Across the region, there's a big disparity in how long people live. Nearly 90 years, on average, in Indian Hill and Mason, but barely over 60 in Arlington Heights and Adams County. That's nearly 30 years of life, love, children, grandchildren, and memories that are lost. Why? Community health experts are looking at the larger forces that shape health and wellness. The places where we grow up, live, work, and age shape our lives and our opportunities to thrive. With this story, we begin a year-long deep dive into the factors that people and neighborhoods need for long, healthful lives, and spotlight individuals and organizations working toward building healthier, resilient communities.
Scott Conley remembers the day the veil was pulled back to reveal how some of his neighbors lived.
His late wife, Lori, had just begun serving as a children’s minister at a church in the small Clermont County village of Bethel. From time to time, she and Scott would visit a family, deliver a balloon and cookies for the kids, and get to know everyone a little better.
One day they went to see a young child and his father, a single parent, who had recently visited the church for the first time. The house they lived in, a couple blocks from the church, looked like a Cape Cod-style starter home. It had seen better days, but so had a lot of the other houses around. As they stepped up on the porch, it appeared that the dwelling had been divided into five apartments, none of which appeared to be the home of the family they wanted to see. They knocked for a bit then walked around back, where they ran into one of the residents and asked about the family. The man pointed to the cellar, saying they had just moved in there. The subterranean shelter was covered with a sheet of plywood and secured with a hand-rigged lock.
“It was literally a set of concrete steps that went down to a plywood door that had a padlock on it,” Conley says. “That’s the kind of stuff you’d see in a Third World country.”
They never met the family, but the direction of their ministry changed from that day. The community had more needs than one small church could handle. Scott and Lori started
Empower Youth, a community-based, not-for-profit that, in the 10 years it’s been around, has built a network of support around the less-privileged children of Bethel and surrounding communities.
Building a resilient, connected, healthy community for kids and families that may not have that is what it’s all about.
“We noticed, with poverty and everything that comes along with that, that you become your own island,” Conley says.
The tiny village of Bethel, population 2,600, is something of an island. While much of
surrounding Clermont County is thriving, with the population growing, hundreds of new homes being built, and millions of dollars worth of commercial development completed or underway, the residents of Bethel haven’t benefited. As a whole, they are
poorer, less educated, and less mobile, factors that make them more susceptible to poor health, and less able to bounce back from illness and adversity.
According to a new measurement by the U.S. Centers for Disease Control and Prevention, they are “extremely vulnerable” to disease, natural disasters, recessions, as well as just the stresses of everyday life that arise in 21
st century America.
The CDC, the nation’s leading public health agency, created the
Social Vulnerability Index, a tool to identify communities that are susceptible to hazards that can affect health, cause lifelong problems, or lead to early death. Delving into data from census tracts, areas of only a few thousand people, the agency ranked communities on a scale ranging from “very low vulnerability” to “extreme vulnerability.” The index is designed to be used to prepare for disasters and identify communities that need support. Not-for-profit organizations can also use it to guide their community-based health initiatives.
The index does not measure access to emergency services such as EMS, fire departments, or hospital emergency rooms. Instead, it measures the conditions that people live in that can lead to good health, or conversely, can contribute to hardship. Among the census data used in compiling the community-by-community measurements are income, education, housing costs, childhood poverty, and access to transportation.
Cincinnati-based
Interact for Health has made use of the index in its work to support efforts to improve community health. “It gets at the obstacles that people have to overcome in their everyday lives that play out in their health outcomes and life expectancy,” says Kelley Adcock, senior director of data and learning at Interact for Health.
Bethel is not alone. Many communities throughout the tri-state are considered extremely vulnerable to the afflictions that can beset people over the course of their lives. Some of those communities are on the rural outskirts, such as in Adams County in Ohio, Pendleton County in Kentucky and Franklin County in Southeastern Indiana, as well as in the urban core. In Hamilton County, many of the neighborhoods in the urban center, up through the Mill Creek valley, are also designated as extremely vulnerable under the CDC’s rankings.
Their vulnerability is largely the result of policies and decisions made decades ago that marginalized communities and their residents, Adcock says. Unfair housing practices such as redlining, systemic racism around hiring, the targeting of low-income communities with focused marketing for tobacco, liquor and vaping products, and the disruption of neighborhoods with highways and commercial development are a few of the practices that have left these communities isolated and prone to health problems.
“The environment around those individuals has not produced the conditions in which they can thrive,” she says. “They're going to face more barriers.”
And while policymakers and legislators often look to improve these communities by adding "urgent services" such as more police, firefighters, emergency responders or new health clinics, the needs go well beyond such quick fixes, and will take time and steady attention, says Ashlee Young, Interact for Health's vice president for policy and engagement. "There has to be a mindset shift," she says. "We have to move upstream, and somebody has to be thinking about what are we doing to address root causes."
