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Ochsner Health is a 501(c)3 not-for-profit organization and one of the US’s largest non-university academic medical centers.  It encompasses 46 hospitals and more than 370 health and urgent care centers. There are more than 38,000 team members and over 4,700 physicians employed or affiliated with Oschner. 

Ochsner. N.d. “About Ochsner.” https://www.ochsner.org/about-ochsner. Accessed March 1, 2024. 

Xavier University of Louisiana -  Oschner and Xavier’s partnership has been centered around establishing a joint College of Medicine, to “create a strong physician pipeline that addresses longstanding inequities within the nation’s health care system and builds the health care workforce of the future” (Xavier University 2023). Xavier and Oschner have partnered since the early 1980s, when Oschner began offering clinical training sites for Xavier pharmacy students. Today, Ochsner and Xavier have established a master data sharing and use agreement that provides Xavier faculty with access to Oschner Health’s electronic medical record data. The program has hired four data scientists to provide data analytic services to Xavier faculty. They have also worked together to launch Oschner’s health equity data and quality improvement strategy. Advocacy emerging from this partnership has focused on the expansion of services covered by Medicaid to include tobacco cessation, as well as increasing access to evidence-based maternal health technology. 

“Xavier University of Louisiana and Ochsner Health Partner to Create College of Medicine and Pursue Health, Educational Equity - Xavier University of Louisiana.” n.d. Accessed February 27, 2024. https://www.xula.edu/news/2023/01/xavier-university-of-louisiana-and-ochsner-health-partner-to-create-college-of-medicine-and-pursue-health-educational-equity.html.

Ochsner. 2023. “Ochsner Health-Community Benefit Report.” https://issuu.com/ochsnerweb/docs/communitybenefitreport_8x10.5_final. 

Chevron - Oschner’s partnership with Chevron is centered around a smoking cessation and education program that was launched in 2021. In 2023, Chevron opted to continue the partnership for a third consecutive year through a $50,000 donation. The program is offered in the following parishes: Jefferson, St. Tammany, East Baton Rouge, West Baton Rouge, Ascension, St. Charles, Terrebonne, and Lafourche.  In a press release for Oschner, cigarette smoking was described as “the leading cause of preventable deaths and diseases in the nation” (Oschner 2023). The release refers to America’s Health Rankings data that indicates smoking as one of the top 20 factors shaping poor health in Louisiana. This program is part of Oschner’s broader Healthy State initiative. Chevron funding also supports initiatives to encourage low-dose CT scans (to detect and diagnose lung cancer), teach high school students about the risks of smoking, and teach people to recognize and treat the stressors that lead to smoking.

Oschner. 2023. “Ochsner Health and Chevron Partner for a Third Consecutive Year to Offer Smoking Cessation and Education Program.” n.d. Online Newsroom. Accessed February 28, 2024. https://news.ochsner.org/news-releases/ochsner-health-and-chevron-partner-for-a-third-consecutive-year-to-offer-smoking-cessation-and-education-program.

 The Healthy State by 2030 initiative emerged in 2020. The goal of the initiative is to improve access to healthcare in Louisiana through community engagement and by partnering with organizations across different sectors (healthcare, business, religion, education, government, and education). The program also includes a focus on collecting, analyzing, and sharing health data. The program’s priorities are to reduce smoking cessation (with 214,000 fewer residents smoking by 2030); improve access to care for cancer and other chronic conditions like diabetes and high blood pressure through screenings (aiming for 100,000 fewer residents with chronic conditions by 2030); reduce obesity rates (with 182,000 “more physically active adults” by 2030); reduce rates of food insecurity (helping 72,000 more households gain access to healthy food); improve per-capita income levels (by $4,838); and improve access to high-speed internet (with 86,000 more homes having access). 

 This initiative is focused on improving health by improving “the conditions in which we are born, live, and work,” in the words of Dr. Eboni Price-Haywood, the medical director of the Healthy State 2030 Initiative and the Oschner Xavier Institute for Health Equity and Research. However, the projects that have been highlighted under this initiative seem to largely consist of expanding Oschners’ service delivery footprint. Ochsner’s expansion has been welcomed by communities that have long struggled to access care, but this form of intervention is limited in addressing broader structural drivers of health. 

