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2026 - 2029 Community Health Improvement Plan Health improvement in Elizabeth is informed by the people, guided by the data, and sustained through collective action.

Prepared for: City of Elizabeth, New Jersety Prepared Jointly with: Iona Concepts, Inc.

TABLE OF CONTENTS Community Health Improvement Plan 2026 - 2029 MAYOR’S LETTER

DIRECTOR’S LETTER

ABOUT THE CITY OF ELIZABETH

HOW TO READ THIS PLAN

ACKNOWLEDGEMENTS

7-9

EXECUTIVE SUMMARY

10 - 15

COMMUNITY CONTEXT

16 - 27

HOW THIS PLAN WAS BUILT

27 - 34

COMMUNITY ENGAGEMENT FINDINGS

35 - 41

FROM ROOT CAUSES TO CHIP ACTION

KEY HEALTH FINDINGS AND DISPARITIES

43 - 49

SMART GOALS AND IMPLEMENTATION FRAMEWORK

50 - 58

CONCLUSION

59 - 60

ABOUT IONA CONCEPTS, INC.

FORMAL ADOPTION AND APPROVAL

CITATIONS

63 Page 2

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About the City of Elizabeth The City of Elizabeth is one of New Jersey’s most historic and diverse urban centers. Located in Union County, the City of Elizabeth has long served as a gateway for commerce, migration, public service, culture, and community life. The city’s history includes its role as New Jersey’s first capital, its development as a major industrial and transportation hub, and its continued importance as a county seat and regional economic center.

This CHIP treats Elizabeth’s diversity, density, and institutional capacity as assets. It is built on what residents said, what data confirmed, and what partners committed to. The goal is not to describe the problems Elizabeth faces. It is to act on them.

Today, Elizabeth is home to approximately 137,000 residents across six wards, each with distinct neighborhood identities and histories.¹ Over half of Elizabeth’s residents are born outside of the United States, and more than 80 languages are spoken across the city’s households -- a demographic reality that shapes every dimension of this plan.1 Immigrant communities, multigenerational families, elders, youth, workers, and entrepreneurs are the foundation of Elizabeth’s civic and cultural life. Elizabeth’s public health landscape reflects decades of concentrated poverty, industrial land use, housing cost pressure, and underinvestment in preventive and behavioral health infrastructure. These conditions do not affect residents equally. They fall most heavily on low-income households, immigrant and multilingual communities, and residents who have historically faced barriers to care and representation. Page 5

How to Read This Plan The City of Elizabeth Community Health Improvement Plan is a four-year roadmap for eight interconnected health priorities. Residents, community partners, and the City of Elizabeth as a whole helped develop it. Different readers will find different sections most relevant to their role.

Start with the SMART Goals‌‌ Find your name in Partners & Resources‌ Review (Governance) for reporting obligations

Read the Executive Summary‌‌ Review Key Health Findings for your service area‌‌ Contact the Health Department to join the Community Health Council

See the Conclusion for what the City commits to you‌ Read Community Engagement Findings to see what other residents shared‌ Ask about joining the Community Health Council

Read the Executive Summary and Key Health Findings‌‌ Review SMART Goals at a Glance for measurable commitments‌‌ Explore the CHIP Implementation Matrix for partner roles, timelines, and accountability‌ ‌structures aligned to each priority area Page 6

Acknowledgements Land Acknowledgements The City of Elizabeth sits within Lenapehoking, the ancestral homeland of the Lenape people, whose relationships with this land, water, plants, animals, and community life extend far beyond the period of colonial settlement. We acknowledge the Lenape people and other Indigenous nations connected to this region, whose descendants remain present and active throughout New Jersey and beyond. We recognize that Elizabeth’s public health story begins before the city's founding, before industrialization, and before modern systems of government. This land carries histories of stewardship, displacement, survival, and resilience. As this Community Health Improvement Plan advances equity, repair, and wellness, we commit to remembering that land, health, housing, language access, environmental justice, and community power are deeply connected. This acknowledgment is offered with humility and with the understanding that acknowledgment alone is not a repair. It is a call to deepen relationships, honor Indigenous knowledge, and support policies and practices that advance justice for all who live, work, learn, worship, and gather in the City of Elizabeth.

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Honoring the People & Partnerships Behind the Plan This Community Health Improvement Plan was shaped through the leadership, insight, and contribution of local public health, civic, and community stakeholders committed to a healthier and more equitable City of Elizabeth. Their guidance helped ground this report in the lived realities of Elizabeth residents, the operational knowledge of city systems, and a shared commitment to improving health outcomes across neighborhoods, cultures, languages, and generations. We also acknowledge the residents, community-based organizations, service providers, city staff, educators, faith leaders, and advocates who contributed time, experience, data, and wisdom to this process. Their voices are essential to building a CHIP that is not only data-informed but community-rooted.

Leadership Mayor J. Christian Bollwage — Mayor, City of Elizabeth Krishna Garlic — Director, Elizabeth Health and Human Services

Participants and Community Stakeholders Hassan Abdur-Rahman — Health Officer, Elizabeth Health and Human Services Patricia Alcivar — Recreation Leader Tahiyah Brinkley — Community Outreach John Brooks — Community Stakeholder, The Interruptors Vanee Brown — Supervisor of Transportation, Health & Human Services James Carey — Community Stakeholder and Community Representative Sheila Casey — CEO, Josephine’s Place Women’s Health & Resource Center Mark S. Colicchio — Health Officer, Elizabeth Health and Human Services Jerrell Coleman — Community Liaison Danielle Coon — Health Educator, International Rescue Committee Rev. Leonard Grayson — Public Health Supervisor, Elizabeth Health Department Naomi Guerrero — Recreation Leader Salaam Ismiall — Youth Mentor and Activist Brian Jefferson — Bus Aide/Clerk, Senior Services Dennise Lebron — Rental Assistance Supervisor, Health & Human Services Jessica Martinez — Supervisor, Office of Aging, Elizabeth Health Department Alison Millan — Deputy Director, International Rescue Committee Dr. Guillermo Muñoz — Family Practice Physician, Elizabeth Board of Education Kerri Powell — CEO, Neighborhood Health Services Angelica Rodriguez — Public Health Supervisor, Elizabeth Public Health Katherine Rodriguez Almeida — Clerk, Office of Aging Yaramo E. Soumaoro — Health Officer, Elizabeth Health and Human Services Page 8

Hannah Steele — Health & Wellness Coordinator, Rescue (Elizabeth, NJ)* Lagrette Stephens — Infectious Disease Generalist Angeline Vil — Community Health Worker, Irvington Public Library Dr. Chana Zablocki — Family Practice Physician

Participating Organization African Diasporatas Trinitas Boxwood Collaboration over Competition Cranford & Elomora Soup Kitchen Elizabeth Board of Health Elizabeth Coalition to House The Homeless Elizabeth Environmental Company Health Department Jefferson Park Ministry Lakay Access Sante (LAS) Oak Street Health Proceed Refugee & Immigrant Services Organization UCSS/Welfare United Corp For Lead Safe

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Executive Summary Overview Elizabeth’s Community Health Improvement Plan 2026–2029 commits the City, its health partners, and community residents to eight measurable goals across the health priorities residents identified as most urgent: housing stability, environmental health, behavioral health access, chronic disease prevention, and food security. It is grounded in 18 months of community engagement with approximately 300 participants through surveys, interviews, listening sessions, and cross-sector collaboration. The CHIP takes a health equity approach, examining how Elizabeth, New Jersey’s demographic, social, and economic conditions shape health outcomes and access to care. With approximately 60% of residents foreign-born¹ and nearly 1 in 3 living below the poverty line,1 the plan prioritizes community-informed strategies that address barriers to health and well-being. This plan is a shared accountability framework, not a departmental work plan. It names lead partners, sets baselines, and tracks progress on outcomes that no single agency can move alone.

