverty line)

EVALUATION AND ADJUSTMENT Resilience conditions are regularly updated as new data becomes available, and the findings inform program and project prioritization for ensuing work plans. Biennial performance report used as feedback to be cross-referenced for adaptation and adjustment within each Performance Phase Work Plan.

LETTERS OF SUPPORT FOR THE RESILIENCE IMPERATIVE • Frank G. Jackson, Mayor, City of Cleveland • Jill Rizika, Towards Employment • Councilwoman Jasmin Santana,

CLIMATE PROTECTION COMMITMENT

VISION AND SCOPE The District Team defines climate protection as “actions taken to eliminate greenhouse gas emissions and reduce climate change”. These types of actions, including supporting public transit, initiating beautification projects such as public parks, green spaces and tree plantings, and localizing food and energy production, and improving storm water management will not only positively impact the climate, but they will also enhance the quality of life and health of residents. Working collaboratively and in the interests of the greater good, local actors in Clark-Fulton can confront the complexities of climate change, strengthen their communities, and provide an inspiring example to surrounding communities.

The District Team commits to reaching carbon neutrality in the Clark-Fulton neighborhood by eliminating, sequestering, and/or off-setting direct and indirect operational CO2 and CO2 equivalent emissions from building, water, and infrastructure energy use and production, solid waste and hazardous waste management and transportation within and connected to the district. The District Team further commits to establishing a time horizon for carbon neutrality in the district and pledges that a specific target date for achieving carbon neutrality will be determined during the Roadmap Phase along with a detailed emissions inventory.

Seeking to capitalize on the $1B commitment toward a Campus Transformation Plan launched in 2016 by The MetroHealth System, the District Team supports not just a transformation of the hospital campus but also of the wider community surrounding it. A key effort of the District Team’s climate protection work will be a major expansion of the urban tree canopy on the hospital campus, a new 12-acre public park and within the district, an effort consistent with City of Cleveland Tree Plan. Tree canopy is an important element in improving the quality of life and health and wellbeing for all citizens. Reduced tree canopy negatively impacts disadvantaged neighborhoods like Clark-Fulton to a greater extent than other Cleveland neighborhoods. Cleveland has lost significant canopy since the 1940s. Tree canopy cover today citywide is low (19%, only one quarter of what is possible) and each year an estimated 97 acres of tree canopy is lost. At this rate, tree canopy will drop to 14% by 2040 unless we rebuild. The benefits of this strategy include cleaner air, reduction of the urban heat island effect, carbon sequestration by carbon sink, and water filtration and retention. Additionally, the District Team will study and pursue the following greenhouse gas (GhG) reduction strategies: • Energy efficiency in buildings • Smart Growth and density seeking to reduce VMT, in particular transit oriented development along West 25th Street • Incentivizing transit, car share, biking and walking opportunities • Increased use of tele-presence where appropriate • Use of renewable energy • Deployment of zero emission auto fleets

And, as part of its physical transformation of the hospital and campus, the MetroHealth System will pursue both LEED for Building Design and Construction (LEED BD+C v4) for Healthcare silver level and WELL Building Standard v2 certifications, including Energy Use Intensity (EUI) and other operational targets for the new hospital itself and the campus more broadly. The key strategies in achieving these sustainability certifications, each playing an important role in the commitment to climate protection, will be sustainable sites, heat island reduction, outdoor water use, optimizing energy performance and demand response, materials and resources used, waste and water management and evidence-based design for healthy spaces. MetroHealth continues to study the means by which to deploy photovoltaic solar panels on the new hospital campus buildings and recently designed and built a parking structure that is PV ready.

CURRENT CONDITIONS Cities consume over two thirds of the world’s energy and account for 70% of global emissions and are, therefore, at the leading edge of climate change risk (but also opportunity). Like most US cities and their urban neighborhoods, energy consumption in Cleveland and Clark-Fulton is on the rise due to the high levels of car ownership typical in the US, a dense fabric of homes – in Cleveland and Clark-Fulton, many are older with limited insulation – filled with appliance and many commercial buildings including several very large industrial operations. Perhaps the largest and most variable user of energy, the MetroHealth campus, each day serves thousands of employees, patients, and visitors. To achieve this level of service 24 hours per day, the hospital campus consumes a great deal of energy for purposes such as lighting, space heating and cooling, ventilation, the operation of medical equipment, computers, refrigeration and cooking, among others. But the utility grid delivers all the energy and there are no sources of power generation in the neighborhood.