One of the largest investments of Health States has revolved around the opening of five new health centers (in Baton Rouge, Lafayette, Monroe, and Shreveport). The health centers are framed as addressing health equity because they are “strategically located in areas of the state with high instances of chronic conditions, low birth weights, infant mortality, and early adult mortality” (Mcelfresh np, 2022). In addition to healthcare services, the centers offer resources for smoking cessation, diabetes management, and “social issues” that include transportation and food insecurity. Each center has an advisory council that includes patients, elected officials, businesspeople, and community members. 

In 2023, Oschner’s executive leadership announced their commitment to the Global Health Network (GHEN) Zero Health Gaps Pledge.  This initiative falls under the UN Sustainable Development Goals and has been described as a part of Healthy State.  

Ochsner Health. N.d. "Healthy State." https://www.ochsner.org/healthystate. 

Oschner Health. N.d. “Ochsner Health Pledges Zero Health Gaps for World Health Day.” Accessed February 28, 2024. https://www.newswise.com/articles/ochsner-health-pledges-zero-health-gaps-for-world-health-day.

McElfresh, Amanda. 2022. “Ochsner’s Healthy State 2030 Uses Community-First Approach to Improve Life for Louisianans.” NOLA.Com. August 7, 2022. https://www.nola.com/sponsored/cox_business/ochsner-s-healthy-state-2030-uses-community-first-approach-to-improve-life-for-louisianans/article_cfb1a366-1345-11ed-bfdf-33daaec76946.html.

Louisiana Clinical Data Research Network (LACDRN) is a collaborative project between the Louisiana Public Health Institute (LPHI), Pennington Biomedical Research Center, Tulane University, and Ochsner Health System. The network provides warehouses of clinical data available to clinical and health systems researchers: “representing a state and region that has unique health challenges related to disparities, natural disasters, high prevalence of chronic diseases, and some rare conditions, LACDRN is an important resource for clinical and health system research that will advance evidence-based diagnosis, treatment, disease management, and healthcare delivery” (Kurshid et al. 2014, 612).

Khurshid, Anjum, Elizabeth Nauman, Tom Carton, and Ron Horswell. 2014. “Louisiana Clinical Data Research Network: Establishing an Infrastructure for Efficient Conduct of Clinical Research.” Journal of the American Medical Informatics Association : JAMIA 21 (4): 612–14. https://doi.org/10.1136/amiajnl-2014-002740.

Ochsner is using a digital platform developed by Unite US to expand and improve community health throughout Louisiana, in partnership with CVS Health and Humana. The platform is used by insurance companies’ care managers and provider teams to coordinate social services for patients. The Louisiana Unite US more than doubled following the outbreak of COVID-19 (Unite US, 2020).

Unite US. “CVS Health, Humana, Ochsner Health, and Unite Us Join Forces.” 2020. Uniteus.Com. November 18, 2020. https://uniteus.com/press/unite-louisiana-healthcare/.

As a tax-exempt hospital, Ochsner produces publicly accessible community health assessments as a requirement of the Patient Protection and Affordable Care Act (PPACA). As a statewide network, Ochsner has conducted health assessments for Shreveport, Lafayette, Monroe, New Orleans, Kenner, Baton Rouge, St. Mary, St. Anne, Northshore, Houma, Kaplan, Crowley, and Breaux Bridge, as well as Bay St. Louis in Mississippi. 

Ochsner’s proprietary Diversity, Equity and Inclusion (DE&I) Dashboard launched in 2022. The dashboard does not appear to be public however and there is very little available information about this tool. Ochsner's 2022-2023 impact report describes the tool as follows:  “In 2022, Ochsner’s proprietary Diversity, Equity and Inclusion (DE&I) Dashboard launched, informing delivery model innovations and enabling clinicians to identify populations with gaps in care and outcomes. The dashboard includes patient experience and care metrics, with data sortable by sociodemographic groups like race, location, and insurance type. Through the dashboard, we could see that 36% of Ochsner Health Network patients with hypertension are Black or African American, and of those, 80% have their hypertension controlled. In comparison, 86% of white patients with hypertension have it controlled. This data was in turn used to inform strategies to close gaps in care and improve outcomes”  (Ochsner 2022-2023 Impact Report, n.p.). 