The 2026 - 2029 Direction This CHIP is not a list of aspirations. It is a coordinated accountability framework with SMART goals, named implementation partners, milestone deadlines, performance baselines, and a public-facing progress dashboard that the Community Health Council will review quarterly. The strategic direction for 2026–2029 is a deliberate shift: From

Fragmented services

Connected systems

Crisis response

Prevention

Translation alone

Culturally grounded communication

Resident input

Shared community power

Documenting disparities

Changing the conditions that produce disparities

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Who This Plan Serves Elizabeth is New Jersey’s fourth-largest city and one of its most diverse. Residents speak more than 40 languages.1 Neighborhoods vary significantly in exposure to environmental hazards, access to green space, proximity to fresh food, and availability of behavioral health services. These differences are not random. They reflect decades of disinvestment and structural inequity that this plan directly names and intends to address. The four priority populations driving this plan’s design are long-term Latino residents, recent immigrant and refugee families, low-income households in the South and West wards, and youth ages 12 to 24.

How The CHIP Was Built The Elizabeth Health Department, in partnership with Iona Concepts, LLC, used a Participatory Action Research model to develop this plan.2 Community members were not consulted after decisions were made. They shaped the questions, validated the findings, and identified the priorities. Data collection included a resident health survey, key informant interviews with more than 30 service providers and organizational leaders, focus groups conducted in English, Spanish, and Portuguese, and secondary data analysis from the New Jersey Department of Health and the American Community Survey.

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What the Community Said Between October 2025 and June 2026, Iona Concepts engaged 113 survey respondents, conducted 18 key informant interviews, and facilitated 6 community listening sessions across Elizabeth’s four ZIP codes. The findings were direct:

Eight Priority Areas

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The Eight Goals This plan organizes action into eight SMART goals aligned to the priority areas above:

Chronic disease prevention and food security are cross-cutting priorities tracked through existing goals and the Elizabeth Health Dashboard rather than as standalone goals. Baselines for both will be established through the 2026 resident survey and recalibrated in Year 1.

Equity as a Design Principle Every goal in this plan includes an equity measure. Progress will be tracked not only by whether the overall metric moves, but by whether it moves for the residents who are currently furthest from a good outcome. The Community Health Council will review equity implications at each quarterly meeting and flag disparities for corrective action. This plan also acknowledges the historic distrust of institutions that shapes how many Elizabeth residents interact with public systems. Every implementation strategy is designed with that reality in view.

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Implementation and Accountability This plan rolls out in phases across 2026–2029. As the infrastructure builds, accountability will operate at three levels: monthly milestone updates submitted by each goal’s lead partners; quarterly review by the Elizabeth Community Health Council, which will assess equity implications, resource gaps, and course corrections; and annual recalibration of baselines and targets against the most current survey and administrative data. A publicfacing CHIP dashboard, launching January 2027, will make goal-level progress visible to all Elizabeth residents throughout the plan period.

Accountability will extend beyond compliance. The City will use measurable indicators, named partners, public progress updates, and recurring community feedback loops to support transparency, shared learning, and course correction. The CHIP is therefore a living roadmap: priorities and strategies may be refined as implementation data, resident experience, and available resources evolve.

Health improvement in Elizabeth will be informed by the people, guided by the data, and sustained through collective action.

This Plan Cannot Wait One in two Elizabeth residents was born outside the United States.¹ More than three in four speak a language other than English at home.1 And when residents were asked in 2025 and 2026 to rate the cultural and linguistic respect they receive from health and social service providers, the average score was 1.8 out of 5.3 Page 14

This Plan Cannot Wait A score of 1.8 on a 5-point respect scale does not describe a gap in customer service. It describes a system that most Elizabeth residents do not trust, do not feel welcomed by, and in many cases have stopped using. Thirty-two percent of survey respondents reported experiencing discrimination when seeking care.3 When residents avoid care because they do not feel safe in the system, every other health investment the City makes operates at reduced effectiveness. This plan is the City’s structured response to that reality. The costs of inaction are not abstract. When 67% of residents perceive housing as unaffordable and 42% report living in overcrowded conditions,3 those conditions drive chronic stress, respiratory illness, and childhood developmental delays that increase emergency department utilization4 and long-term disability costs. When residents cannot navigate a fragmented service system, they cycle through crisis care rather than prevention. When harm reduction information does not reach the people who need it in the language they speak, overdose deaths follow.5 This plan is built on the recognition that health outcomes in Elizabeth will not improve by treating symptoms in isolation. The conditions that produce those symptoms must change.

This plan belongs to Elizabeth. The data are the residents. The priorities are the community’s. The accountability is shared.

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Community Context Understanding the Conditions that Shape Health Historical and Structural Context Elizabeth’s history continues to shape its public health landscape. Established as an English settlement in 1664 and later recognized as New Jersey’s first capital, the city grew through its port, transportation networks, industry, and successive waves of immigration. This growth created economic opportunity and a diverse community, while also contributing to environmental exposures, aging infrastructure, housing pressures, and uneven investment. Today, the city’s proximity to the Port of New York and New Jersey remains relevant to these challenges, as diesel emissions, freight traffic, and industrial air pollution are associated with asthma, impaired lung function, and cardiovascular disease. Together, these historical and environmental conditions provide important context for understanding health disparities and guiding the CHIP’s priorities. Elizabeth’s population density, aging housing stock, transportation corridors, port activity, and economic pressures intersect with factors such as race, income, immigration status, language, age, disability, housing stability, and access to care to shape residents’ health and well-being.

City Demographics and Population Overview Elizabeth is one of New Jersey's largest, most diverse, and most densely populated cities. The 2020 U.S. Census counted 137,298 residents; recent American Community Survey estimates place the population at approximately 140,401 across 12.3 square miles, or about 11,145 residents per square mile.1 Located about 15 miles from New York City, Elizabeth includes compact residential neighborhoods, major transportation corridors, and a significant industrial and logistics presence shaped by Port Newark-Elizabeth, Newark Liberty International Airport, and the New Jersey Turnpike. These assets support employment, mobility, and regional access while also placing pressure on housing, infrastructure, traffic, parking and environmental conditions. Elizabeth is also a deeply multilingual immigrant gateway. An estimated 51.6% of residents were born outside the United States, and 77.1% of residents aged five and older speak a language other than English at home.1 Spanish, Portuguese, and Haitian Creole are among the languages spoken across the city. Approximately 25% of residents are under age 18, 11% are age 65 or older, and the median age is 34.6.1 This diversity is a central community strength and makes multilingual, culturally responsive public health communication essential.

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Note: Selected language categories shown; figures do not total 100%. English-only figure calculated as complement of non-English speakers. Source: U.S. Census Bureau, American Community Survey (ACS) 2019--2023 Five-Year Estimates, Table B16001: Language Spoken at Home by Ability to Speak English for the Population 5 Years and Over. Elizabeth City, New Jersey. data.census.gov.