In Cleveland and in Northeast Ohio generally, power is largely generated using the energy resources of coal, natural gas and nuclear. In the case of the non-renewable, fossil fuel sources, the highest emitters of carbon, coal is used to generate 47% of the electricity in Ohio. Burning natural gas produces approximately 34% of Ohio’s electricity. Nuclear power, also a non-renewable resource albeit with low emissions, is used to generate about 15% of Ohio’s electricity. Renewable resources such as wind, biomass and utility-scale solar are used to generate electricity in Ohio but such renewables currently only produce about 3% of the state’s electricity. But growth in renewable energy production and technology in Ohio is robust given Ohio and Cleveland’s proximity to infrastructure, resources and skilled labor. Ohio is a national leader in solar deployment and Northeast Ohio is a national leader in fuel cell technology.

Extensive suburbanization in Northeast Ohio contributes to a generally higher and overall net increase in average household carbon footprint for the metro region in the past decade. That said, as an urban core neighborhood with higher density (albeit sparsely populated) and smaller homes on average, Clark-Fulton exhibits lower average household carbon footprint as compared to outlying suburban towns and cities. Average household CO2e in Clark Fulton (and in zip code 44109 overall) is 44 tons per year (compared to 85 tons per year in nearby Gates Mills Village). Housing, including many older, drafty homes, contributes the largest share of the total average household emissions at 17 tons.

Energy consumption and emissions overall in Clark-Fulton generally mirror the City of Cleveland overall and most legacy cities. Power use and industrial processes and products are the largest emissions sources at 49% and 34% respectively. Emissions from transportation are a relatively small subset of the total today at 16%, but emissions from transportation are increasing exponentially – the fastest growing of all sources – a trend to be mindful of during the Formation and Roadmap phases. As mentioned, the significant loss of urban tree canopy since the 1940s – the only meaningful carbon sink left in the Clark-Fulton neighborhood is the Riverside Cemetery – limits the ability to reduce emissions.

It is important to note that, since 2010, Cleveland, citywide, has, like other cities, seen a small reduction in total carbon emissions. The two major contributors to Cleveland’s current reduced carbon footprint are 1) decreased emissions from electricity generation attributable to a shift in the fuel used to generate power (largely from coal to more natural gas) and 2) reduced natural gas use in buildings. However, these reductions have been

largely offset by increased emissions from on-road vehicles and industrial processes since 2010, largely due to the economic recovery since the recession. And, the Clark-Fulton neighborhood is particularly vulnerable to emissions and pollution from transportation and industrial processes given its close proximity to two interstate highways and the ArcelorMittal Steel Cleveland Works, one of the largest sources of carbon emissions in the region.

When the United States announced its intention to pull out of the Paris Climate Agreement in 2017, Cleveland’s Mayor Frank Jackson, along with 400 other Mayors across the country (but one of only two in Northeast Ohio!), re-affirmed the city’s commitment to climate action by signing the Climate Mayors Agreement, thereby adopting, honoring and upholding the historic Paris climate agreement. And, the 2018 Update to the Cleveland Climate Action Plan, initially launched in 2013, is courageous in a state that produces over 80% of its electricity from non-renewable fossil fuels. As part of the Update, City of Cleveland officials announced a 100% renewable power target that aims to reduce greenhouse gas emissions to 80 percent below the 2010 level by 2050. The 2018 Update also builds off previous work by establishing the following crosscutting CAP priorities that serve as a model to pursue within the Clark-Fulton neighborhood: • Social and racial equity • Good jobs, Green jobs • Resilience to the impacts of climate change • Business leadership

The following is an excerpt from the 2018 update to the Cleveland CAP: “Collectively, we’ve made progress since the first Cleveland Climate Action Plan launched in 2013. We’ve reduced carbon pollution while growing the economy. Water quality and air quality have continued to improve. The City has been recognized for supporting solar and wind energy. More than 70 miles of bike infrastructure were installed and bike share system launched. Dozens of organizations created and are now implementing the Cleveland Tree Plan. The Cleveland Climate Action Fund has supported more than 50 resident-led, neighborhood-based projects. Finally, the number of Clevelanders who would recommend the city as a place to visit has more than doubled.”