Ochsner Health Network. “2022 – 2023 Impact Report, Accelerating Value-Based Care.” Accessed March 2nd 2024.  https://www.ochsner.org/impact-report/. 

Ochsner’s  Enterprise Data Warehouse (EDW) stores clinical data collected over more than 20 years, includes data captured through EPIC/Clarity and claims data.

According to Philip M. Oravetz, MD, MPH, MBA, chief population health officer at Ochsner Health, Oschner is in the process of developing an electronic health record that includes demographic and SDOH data collected at the point of care, and then integrated into artificial intelligence (AI) and predictive modeling (Caffrey and Klein 2022). 

Caffrey, Mary, and Hayden Klein. 2022. “How Ochsner, Xavier Are Working Together to Make Louisiana a Healthy State,” December 2022, 10 (December). https://www.ajmc.com/view/how-ochsner-xavier-are-working-together-to-make-louisiana-a-healthy-state.

Oschner was founded on January 2, 1942, in New Orleans by Alton Oschner, an American surgeon and medical researcher. Before founding Oschner, he worked at Tulane University and organized a surgical teaching program at New Orleans Charity Hospital. Oschner Medical Center, formerly known as the Oschner Clinic, was the first to document the connection between cancer and cigarette use. This work mobilized Oschner to expose the hazards of tobacco and pioneer the war against smoking. 

Blum, Alan. 1999. “Alton Ochsner, MD, 1896-1981 Anti-Smoking Pioneer.” The Ochsner Journal 1 (3): 102–5.

Ochsner’s mission statement is to “We Serve, Heal, Lead, Educate and Innovate” (Ochsner n.d.).

Their vision is to inspire “Healthier Lives and Stronger Communities” (Ochsner n.d.)

Ochsner. N.d. “Mission, Vision, Values.” https://www.ochsner.org/values. 

Being an archipelago, powering Hawaii's energy grid is a notable economic and technological challenge. As local resources and infrastructures for electricity production are limited, the state consumes nearly 7x more energy that it produces (EIA 2023). Much of Hawaii's power plants are powered by different forms of imported petroleum (including 76.4 Btu of jet fuel! (EIA 2023)), which makes up about 4/5 of the state's energy resource mix (EIA 2023). While they are comparatively easy to ship, these fuels are also much more expensive than other fossil fuels (such as natural gas or coal), which power many of the grids in the continental US. As a result, Hawaii has the highest retail price of electricity of any state in the US, at about 3x the national average price (EIA 2023). Another of Hawaii's energy disadvantages is that each island is run as a separate electricity grid, with no undersea electricity transmission cables. This means that, for grid security reasons, each separate island has to produce a surplus of energy (what's called an energy reserve margin target) to ensure grid reliability against unpredictable factors (such as a sudden operation failure of a power plant coinciding with an upswing in energy demand). For comparison, Hawaii Electric, which powers about 95% of the state's electricity (EIA 2023), set's its energy reserve margin at 30% (Hawaii Electric 2021), while most grids in the contiguous US shoot for a reserve margin of about 15%-20% (Energy Knowledge Base ND). 

That said, due in part to these stringent techno-economic challenges, Hawaii has also pushed quite strongly for the state's transition to renewable energy. Hawaii has set the date for 100% renewable energy to 2045, the earliest target date for this transition in the US. Oahu and Maui hit 34.5% renewable energy in 2021, surpassing the goal to hit 30% by 2020 (Oglesby 2021). A smaller electric coop reported that its energy mix achieved a whopping 60% renewables in 2020 (Oglesby 2021). Interestingly, rooftop solar (which is often seen as a less practical/less significant strategy for achieving renewable energy transition) made up the highest source of renewable energy (EIA 2023).