Elizabeth’s language diversity makes accessible, culturally responsive communication important across healthcare, education, and public services.

Understanding Elizabeth Through Its Neighborhoods Elizabeth may be one city, but residents’ experiences can look very different depending on where they live. Across ZIP codes 07201, 07202, 07206, and 07208, differences in income, education, housing, and homeownership help tell a larger story about the conditions that shape health and well-being. While all four areas reflect Elizabeth’s rich cultural and linguistic diversity, residents do not always have the same resources or opportunities to thrive. Elizabeth’s four residential ZIP codes, 07201, 07202, 07206, and 07208, reflect the city’s diversity while also revealing meaningful differences in income, educational attainment, housing conditions, and homeownership. The profiles below document how these differences vary across neighborhoods and what they mean for residents’ health and well-being.

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Social and economic conditions vary across Elizabeth’s ZIP codes. In 07206, median household income and educational attainment are below citywide levels, while poverty and household crowding are higher. ZIP code 07208 has higher educational attainment and lower poverty and crowding than the city overall, although its median household income remains below the citywide figure. In 07202, median household income is above the citywide level, and poverty is lower. In 07201, poverty is higher than the citywide rate, and only 19.9% of occupied housing units are owner-occupied.1

Disability and Accessibility Across Elizabeth Beyond ZIP code differences, disability is a key factor in understanding health outcomes and access to services in Elizabeth. Among residents under age 65, 8.0% have a disability, compared with 5.9% in Union County and 7.0% statewide1. These findings reinforce the importance of accessible healthcare, transportation, housing, and public spaces, along with services and communication that respond to different disability types and language needs.

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Social, Economic, and Environmental Conditions Elizabeth’s social and economic landscape reflects a diverse, densely populated city where access to resources and opportunities varies across households and neighborhoods. This diversity is central to Elizabeth’s identity, with substantial Colombian, Ecuadorian, Dominican, and Salvadoran communities.1 It also makes access to culturally responsive services, language assistance, and clear health information important considerations across healthcare and social services. Economic circumstances and housing conditions add another layer to this picture. Although Elizabeth supports significant commercial, industrial, and transportation activity, many households continue to face financial constraints. Income, housing affordability, food security, and access to healthcare are interconnected concerns that help explain the challenges some residents face in maintaining their health and well-being.

Socioeconomic Context Economic conditions in Elizabeth shape how households manage basic needs, including housing, food, and healthcare. The city’s median household income is $66,555, while per capita income is $28,969; approximately 15.7% of residents live below the federal poverty level.1 Housing costs add to these pressures. Median gross rent is $1,523 per month, and only 25.6% of occupied housing units are owner-occupied1, reflecting a housing landscape in which most occupied units are renter-occupied. Together, these indicators provide context for the financial demands facing households as they balance housing expenses with other essential costs.

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Food access is another part of this economic picture. The 2025 Trinitas Regional Medical Center Community Health Needs Assessment found that 30.4% of surveyed Union County respondents worried that food would run out before they had money to buy more?. Among Hispanic/Latino respondents, the figure rose to 56.4%?. Census data reported in the same assessment indicate that 15.9% of Elizabeth residents received Supplemental Nutrition Assistance Program (SNAP) benefits during 2019–2023, compared with 8.1% of Union County residents and 8.8% of New Jersey residents?. SNAP participation does not directly measure food insecurity, but it provides additional context about the role of food assistance in the city. Taken together, these indicators illustrate how economic security, housing, and food access intersect in residents’ daily lives. When household budgets are stretched, families may have less money available for nutritious food, medications, transportation, and routine healthcare. Housing affordability and stability can also influence household stress, safety, and exposure to environmental hazards. These conditions provide important context for understanding the broader factors that shape health and well-being across Elizabeth.

74.2%

hold a high school diploma or higher credential

hold a bachelor's

14.6 % degree or higher

Health literacy is the capacity to find, understand, and act on health information to make informed decisions about care, coverage, and prevention. It is shaped by factors that extend well beyond years of schooling: the clarity and reading level of health materials, the availability of language-appropriate information, the complexity of systems residents must navigate, and the presence of culturally responsive support. In Elizabeth, where a substantial share of residents speak a language other than English at home and many have limited English proficiency,¹ these factors carry particular weight. When medical instructions, insurance enrollment forms, public benefit applications, or community resource directories are available only in English, language becomes a structural barrier to health access. This is a gap that educational attainment statistics do not capture and that health programs must actively address.

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Food Access and Economic Pressure

All Union County respondents

30.4%

Hispanic / Latino respondents

worried food would run out before they had money to buy more

56.4%

SNAP Participation Rates, 2019 - 2023 City of Elizabeth

New Jersey

Union County 0

Source: U.S. Census data reported in the 2025 Trinitas Regional Medical Center and RWJUH Community Health Needs Assessment.19 Elizabeth's SNAP participation rate is nearly double the county and state averages.

Taken together, these indicators illustrate how economic security, housing, and food access intersect in residents’ daily lives. When household budgets are stretched, families may have less money available for nutritious food, medications, transportation, and routine healthcare. Housing affordability and stability can also influence household stress, safety, and exposure to environmental hazards. These conditions provide important context for understanding the broader factors that shape health and well-being across Elizabeth.

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Food Access and Economic Pressure Food access is another part of this economic picture. The 2025 Trinitas Regional Medical Center Community Health Needs Assessment found that 30.4% of surveyed Union County respondents worried that food would run out before they had money to buy more?. Among Hispanic/Latino respondents, the figure rose to 56.4%?.

All Union County respondents

30.4%

worried food would run out before they had money to buy more

Hispanic / Latino respondents

56.4%

worried food would run out before they had money to buy more

Census data reported in the same assessment indicate that 15.9% of Elizabeth residents received Supplemental Nutrition Assistance Program (SNAP) benefits during 2019–2023, compared with 8.1% of Union County residents and 8.8% of New Jersey residents?. SNAP participation does not directly measure food insecurity, but it provides additional context about the role of food assistance in the city. Taken together, these indicators illustrate how economic security, housing, and food access intersect in residents’ daily lives. When household budgets are stretched, families may have less money available for nutritious food, medications, transportation, and routine healthcare. Housing affordability and stability can also influence household stress, safety, and exposure to environmental hazards. These conditions provide important context for understanding the broader factors that shape health and well-being across Elizabeth.

Educational Attainment and Health Literacy Among Elizabeth residents age 25 and older, 74.2% have earned a high school diploma or higher credential, and 14.6% hold a bachelor’s degree or higher.¹ These figures offer a useful baseline, but educational attainment does not directly measure health literacy. Health literacy is the capacity to find, understand, and act on health information to make informed decisions about care, coverage, and prevention. It is shaped by factors that extend well beyond years of schooling: the clarity and reading level of health materials, the availability of language-appropriate information, the complexity of systems residents must navigate, and the presence of culturally responsive support.