![]()
The Social Vulnerability Index for the 20-county regionBethel is a nearly all-white community situated at the intersection of Ohio 125 and 133 in eastern Clermont County. Its original business district, like many in small-town Ohio, is aged, but quaint, with a mix of storefronts, some vacant, and some new, such as the Rise and Dine Cafe, a family-owned diner just two years old. Just outside the downtown district, it resembles many suburban communities, with fast-food franchises, a dollar store and a chain hardware store.
It's been said that rural towns and forgotten neighborhoods never get any attention until something bad happens. That's the case in Bethel, where in 2020, a small Black Lives Matter demonstration attracted hundreds of counterprotestors, many from out of town. A resulting confrontation turned violent, bringing every television station in Cincinnati to town for a couple of days.
In Bethel, poverty, as Scott Conley discovered during his “home” visit, is an overriding factor in the well-being of the community. The median income of a household in the village is about $40,000, nearly 40% less than the statewide number. Nearly a quarter of the residents (22%) live in poverty, nearly double the statewide rate.
Women aged 25 to 34 are among the age groups most afflicted with low incomes, a fact that leads to children growing up poor and to persistent, generational poverty.
“There's a lot of large, generational families that live in a bubble,” says Bethel Mayor Jay Noble.
Conley has seen a similar dynamic in his work. “As a kid growing up, your family may be in the same boat as the family next door and the family next to them, and there's no real connection,” he says. “You really need to get people who are connected in those neighborhoods to have a lifeline to pull those kids out.”
That’s the purpose behind Empower Youth, the organization he and his late wife started in 2015. In the kind of public policy decision that can resonate for a lifetime, the local school district cut its budget. That affected the free and reduced lunch program, which nearly half of the students are eligible for. Going hungry left children less receptive to learning.
“I never heard of food insecurities and food deserts and all that stuff, but we noticed there was a need,” he says. School custodians, teachers, and bus drivers volunteered to try and fill the gap, but the need was too great. The Conleys began putting together weekend food packs for students to take home. The program has grown to serve about 1,250 students a week in the Edge of Appalachia communities in Clermont, Brown, and Highland counties.
The food giveaway exposed him to the stories of thousands of residents. One still stands out in his memory. A fourth-grade girl would often ask for, and receive, a little extra in her take-home pack. One day, a volunteer asked her if she was asking because she liked the food so much. “No, but when my mom goes to work, I feed my year-and-a-half-old baby brother out of my food pack,” she replied. “This is a fourth grader!” Conley says. “I've heard stories like that multiple times.”
Another decision made decades ago has made it difficult to attract new employers and has hampered job growth. Some years ago, the village council decided that Bethel’s sewer system, much of it built in the 1940s, was too expensive to keep up, so the council turned its operation and maintenance over to Clermont County, Noble says. Attracting a new manufacturer, like the
new Purina plant in Williamsburg 15 miles away on U.S. 32, requires a costly expansion of water and sewer capacity. But Bethel’s sewer infrastructure is now in the hands of Clermont County officials, who are focused on promoting development in the western part of the county around Batavia, the Eastgate Mall area, and along Interstate 275 in Union Township.
Adding to the potential cost of new sewer infrastructure, the 2,000-acre East Fork Lake just to the north of the village presents an obstacle to sewer construction, as it would require a prohibitively expensive detour around that body of water. “We have a hard time getting any light industry in, or any big-box grocers or anything like that,” Noble says.
“Everything we do has to be baby steps.” The only grocery store in town is the discount retailer Save A Lot.
Like the sewer giveaway decades ago, decisions can create ripple effects for years, creating conditions that can improve or diminish lives. One for the better was made by Community Savings Bank, a small, depositor-owned bank known until a few years ago as Bethel Building and Loan. Around 2018, the bank foreclosed on a farm in Bethel that had been abandoned and neglected. Rather than sell the property, the bank donated it to the Empower Youth organization. The farm is now home base for the organization, where it holds community picnics and other events and where volunteers assemble the weekly food packs. “That changed everything,” Conley says. “We went from being a gypsy to actually having a home to be able to build something.”
Another decision that has benefitted the community for decades was made by Edmund Burke, a Bethel native who made a fortune in real estate in New York City. Burke, who died in 1966, remembered his hometown, leaving a $500,000 endowment for a park, cemetery upkeep and a scholarship fund. “We’ve increased its value to over $2 million in a trust,” Noble says. That's after millions have been spent to improve the community. Today, the 15-acre Burke Park in the center of town offers walking trails, a playground, tennis courts, and greenspace to relax in. New restrooms, a new walking bridge and a pavilion are among the recent investments in the public park thanks to Burke’s foresight more than 50 years ago.
Like those decisions made in that Clermont County village years ago, the choices, opportunities, and challenges that we and our elected representatives, business leaders, and community organizations encounter today will affect lives and shape communities across generations.
This series, Health Justice in Action, is made possible with support from Interact for Health. To learn more about Interact for Health's commitment to working with communities to advance health justice, please visit here.