While these facts show promise for a cleaner and more sustainable and energy-independent energy system in Hawaii, these energy transition efforts have also posed new sociotechnical and ethical challenges of their own. Back n 2022,  the Hawaii State Senate passed a renewable energy bill that threatened to severely limit the state's ability to plan and implement a "just transition" to renewable energy. Rehashing many of the arguments against renewable energy in the contiguous US, the bill cited the "intermittency" of solar and wind power as a threat to grid security and thus proposed a policy that would require the state to produce at least 1/3 of its power from more "firm" renewable resources that can produce energy around the clock (i.e. hydroelectric dams, geothermal, and also biomass, renewable biodiesel, and renewable natural gas). While technically renewable, many of these so called "firm" sources continue to emit GHGs and other harmful pollutants that threaten the climate, ecosystems, and public health (Kane 2022). Others, like the hydro electric project in Kauai, continue to threaten the fishing and agricultural operations that many residents rely on for their own staples or for growing cash crops to produce their income (Lyte 2023). Using plantation-era ditch systems, Kauai's hydro project planned to divert an estimated 4 billion gallons of water from the Waimea River watershed, which would all but dry up the river's numerous braided streams upon which many residents depend. As Brittany Lyte notes in her article covering the issue (2023), this plantation-era practice reproduces the cultural and ecological destruction native Hawaiians have been facing and fighting against for over a century.

While activists continue to struggle to ensure that the Kauai hydro project will be ecologically and socially just, to the relief of many environmental and renewable energy advocates, the Hawaii Governor vetoed the aforementioned renewable energy bill in July of 2022. That said, the very fact that this bill passed the state senate illustrates the potential for "renewable energy" transitions to reproduce many of the same social, economic, and even climate and environmental justice issues and challenges that these transitions are (at least superficially) intended to mitigate or resolve.

Sources:

Indigenous farmers - creating food forests that focus on native crops (though they do include non-natives that serve a purpose or simply taste good) and fostering biodiversity/sustainability, also support Hawaii's ability to be self-sufficient (85-95% of food is imported) and the return of native species of animals

Japanese farmworkers - first arrived in 1860s, particularly influential in coffee industry

Filipino farmworkers - 6,000 arrive in 1946

International Longshore and Warehouse Union - includes sugar plantation workers - 1946 28,000 workers strike; again in 1958, 1974 (pineapple workers strike 1947, 1968, 1974)

Agrochemical transnational companies, e.g. Monsanto, Pioneer, Novartis, Cargill - environmental destruction, disregard for regulations on use and disposal of hazardous chemicals, off-site releases of hazardous chemicals from Maui research facility, political lobbying against regulations for GMOs and pesticides

Historic stakeholders - cattle ranchers, monocrop plantations - less common today but their effects on the environment are still very visible

• Cattle ranching begins in 1809
• Coffee plantations begin in 1830s (peaks in 1957)
• Sugar plantations begin in 1850s, peaks in 1933 and again in 1966
• Pineapple plantations begin in 1880s (Dole plantation established in 1901; peaks in 1955)
• Many plantations close in the 1990s

Tourism - economic control

Beyond Pesticides - national organization with programs in Hawaii

Maui County Department of Agriculture - newly created to invest in food sovereignty, help move the island away from monocrop pasts by rehabilitating the environment and creating jobs

Sources:

https://grist.org/agriculture/the-farmers-restoring-hawaiis-ancient-foo…

https://www.mauinews.com/opinion/columns/2022/03/changes-to-agricultura…

https://hdoa.hawaii.gov/wp-content/uploads/2013/01/HISTORY-OF-AGRICULTU…

Significant pesticide usage from industrial agriculture:

• "[Hawaii] became the biotech GMO capital of the US after agrochemical transnationals were welcomed to open research fields with fewer restrictions on potentially toxic pesticides."
• Legacy contamination from past monocrop plantations
• Research facilities owned by agrochemical companies like Monsanto - potential illegal dumping, off-site releases of chemicals

Runoff from agriculture (even if it contains just sediments and no pesticides) is harmful to coral reefs

Sources:

https://grist.org/agriculture/the-farmers-restoring-hawaiis-ancient-foo…

https://www.hawaii.edu/news/2017/03/02/cooperation-is-key-to-reduce-sed…