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Health Insurance Coverage in Elizabeth Health insurance is a foundational determinant of whether residents can access preventive care, manage chronic conditions, and seek timely treatment. In Elizabeth, coverage gaps are significant and fall disproportionately on low-income adults. According to the U.S. Census Bureau’s American Community Survey, 11.2% of Elizabeth residents were uninsured in 2023, including 15.6% of adults ages 18 to 64 and 4.3% of children.¹ These rates reflect the combined effects of income constraints, limited access to employer-sponsored coverage, and gaps in Medicaid enrollment among eligible residents. The coverage gap is most acute among low-income adults. Data from the U.S. Census Bureau’s Small Area Health Insurance Estimates (SAHIE) program show that 28.0% of Elizabeth residents under age 65 living at or below 138% of the federal poverty level were uninsured in 2023, representing approximately 9,030 individuals.7 This rate exceeds Union County (23.1%), New Jersey overall (16.5%), and the national average (15.7%), and it is the highest among all New Jersey counties. Nearly 3 in 10 low-income adults in Elizabeth lack health coverage. These figures point to an urgent need for targeted outreach and enrollment support, particularly for residents who may qualify for Medicaid or NJ FamilyCare but remain unenrolled. Language-accessible enrollment assistance and community-based navigator services are essential to closing this gap.

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Housing Safety and Overcrowding The City of Elizabeth’s 2025-2029 Consolidated Plan documents housing needs that extend beyond affordability to the physical adequacy of residents’ living environments.²⁷ Overcrowding is among the most widespread concerns, affecting thousands of households across both renter and owner-occupied units. The Consolidated Plan distinguishes between two levels of crowding severity based on the number of persons per room.

Elizabeth households living in overcrowded conditions

3,345 Renters and owner-occupants combined.8

Taken together, these conditions reflect the extent to which a share of Elizabeth’s residents navigate daily life in housing that does not meet basic standards of adequacy. Overcrowding constrains access to

Overcrowding is not the only measure of housing inadequacy documented in the Consolidated Plan. A separate and distinct concern affects households that lack access to complete plumbing or kitchen facilities.

724

Elizabeth households lack complete plumbing or kitchen facilities 8 (675 renter, 49 owner)

rest, privacy, and personal space, and is associated with higher transmission of communicable illness and elevated household stress. The absence of complete plumbing or kitchen facilities compounds barriers to hygiene and food preparation. These are upstream conditions that shape health outcomes across multiple priority areas identified in this plan, and they underscore the importance of housing as a cross-cutting strategy in any community health improvement effort.

Employment and Economic Vulnerability Elizabeth continues to attract commercial investment, redevelopment, and new housing construction. Initiatives such as the Urban Enterprise Zone and Midtown redevelopment aim to support business activity, strengthen commercial corridors, and encourage private investment. These efforts create opportunities, but their benefit to residents depends on whether the resulting jobs and housing remain accessible across income levels. Labor force participation in Elizabeth is substantial: 67.6% of residents age 16 and older are active in the civilian workforce.¹⁷ Yet 15.7% of residents live below the federal poverty line, a figure that reflects a persistent gap between employment and economic security.¹⁷ For many working families, wages have not kept pace with the cost of living, and housing costs are a primary driver of financial strain.

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Fair Market Rent (FMR) benchmarks for the Newark metropolitan area, which includes Elizabeth, illustrate the scale of that strain. For FY 2026, estimated monthly rents for modest units are $1,612 for a studio, $1,822 for a one-bedroom, $2,205 for a twobedroom, and $2,761 for a three-bedroom apartment.9 These figures represent the estimated cost of modest private-market housing and are used to determine eligibility for federal housing assistance programs. For a household earning at or near the poverty line, even a studio apartment exceeds what most housing affordability standards would consider manageable.

Residents have named this tension directly:

“It’s stressful with the creation of high-rises. It’s unaffordable for them. New townhouses are too expensive. This causes stress on the families. Income doesn’t match the rising housing cost.” - Elizabeth Resident

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As investment and development continue, ensuring that economic growth translates into tangible benefit for existing residents across income levels remains a central challenge. The gap between workforce participation, poverty rates, and housing costs reflects a broader pattern in which economic activity does not automatically produce economic security. Addressing this gap requires strategies that connect employment growth to wage quality, housing affordability, and resident stability. As Elizabeth continues to attract investment and development, an important consideration is whether new housing and economic opportunities remain accessible to existing residents across income levels. The contrast between workforce participation, poverty, and rental costs highlights why economic growth should be considered alongside housing affordability and household financial stability. Together, these indicators provide a broader picture of Elizabeth’s changing economic landscape and the challenges residents may face as the city develops.

Community Assets & Strengths Elizabeth has an established network of public institutions, healthcare providers, and community organizations whose reach extends well beyond clinical care. The Elizabeth Health Department anchors the city’s public health infrastructure, providing direct services, health education, and coordination across programs. Trinitas Regional Medical Center serves as the primary acute care facility for city residents and offers a range of specialty and behavioral health services. Together with schools, social service agencies, housing assistance programs, food-access organizations, and services for older adults and youth, these institutions form the foundation of Elizabeth’s community health ecosystem.10 Community life is further shaped by Elizabeth’s cultural and linguistic diversity. Faith communities, immigrant-serving organizations, cultural associations, and informal neighborhood networks serve as trusted channels through which residents find information, maintain social connections, and seek help when formal systems are difficult to navigate. These relationships carry particular significance in a city where language, immigration status, and economic pressure can create distance between residents and institutional services. Taken together, Elizabeth’s formal institutions and community-based networks represent a substantial asset base for CHIP implementation. Effective action will depend on activating and coordinating these assets, rather than building parallel systems from scratch.

Community-Identified Resources As part of the community health needs assessment process, residents were asked to identify the services they currently find most helpful. Their responses reflect both existing trust in key institutions and an opportunity to strengthen coordination across those systems. Page 26

Helpful Service

Survey Result

Health Department

46.24%

Schools

38.71%

Hospitals

29.03%

Taken together, Elizabeth’s demographic diversity, neighborhood-level inequities, structural conditions, and demonstrated community assets point to a clear direction for this plan. CHIP implementation must be place-based, multilingual, culturally responsive, and accountable to the residents it serves. The City’s strongest path forward is to pair datainformed investment with trusted community partnerships, coordinated service delivery, resident leadership, and consistent public reporting on progress.

How This Plan Was Built Centering Resident Voice in Public Health Planning The City of Elizabeth Community Health Improvement Plan was developed through an equity-centered, community-driven process grounded in the understanding that health is shaped by social, economic, environmental, cultural, and policy conditions. Residents, workers, service providers, and community stakeholders helped interpret data, identify priorities, and shape solutions. Community engagement was treated as an ongoing planning practice rather than a one-time activity. This process reflects four core commitments: 1. Health priorities must be informed by people most impacted by inequity. 2. Data must be combined with lived experience to tell a fuller story. 3. Solutions must address root causes, not only symptoms. 4. Implementation must remain accountable to residents over time. Surveys, stakeholder interviews, listening sessions, secondary data analysis, and community validation sessions connected measurable health indicators with residents’ lived experiences and the structural barriers shaping daily life.

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Participatory Action Research Model The CHIP used a Participatory Action Research model in which those closest to the conditions being studied helped define questions, interpret findings, identify priorities, and shape recommendations.

Who Participated The CHIP was developed using a Participatory Action Research (PAR) model in which those closest to the conditions being studied helped define questions, interpret findings, identify priorities, and shape recommendations. This meant the planning process was not limited to expert analysis or institutional data. It included residents, youth, older adults, unhoused individuals, immigrant community members, service providers, municipal staff, healthcare partners, school representatives, housing partners, and community-based organizations.