National, state and local climate protection measures will influence the District Team’s approach to the Climate Protection Imperative. The following list of policies and programs has been organized in descending order of importance. This format is intended to inform the work of the district by highlighting and identifying the most impactful areas for the District Team to focus their attention:

Entity Program/Policy Program/Policy Description Relation to CF/MH EcoDistrict U.S. Environmental Protection Clean Power Plan (Federal) 2015 plan issued under the Clean Impacts sustainability initiatives of Agency Air Act to set limits on carbon MetroHealth campus and Clark- pollution from U.S. power plants Fulton neighborhood State of Ohio Renewable Portfolio Standard State’s requirement that 12.5% of Impacts sustainability initiatives of (RPS) electricity sold is generated from MetroHealth campus and Clark- renewable energy sources by Fulton neighborhood 2027. Sets annual benchmarks with which utilities and electric service companies must comply State of Ohio Energy Efficiency Resource State’s requirement on electric Impacts sustainability initiatives of Standard (EERS) utilities to meet a portion of their MetroHealth campus and Clark- customer demand through energy Fulton neighborhood (rebates

Entity Program/Policy Program/Policy Description Relation to CF/MH EcoDistrict efficiency. Sets annual energy from this program fund reduction targets that utilities sustainability efforts at achieve via discounts/rebates on MetroHealth) energy efficient lighting, weatherization and household appliances City of Cleveland Office of Cleveland Climate Action Plan Plan for the City of Cleveland to Impacts sustainability initiatives of Sustainability reduce carbon pollution, improve MetroHealth campus and Clark- air and water quality, support Fulton neighborhood renewable energy, improve bicycle accessibility, strengthen the local economy, and improve the health and wellness of Clevelanders Cuyahoga County Office of Cuyahoga County 5-year Plan to reduce GHG emissions, Impacts sustainability initiatives of Sustainability Sustainability Strategic Plan and increase resources for clean MetroHealth campus and Clark- Climate Change Action Plan energy and environmentally Fulton neighborhood as well as sustainable programs, increase public health initiatives access to alternative methods of countywide (the public health plan transportation, increase is a key action area for Cuyahoga community awareness of climate County). issues, improve water quality, adopt sustainable practices in County operations, and enhance land use practices to spur clean energy development City of Cleveland, Cleveland Tree Cleveland Tree Plan Community-wide collaboration to Supports expanding the tree Coalition rebuild the urban forest and tree canopy in the Clark-Fulton canopy in the City of Cleveland neighborhood and the proposed 12-acre community park adjacent to the hospital. City of Cleveland Cleveland Green Building City program offering tax Applicable to properties in Clark- Standards abatement on residential Fulton neighborhood properties if Green Building Standards are met 2030 Districts Network, City of Cleveland 2030 District Goal to create high-performance Applicable to properties in Clark- Cleveland, Cuyahoga County, building districts throughout Fulton neighborhood various corporate, government, Greater Cleveland to reduce non-profit stakeholders environmental impacts of building construction and operations

Entity Program/Policy Program/Policy Description Relation to CF/MH EcoDistrict Northeast Ohio Areawide Transportation for Livable Provides assistance to Related to West 25th Street Coordinating Agency Communities Initiative (TLCI) communities and public agencies corridor development for integrated transportation and land use planning and projects that strengthen community livability Northeast Ohio Regional Sewer Regional Stormwater Addresses problems related to Impacts stormwater management District Watershed Advisory Management Program stormwater runoff from hard initiatives of MetroHealth campus Council surfaces, offers fee credits to and Clark-Fulton neighborhood customers who make improvements on their properties to reduce runoff Local corporate, government, Other Organizations’ Climate Various organizations throughout Impacts sustainability initiatives of non-profit entities Action Plans and Sustainability Cleveland have established their MetroHealth campus and Clark- Programs own plans to take action on Fulton neighborhood climate and sustainability. Examples: KeyBank, , Cleveland Clinic, and others

WORK PLAN The District Team will incorporate and integrate the following tasks and actions into the planning, implementation and certification processes during each phase to endeavor to minimize energy demand, maximize energy efficiency, produce energy from clean and renewable sources, and sequester or off-set CO2 emissions:

Climate Protection in the Formation Phase • Task 1: Outreach to key stakeholders (major energy users such as MetroHealth, Nestle, Lincoln West High School, Steelyard Commons (adjacent retail development), design professionals, waste and transportation system operators, energy utilities such as First Energy and Cleveland Public Power), to understand climate protection goals and participation opportunities and explain both to the community all held in multiple population appropriate languages • Task 2: Recruit and develop climate protection practitioners and interested community group representatives to participate in decision- making

Climate Protection in the Roadmap Phase • Task 3: Enable and encourage participation of vulnerable groups in Roadmap development, process orientations and workshops all held in multiple population appropriate languages • Task 4: Create and emissions inventory for the district including all current uses and evaluate the carbon footprint of all proposed projects and programs while ranking strategies to achieve carbon neutrality • Task 5: Establish the time horizon for carbon neutrality in the district and pledge a specific target date for achieving carbon neutrality

