"You can’t bring about healthcare transformation unless you have it as part of a cultural change within the community. We need the type of cultural change that will realize the prospect for a type of self agency that each member of the community must have as it relates to their health, the health of their family, and the health of their neighborhood."

--Roger Green, Coalition to Save Interfaith Co-Chair.


The American healthcare system stands on the precipice between reform and collapse. While its problems  predated the current pandemic, they have been made much worse in the months since the novel coronavirus outbreak began. Many of the issues being encountered nationally today, such as lack of access to resources and care, overwhelmed hospitals, and unemployment can be found in the microcosm of Brooklyn, New York. It is there—where the threat of a hospital closure laid the foundations for a cultural and economic reckoning—that potential resolutions and valuable lessons for systemic reform can be found.

In 2012, the New York State Governor announced plans to close Interfaith Medical Center. It would have been the fifth Brooklyn safety net hospital to close in the last decade. Instead, the announcement sparked a community-wide movement, led by the Coalition to Save and Transform Interfaith, that not only kept Interfaith open, but catalyzed the formation of a new health system in Central Brooklyn. In that disruptive moment in the healthcare sector--defined by shifting economic models, racing to contain costs, and a failure of political will--union and community leaders knew business-as-usual tactics would not save the day.

This case study, Building a Culture of Health in Central Brooklyn: From Protest to Health Systems Transformation  is the story of the Coalition—why it formed, and what it accomplished. It documents the partnership with Maimonides Hospital’s Community Care of Brooklyn health system as part of a New York State Medicaid reform effort.

The case study highlights the ways in which a Culture of Health has begun to emerge in Central Brooklyn, moving residents to see health both as a right to which they are entitled, and one for which they must fight. It also identifies the changes in public attitudes that have activated major institutional commitment across sectors to make deep investment in health equity within Central Brooklyn.  Guided by principles of racial and economic justice, the group  believes that informed community members and proactive planning processes are necessary for effective, equitable, humane and sustainable systems.

Building a Culture of Health in Central Brooklyn: From Protest to Health Systems Transformation is also about how a small group of healthcare and nurses union leaders, Coalition members and others came together from across siloed interest groups to forge a strategy for the whole community. They built civic infrastructure1 -- a varied assortment of public spaces that created opportunities for ongoing discussion, planning and coordination to support partnerships among community, labor, and institutional leaders.

They also developed a comprehensive wellness-based development approach to addressing social determinants of health (“SDOH”).  And they are now working to build a series of initiatives that leverage local assets and, building on local healthcare institutions’ procurement streams, begin to build community-based wealth-generating enterprises to address poverty, the single most decisive determinant of health.

1. An Epidemic of Hospital Closures
2. Crisis at Interfaith
3. Time to Mobilize: Forming the Coalition to Save Interfaith
4. Protest and Resolution
5. Medicaid Reform
6. Research-Based Action
7. Participatory Action Research as a Tool for Change
8. Healthcare System Reform: Cross-Sector Collaboration
9. Reinventing Interfaith
10. Focus on Health Equity
11. Creating Healthier Communities: Leveraging Community Assets
12. Community Planning for Healthier Communities
13. Making Health a Shared Value: Building Civic Infrastructure
14. Building a Culture of Health: Outcomes
15. Planning for the Future
16. Sustaining Transformation in the Face of Challenge
About the Report