Participatory Practice

Purpose

Community surveys

Captured resident perceptions of health, safety, access, housing, services, and priorities

Stakeholder interviews

Gathered system-level insight from city departments, health systems, schools, housing partners, nonprofits, and community leaders

Listening sessions

Created space for residents to describe lived experiences, barriers, and community strengths

Data synthesis

Combined survey data, interviews, listening sessions, and secondary data sources

Equity lens coding

Analyzed findings by race, language, ZIP code, age, determinant category, and lived experience where possible

Community validation

Brought findings back to residents and partners to confirm meaning and priority areas

Cross-sector sense-making

Supported shared interpretation among city agencies, providers, nonprofits, and community leaders

Together, these practices produced a data-informed, community-validated plan grounded in both measurable indicators and lived experience.

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Guiding Values The CHIP process was shaped by four guiding values: voice, trust, access, and accountability.

Voice Resident voice is central to this plan because community knowledge reveals barriers, strengths, and solutions that do not appear in traditional datasets. Through surveys, listening sessions, interviews, and validation sessions, residents identified concerns related to housing, environmental conditions, mental and maternal health, harm reduction, service navigation, language access, discrimination, and cultural responsiveness. Their input directly shaped the final priorities and recommendations.

Trust Trust is a public health condition. Residents are more likely to seek help, use services, share information, and engage in prevention when systems are safe, respectful, and responsive. Building trust requires transparent communication, culturally grounded engagement, community-based outreach, and trusted messengers. This is especially true where language barriers, immigration-related fear, discrimination, fragmented systems, or prior institutional harm have affected residents’ willingness to participate.

Access Access extends beyond service availability to include affordability. It includes affordability, language and disability accommodations, transportation, digital access, cultural responsiveness, clear eligibility information, effective navigation support, and freedom from fear or stigma. Across healthcare, housing, behavioral and maternal health, social services, harm reduction, and public information, these barriers call for coordinated strategies such as multilingual communication, community navigators, referral pathways, resource hubs, trusted messengers, and public dashboards.

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Accountability Accountability requires visible action. Residents and partners must be able to see the selected priorities, responsible parties, progress made, remaining barriers, and any adaptations over time. Measurable objectives, timelines, responsible partners, a Community Health Council, annual reporting, and an equity dashboard will support transparency and responsiveness throughout implementation.

How Community Knowledge Informed This Plan Residents described health as inseparable from housing, safety, mental health, language, culture, environment, trust, affordability, transportation, food access, and service navigation. This broader understanding shaped the CHIP’s findings, priorities, and recommendations. The engagement process revealed several cross-cutting themes: Housing is a health issue. Residents connected affordability, overcrowding, pest infestations, deferred repairs, water interruptions, homelessness, and unsafe conditions to stress, illness, instability, and reduced quality of life. Mental health is a community priority. Residents and stakeholders identified stress, trauma, isolation, youth needs, crisis support, and behavioral health access as major concerns. Language access is essential. In a multilingual city, health information must be available in the languages residents use and delivered through messengers they trust. Cultural responsiveness affects care-seeking. Residents described the importance of being respected, understood, and safe when using health and social services. Systems are difficult to navigate. Residents often struggle to identify which services exist, where to go, who qualifies, and how to access help. Environmental conditions are public health issues. Trash, rodents, mold, air quality, water concerns, and neighborhood conditions affect physical and emotional wellbeing. Harm reduction and cannabis education must be stigma-free. Residents identified the need for education, prevention, safe use information, youth support, senior education, and trusted guidance. Community assets already exist. Residents identified health and wellness services, housing supports, schools, hospitals, senior centers, youth-serving and immigrantserving organizations, and grassroots networks as essential assets. These insights clarified the issues residents consider most urgent, the systems that must coordinate, and the populations requiring focused support. Page 30

Equity-Centered Planning in Practice An equity-centered approach means that the CHIP does not only ask, “What are the health problems?” It also asks: Who is most impacted? What conditions are creating the problem? What barriers prevent residents from getting help? Which systems need to change? What community assets can be strengthened? How will residents know whether progress is being made? These questions connect lived experience to systems and policy, recognizing that health inequities arise from conditions such as economic inequality, housing instability, environmental exposure, language barriers, discrimination, underinvestment, workforce burnout, and fragmented services. Accordingly, the CHIP emphasizes systems change through housing-health partnerships, environmental health response, language access, culturally responsive care, service navigation, mental and behavioral health integration, and sustained resident accountability.

Community-Driven Implementation Resident engagement must continue after this plan is published. The following practices will support ongoing accountability and responsiveness.

Sustaining Accountability and Resident Leadership Implementation Practice

Purpose

Community Health Council

Sustain resident leadership and partner accountability

Annual resident pulse surveys

Track changing needs and resident experience over time

Listening sessions

Continue gathering qualitative insight and community validation Page 31

Reaching and Communicating with Residents Implementation Practice

Purpose

Youth and senior engagement

Ensure age-specific priorities remain visible

Trusted messenger outreach

Share information through credible community channels

Multilingual communication

Ensure information reaches residents across language groups

Public dashboard review

Make progress visible and actionable

Resident stipends where possible

Recognize community expertise and reduce participation barriers

These practices will help the CHIP remain responsive to changing conditions and accountable to the residents it serves.

Data Collection and Analysis Primary Data The CHIP used multiple forms of primary data collection to understand residents’ lived experiences, health priorities, and service barriers. The resident survey gathered information about health priorities, housing, environmental conditions, mental health, maternal health, cannabis and harm reduction education, service navigation, cultural responsiveness, neighborhood safety, and preferred communication channels. The survey yielded 113 completed responses. Eighteen key informant interviews were conducted between October 2025 and June 2026, guided by a structured nine-section protocol covering healthcare access, behavioral health, housing, systems coordination, equity and representation, policy, and harm reduction. Interviewees represented public health, healthcare, housing, emergency management, municipal leadership, aging services, immigrant and refugee services, education, and community-based organizations. The full interview guide is provided in Appendix C. Iona Concepts conducted six community listening sessions across multiple neighborhoods and resident groups, including sessions with youth, seniors, unhoused residents, Hispanic residents, African American residents, service providers, and community stakeholders. These sessions surfaced lived experience, community strengths, barriers to care, and resident-defined health priorities. Page 32

Secondary Data To complement resident and stakeholder input, the CHIP drew on a range of secondary data sources. These sources provided population-level context, health outcome data, and structural indicators that helped situate Elizabeth’s conditions within county, state, and national trends.