Climate Protection in the Performance Phase • Task 6: As part of biennial progress reporting, prepare an evaluation of carbon reduction results to date and recommend strategy adjustments to accelerate the rate of reduction • Task 7: Ensure district performance is transparent and accessible to ensure the results can be used to adjust and strengthen the Climate Protection commitment. Report out via website, social media, community meetings, newsletters and any additional methods deemed appropriate for the district • Task 8: Meet with stakeholder groups to review the burdens and benefits from Roadmap execution, creating an indicator feedback loop that gauges progress made and recommends strategy adjustments

RESPONSIBILITIES AND SCHEDULE Task 1 (Climate Protection in the Formation Phase) • Organization(s) with primary responsibility: District Team with assistance from City of Cleveland Office of Sustainability • Process: Stakeholder engagement • Schedule/Timetable: Target completion for December 2019 Task 2 (Climate Protection in the Formation Phase) • Organization(s) with primary responsibility: District Team with assistance from City of Cleveland Office of Sustainability • Process: Leadership development and training • Schedule/Timetable: Target completion for December 2019 Task 3 (Climate Protection in the Roadmap Phase) • Organization(s) with primary responsibility: District Team with assistance from Cleveland Neighborhood Progress and Neighborhood Connections • Process: Leadership development and community organizing • Schedule/Timetable: Target completion for December 2020 Task 4 (Climate Protection in the Roadmap Phase) • Organization(s) with primary responsibility: District Team with assistance from City of Cleveland Office of Sustainability, NEORSD, NOACA, City of Cleveland Department of Public Health Division of Air Quality Management • Process: Data analysis, evaluation and research • Schedule/Timetable: Target completion for December 2020 Task 5 (Climate Protection in the Roadmap Phase) • Organization(s) with primary responsibility: District Team with assistance from City of Cleveland Office of Sustainability and Cuyahoga County Office of Sustainability • Process: Data analysis, evaluation and research • Schedule/Timetable: Target completion for December 2020 Task 6 (Climate Protection in the Performance Phase) • Organization(s) with primary responsibility: Backbone Organization with assistance from City of Cleveland Office of Sustainability, NEORSD, NOACA, City of Cleveland Department of Public Health Division of Air Quality Management • Process: Data analysis, evaluation and research • Schedule/Timetable: Ongoing Task 7 (Climate Protection in the Performance Phase) • Organization(s) with primary responsibility: Backbone Organization with assistance from Neighborhood Connections and City of Cleveland Office of Sustainability

• Process: Leadership development and community organizing • Schedule/Timetable: Ongoing Task 8 (Climate Protection in the Performance Phase) • Organization(s) with primary responsibility: Backbone Organization with assistance from Neighborhood Connections and City of Cleveland Office of Sustainability • Process: Leadership development and community organizing • Schedule/Timetable: Ongoing

INDICATORS The following indicators of Climate Protection developed to date by the District Team are illustrative and not meant to be exhaustive. However some indicators are more meaningful, relevant and available than others and the District Team understands that too many indicators can be confusing. The four or five indicators most relevant and meaningful to the neighborhood will be confirmed in the Formation and Roadmap Phases: • Zero Energy Performance Index for major building types (ratio • Clean-fueled thermal energy produced (heat produced from of energy performance to the average energy consumption of solar energy or geothermal) a similar building in 2000) • Renewable energy generated in the district (kWh/day) • EUI targets for major building types (annual energy • Renewable energy used in the district (kWh/day) consumption relative to its gross square footage) • Per capita net tons of CO2 emissions in the district • Household vehicle fuel use • Volume of reclaimed and reused materials • Large employers’ employee commuting mode split • Number of homes weatherized/solarized • Transit ridership (people served daily by transit lines located • Number of green jobs created in Clark-Fulton neighborhood) • Urban tree canopy percentage • Air quality (utilizing NOACA daily ground-level ozone and fine • Number of green infrastructure projects in the district particulate matter data) • Gallons of storm water diverted from combined sewer • Number of asthma cases, heat-related illnesses overflow • Per capita total energy use (Btu per person in the district, • Acres of green space open to the public including residents and employees) • Acres of food-bearing community gardens

EVALUATION AND ADJUSTMENT Climate Protection conditions are regularly updated as new data becomes available, and the findings inform program and project prioritization for ensuing work plans. Biennial performance report used as feedback to be cross-referenced for adaptation and adjustment within each Performance Phase Work Plan.

LETTERS OF SUPPORT FOR THE CLIMATE PROTECTION IMPERATIVE • Joel Ratner, Cleveland Neighborhood Progress • Brian Zimmerman, Cleveland Metroparks