National and State Data Sources Data Source

Use in CHIP

U.S. Census Bureau / American Community Survey (ACS)

Population demographics, income, poverty, language spoken at home, housing characteristics, immigration, age distribution, and household composition

U.S. Census Bureau Small Area Health Insurance Estimates (SAHIE)

Uninsured rates among low-income adults under age 65 at the city and county level

CDC Population Level Analysis and Community Estimates (PLACES)

Chronic disease prevalence, behavioral health indicators, and preventive care utilization at the local level

County Health Rankings

Health outcomes and health factor rankings by county, including social and economic determinants

NJ Department of Health (NJDOH) and NJ State Health Assessment Data (NJSHAD)

State and local public health indicators, mortality data, and disease surveillance

NJ Office of the State Comptroller / U.S. Department of Housing and Urban Development

Fair Market Rent benchmarks used to assess housing affordability relative to resident income

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Secondary Data Local and Regional Data Sources Data Source

Use in CHIP

RWJBarnabas Health / Trinitas Regional Medical Center Community Health Needs Assessment (2025)

Local health needs data including food insecurity, insurance coverage, SNAP utilization, and priority health conditions for Elizabeth and Union County

Union County Community Health Needs Assessment and CHIP

Regional health priorities and alignment with hospital community benefit planning

City of Elizabeth Health Equity and Diversity Assessment

Local equity context, demographic disparities, and baseline health conditions specific to Elizabeth

Local administrative data

Housing code enforcement records, sanitation complaints, emergency management data, public works activity, and municipal service utilization patterns

Cannabis tax revenue data

Context for public health reinvestment planning related to cannabis education and harm reduction programming

These secondary sources complement resident and stakeholder input, providing a fuller picture of local health conditions, disparities, and structural determinants. Appendix D provides a complete list of citations, dataset names, access dates, and source URLs.

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Community Engagement Findings Who Participated The community engagement process included 113 completed resident surveys, 18 key informant interviews, and 6 community listening sessions conducted between October 2025 and June 2026. Findings were closely aligned across all three methods. Interviewees represented public health, healthcare, housing, emergency management, immigrant and refugee services, aging services, municipal leadership, education, youth advocacy, maternal health, and community-based organizations. Participating organizations included Health and Human Services, Division of Aging, Neighborhood Health Services, the Elizabeth Board of Education, emergency management and immigrant and refugee service providers, Josephine’s Place, Rescue, Pivot, and additional community partners. Together, they contributed both system-level perspectives and direct resident experience. The English-language resident survey reflected substantial racial, ethnic, gender, and youth participation. Among respondents, 54.17% identified as Black or African American, 41.67% as Hispanic or Latino/a/x, and 5.21% as White. Women accounted for 71.13% of respondents, and 27.84% were under age 18. Responses from ZIP codes 07206, 07208, and 07202 provide a foundation for future ZIP code-level analysis in the CHIP dashboard. Six community listening sessions reached residents across multiple neighborhoods and settings, including the Snyder Center, Building Future Leaders, O’Donnell Dempsey Center, Stephen Sampson Senior Center, Liberty Square Senior Center, and Peterstown Recreation Center. Participants included youth, older adults, unhoused residents, immigrant community members, Hispanic and African American residents, service providers, and other community stakeholders. Community listening sessions included:

Listening Sessions

Total

156 Participants

Engagement

6 Sites

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Engagement Site

Primary Participants

Participants

Snyder Center

Food kitchen and unhoused residents

Building Future Leaders

Youth

O'Donnell Dempsey Center

Primarily Hispanic residents

Stephen Sampson Senior Center

Primarily African American senior residents

Liberty Square Senior Center

Senior residents

Peterstown Recreation Center

Community residents

Total Participants

156

Source: City of Elizabeth Community Health Improvement Plan, 2026–2029. Listening session participant counts reflect in-person attendance at each site.

Language Access and Accessibility Language access and cultural responsiveness emerged as both engagement requirements and major community findings. In a multilingual city, effective health communication must extend beyond translation to include trusted, culturally grounded outreach. Across surveys, interviews, and listening sessions, multilingual, immigrant, refugee, Hispanic, African American, youth, older-adult, and unhoused participants identified language gaps, cultural disconnect, immigration-related fear, and institutional distrust as recurring barriers to care. A Transmedia Language Access Strategy should combine print materials, digital media, video, social media, community radio, text-based outreach, and trusted messengers to provide consistent, accessible, and culturally relevant health information.

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What We Heard Most Often: Cross-Cutting Themes Several themes appeared consistently across surveys, interviews, and listening sessions and directly informed Elizabeth’s 2026-2029 CHIP priorities.

1. Housing Stability, Affordability, and Homelessness Residents and stakeholders repeatedly identified lack of affordable housing, overcrowding, homelessness, and housing instability as major drivers of health. Housing was connected to stress, family stability, access to care, neighborhood safety, and exposure to environmental hazards. Survey results reinforced this theme, with residents reporting concerns about affordability, safety, overcrowding, pest infestations, incomplete repairs, and the absence of stable housing.

“There are so many people living in the streets. I have witnessed people who served in the service that are on the streets as well. “ - Community Partner

“It’s hard for someone to maintain their health if they are unhoused and don’t have access to healthy food. If you are unhoused, how do you focus on going to a health appointment?”- Key Informant

“Not being able to afford housing leads to mental stress. Impacts family and kids by not taking kids to school and abuse due to stress.”- Elizabeth Resident

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2. Mental and Behavioral Health Mental health was one of the most frequently identified health priorities. Residents and stakeholders described a growing need for mental health support, substance use services, and crisis response. Low awareness of behavioral health resources, including the 988 Suicide and Crisis Lifeline,3 was a major finding across engagement activities.

“I witnessed today someone defecating outside. There’s a need for dealing with the disease of addiction, more promotion of Narcan. Mental health services and substance abuse services go hand in hand. Do something about it beyond just talking about it. More programs to address mental health. “ - Community Partner

“TalkSpace is an app where City residents can get access to free counseling. The City pays for up to 500 members.” - Community Partner

3. Environmental Health and Sanitation Residents cited environmental conditions as both quality-of-life and public health concerns, raising issues related to trash management, rodents, mold, poor air quality, water interruptions, pests, noise, and general neighborhood conditions. These concerns were linked to respiratory health, chronic stress, safety, and neighborhood well-being. “There was an initiative to address air pollution and identify changes that could improve air quality. The City had a Tree Canopy initiative.” - Key Informant “The mold in homes is a serious issue. He also works in water restoration and mold removal. Houses are infested with mold.”

- Community Partner

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4. Healthcare Access and Affordability Residents identified cost of care, transportation barriers, limited insurance coverage, and difficulty navigating services as persistent challenges. These barriers affect preventive care, chronic disease management, maternal health, behavioral health, and timely access to medical services. “Taking billions out of healthcare is going to make situations very difficult. It depends on income level. Social services are getting burned out; they are carrying a major load currently. Lack of funding is causing issues.” - Community Partner

“Fifty years ago, there were four hospitals, but now there is only one.” - Elizabeth Resident

5. Language Access, Cultural Competency, and Immigration-Related Fear Language access and cultural responsiveness emerged as both engagement requirements and major community findings. In a multilingual city, effective health communication must extend beyond translation to include trusted, culturally grounded outreach. Across surveys, interviews, and listening sessions, multilingual, immigrant, refugee, Hispanic, African American, youth, older adult, and unhoused participants identified language gaps, cultural disconnect, immigration-related fear, and institutional distrust as recurring barriers to care. Community members and partners called for a multilingual, multi-channel outreach approach combining print materials, digital media, video, social media, community radio, text-based communication, and trusted community messengers to ensure health information reaches residents in accessible and culturally relevant ways. “Translation services are needed, especially for healthcare. Immigration services become an issue for people who think that it will be an issue.” - Community Partner

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Residents also described a broader range of accessibility barriers across engagement settings: Language and translation gaps Immigration-related fear Transportation challenges Parking Cost of care Difficulty navigating services Limited awareness of available resources Lack of culturally responsive care Fragmented coordination among providers and agencies

“If my fear of getting deported due to immigration status, I’m going to be less ready to get treatment. Immigrants are afraid of seeking services” - Elizabeth Resident

6. Harm Reduction, Cannabis Education, and Substance Use Awareness Residents showed limited familiarity with harm reduction services and products, including naloxone, fentanyl test strips, and safe use education. Youth were identified as the population most in need of harm reduction support. Community cannabis education is also needed, particularly for youth and older adults, as adult-use dispensaries expand within the jurisdiction.

“Everything is via technology. If the city can create links and QR codes throughout the city it will provide more discreet access. Less contacting of a live person.” - Community Partner

7. Sexual Health Awareness and Preventive Education Sexual health education emerged as a consistent need across engagement activities. Participants described gaps in accessible, culturally responsive sexual health information, particularly for populations that face stigma, language barriers, or limited access to confidential services. The findings support expanding sexual health awareness and prevention outreach with attention to language, age, culture, confidentiality, and stigma reduction. “Sexual health begins with knowledge, prevention, and care without stigma.” - Key Informant

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8. Fragmented Systems and Need for Better Coordination Residents and stakeholders described a need for stronger coordination among city agencies, healthcare providers, schools, community-based organizations, housing partners, emergency management, and social service providers. The findings support clearer referral systems, stronger cross-agency communication, and more proactive community outreach.

The themes identified through community engagement point to root causes that extend beyond individual health behaviors to systemic and structural conditions. The table below connects each root cause or systems driver to the corresponding CHIP response, illustrating how community voice directly shaped the priorities and strategies in this plan.

“Some of the resources are the best-kept secrets. People learn through word of mouth. There is not a lot of effective marketing.” — Key Informant

“Doing more in-person, doorto-door outreach is also necessary to discuss issues.” - Key Informant

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From Root Causes to CHIP Action Root Cause or Systems Driver

Related CHIP Response

Economic inequality and rising living costs

Integrate food, housing, economic supports, and health navigation

Housing affordability and unsafe conditions

Coordinate public health, housing assistance, sanitation, inspections, code enforcement, and homelessness response

Environmental and neighborhood burdens

Establish accessible reporting, response tracking, neighborhood monitoring, and interdepartmental accountability

Fragmented services and institutional silos

Develop a multilingual resource hub, coordinated referrals, follow-up procedures, and cross-sector governance

Language, cultural, immigration, and trust barriers

Expand language access, cultural responsiveness, trusted messengers, and resident feedback

Transportation, digital, and information barriers

Use multiple communication and service-delivery channels, including in-person navigation

Workforce and organizational capacity

Strengthen staffing, bilingual capacity, community health workers, training, partner infrastructure, and sustainable funding

Stigma, discrimination, and criminalization

Provide confidential, trauma-responsive, stigmafree behavioral health, sexual health, harm reduction, and cannabis education

The themes documented here reflect the lived experience of Elizabeth residents and the observations of the community partners and systems-level informants who serve them. Together, they form the foundation of Elizabeth’s 2026-2029 Community Health Improvement Plan. Each priority, goal, and strategy in this plan traces to something the community named, and accountability for implementation returns to the community through the review structures described in the pages that follow.

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Key Health Findings and Disparities Community engagement and secondary data identified eight interconnected priorities: chronic disease prevention; mental health; housing and environmental conditions; food insecurity and economic stability; access to care; trust and cultural responsiveness; harm reduction and behavioral health safety; and maternal health access. These priorities reflect both residents’ reported experiences and documented health, housing, and socioeconomic conditions. The 2025 Community Health Needs Assessment conducted by Trinitas Regional Medical Center and Robert Wood Johnson University Hospital Rahway provides additional regional context, while New Jersey Department of Health data document health outcomes in Elizabeth and Union County.11 The City of Elizabeth’s 2025-2029 Consolidated Plan further identifies housing affordability and overcrowding as ongoing local challenges.8 Source note: Resident-reported percentages throughout this section are drawn from the Elizabeth Community Survey Instrument unless otherwise indicated. Secondary sources are cited separately to distinguish local survey findings from independently documented health and socioeconomic indicators. See Appendix A.

Chronic Disease and Prevention Key Findings Cost, transportation, housing instability, environmental conditions, and difficult service navigation constrain chronic disease prevention and management in Elizabeth. Residents with chronic or behavioral health

90.0

asthma Emergency Department visits per 10,000 - 58% above county average11

Conditions: uninsured and underinsured individuals, seniors, youth, and immigrant or multilingual residents face the greatest barriers. More than half of survey respondents (50.56%) reported that they or someone they knew had avoided seeking healthcare because of a lack of insurance. Fear of deportation (16.85%) and language barriers (13.48%) were also cited, reflecting that access gaps extend beyond financial constraints to include immigration-related fear and limited availability of linguistically responsive services. These percentages represent community survey responses and should not be interpreted as citywide prevalence estimates. Independent health data reinforce the importance of prevention and timely treatment. According to the New Jersey Department of Health’s Healthy Community Profile for Elizabeth City, the age-adjusted asthma emergency department visit rate was 90.0 per 10,000 residents in 2016-2019, compared with 56.9 in Union County and 55.7 statewide11. Elizabeth’s rate was approximately 58% higher than the county rate and 62% Page 43

higher than the statewide rate.²⁸ The same report documented an age-adjusted COPD emergency department visit rate of 44.4 per 10,000 in Elizabeth, compared with 20.6 in Union County and 24.6 statewide.11 These findings underscore the importance of integrating chronic disease prevention with environmental health, early intervention, and access to ongoing care.

CHIP Implications Connect prevention and clinical care with affordable services, navigation, referrals, and social support.

Mental Health and Emotional Well-Being Key Findings Mental health was a leading concern in the community survey: 48.42% of respondents selected it among their top three health priorities, selected mental and access to mental health support averaged health support 3.2 out of 5. Community input highlighted rated 3.2 out of concerns about stress, trauma, isolation, 5 by survey substance use, and crisis support, particularly among youth, seniors, immigrant and multilingual residents, people experiencing homelessness, and households facing economic hardship. Residents also identified limited awareness of the 988 Suicide and Crisis Lifeline as an area requiring targeted outreach.3

48.4%

The 2025 Trinitas Regional Medical Center and RWJUH Community Health Needs Assessment provides important regional context, documenting health needs and community conditions across the hospital service area, including Union County, and reinforcing the local findings above.6

CHIP Implications Expand culturally responsive care, peer support, community referrals, stigma reduction, and multilingual 988 outreach through trusted community hubs.

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Housing, Environment, and Neighborhood Conditions Key Findings Housing and environmental conditions emerged as major concerns in the community survey. reported housing as Among respondents, 67.12% reported that unaffordable in the housing was unaffordable, only 36% considered community survey their housing safe, and 42.67% reported overcrowding. Residents also described water interruptions, mold, pest infestations, rodents, incomplete repairs, trash accumulation, noise, poor air quality, and other neighborhood hazards. Low-income renters, families, seniors, people experiencing homelessness or overcrowding, and residents with respiratory conditions are especially affected.

67%

These findings are consistent with the City’s 2025-2029 Consolidated Plan, which identifies rising rental costs and overcrowding as persistent challenges linked directly to a shortage of affordable multi-bedroom units.8 Affordable housing needs are especially acute among extremely low- and very low-income households, seniors, and people with disabilities. New high-rise development has not provided sufficient relief for Elizabeth’s most cost-burdened residents.

CHIP Implications Treat housing and neighborhood conditions as public health priorities through coordinated action across health, housing, sanitation, and community partners.

Food Insecurity and Economic Stability Key Findings Although the community survey did not directly assess economic instability, resident responses concerning housing, food access, healthcare, transportation, utilities, and services point to overlapping financial pressures that force households to choose among basic needs.

10.9 %

food insecurity rate in Union County — 13.3% among children Page 45

The 2025 Trinitas Regional Medical Center Community Health Needs Assessment reinforces these concerns. In its 2024 survey, only 44.0% of Union County respondents agreed or strongly agreed that people in their community could afford basic necessities, including food, housing, and transportation. Agreement was lower among Latino (30.7%) and Black (41.9%) respondents.6 Food insecurity data further illustrate the issue. According to the New Jersey Office of the Food Security Advocate, an estimated 62,360 Union County residents (10.9%) experienced food insecurity in 2023, with the rate among children reaching 13.3%.12 Nutrition assistance data provide additional context. In September 2025, 47,393 Union County residents received SNAP benefits, reported housing as including 26,651 adults and 20,742 unaffordable in the children, according to the New Jersey community survey Department of Human Services, Division of Family Development.¹³ Elizabeth also has a local WIC program operated through RWJ Barnabas Health Trinitas, which provides nutrition assistance to eligible pregnant and postpartum individuals, infants, and young children.6 Although these figures do not establish food insecurity rates specifically for Elizabeth, they highlight the need to address food access alongside housing affordability and economic pressures throughout the CHIP planning framework.

67%

CHIP Implications Integrate food access, housing and economic supports, and health navigation so residents are not forced to choose among basic needs and care.

Harm Reduction and Behavioral Health Safety Key Findings Harm reduction awareness was low across the community survey: more than half of respondents selected “none of the above” when asked about familiar services or products, and familiarity with naloxone and fentanyl test strips was limited. Residents identified stigma, fear of judgment or law enforcement, and limited access to trusted information as barriers. Youth were identified as most in need, followed by people experiencing homelessness and people with mental health or substance use needs. People in recovery, older adults, caregivers, uninsured residents, and people affected by stigma or criminalization also face elevated risk. State data reinforce the scale of need and the value of expanded infrastructure. The New Jersey Department of Health’s Harm Reduction Centers Biennial Report 2022-2024 Page 46

documented an increase in authorized centers from 7 in 2022 to 52 by the end of 2024. The number of people served increased by 122% over the same period, while successful connections to medical and social referral services rose from 64% to 78%.14

122%

increase in people served at NJ harm reduction centers, 2022–2024

These findings underscore the importance of accessible, coordinated support systems that connect people with healthcare, substance use treatment, and other essential services. Community input connected harm reduction to housing, employment, mental health, recovery, youth prevention, and cannabis education. Elizabeth’s cannabis reinvestment framework offers aligned opportunities for youth and senior education, safer access, harm reduction programming, and medical-benefit navigation. Community engagement also identified a need for culturally responsive, confidential sexual health education, particularly for youth, with attention to language, stigma, and age-appropriate outreach.

CHIP Implications Expand stigma-free education on naloxone, fentanyl test strips, 988, cannabis safety, safer-use practices, and sexual health awareness. Strengthen connections to recovery and behavioral health services and prioritize health and safety over punishment.

Maternal Health Access Key Findings Resident and stakeholder engagement identified a need for accessible, culturally responsive maternal health information and support across prenatal, postpartum, reproductive, and family health needs. Engagement findings highlighted

prenatal · postpartum · reproductive health access gaps identified

3 Domains

concerns about access to prenatal care, postpartum support, and limited culturally responsive maternal health programming in community settings. The broader community survey provides relevant access context. Among respondents who answered the healthcare avoidance question, 50.56% cited lack of insurance, 16.85% cited fear of deportation, and 13.48% cited language barriers affecting them or someone they knew. These findings were not specific to pregnant or postpartum respondents and cannot establish the frequency of barriers within that population. They nevertheless identify issues that maternal health planning should assess directly. Page 47

The available findings establish a need for stronger education, navigation, and continuity of support, but do not establish Elizabeth-specific maternal mortality or morbidity rates. Confirming the maternal health access baseline and collecting feedback from pregnant and postpartum residents will be important early implementation steps.

CHIP Implications Establish a maternal health workgroup and multilingual referral pathway connecting prenatal care, postpartum services, nutrition assistance, and family supports. Provide recurring community-based outreach and use participant feedback to identify unmet needs and improve service connections.

Access to Care and System Navigation Key Findings Community survey and stakeholder findings indicate that access depends on more than service availability. Insurance coverage,

50.6%

avoided care due to lack of insurance (survey respondents)

affordability, transportation, language assistance, clear eligibility information, and coordinated referrals influence residents’ ability to obtain timely care. Of the 89 respondents who answered the healthcare avoidance question, 50.56% reported that they or someone they knew avoided healthcare because of a lack of insurance. Respondents cited fear of deportation (16.85%) and language barriers (13.48%). These findings describe respondents’ experiences and perceptions, rather than citywide rates of healthcare avoidance. Engagement participants also described difficulty identifying available resources, determining eligibility, and navigating disconnected providers and agencies. Residents identified the Health Department, schools, and hospitals as trusted access points, suggesting that navigation support should build on these existing relationships. Together, the findings support a coordinated approach to address financial, informational, linguistic, and logistical barriers.

CHIP Implications Develop a multilingual resource hub supported by community health workers and trusted messengers. Connect residents to coverage assistance, clear eligibility guidance, transportation resources, and coordinated referrals through in-person and digital outreach. Page 48

Trust, Representation, and Cultural Responsiveness Key Findings

1.8 out Community survey respondents rated respect for cultural respect for their cultural or linguistic of 5 and linguistic needs needs at an average of 1.8 out of 5, and 32% reported experiencing iscrimination when seeking services. These findings highlight service-experience concerns that warrant attention alongside affordability and availability. average rating for

Community survey respondents rated respect for their cultural or linguistic needs at an average of 1.8 out of 5, and 32% reported experiencing discrimination when seeking services. These findings highlight service-experience concerns that warrant attention alongside affordability and availability. Additional survey findings demonstrate how language and immigration-related concerns intersect with access. Among respondents who answered the healthcare avoidance question, 13.48% cited language barriers and 16.85% cited fear of deportation as reasons they or someone they knew avoided care. These measures describe related barriers; they do not establish that discrimination caused healthcare avoidance. Listening sessions and interviews added context: participants described cultural disconnect, institutional distrust, and the importance of receiving information through familiar community channels. The findings support an approach that extends beyond translating materials to include respectful interactions, understandable information, resident representation, and reliable opportunities to raise concerns.

CHIP Implications Embed language assistance, cultural humility, antidiscrimination practices, and resident feedback into service delivery. Track residents’ reported experiences alongside provider training and material availability to assess whether these efforts improve care.

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SMART Goals and Implementation Framework The City of Elizabeth’s community health improvement process identified priority areas that form the foundation of this plan. Eight are addressed through dedicated SMART goals in this section. Two priorities, Chronic Disease and Prevention and Food Insecurity and Economic Stability, are designated cross-cutting priorities, embedded across multiple goal areas and tracked through the Elizabeth Health Dashboard rather than through a standalone goal. Of the eight SMART goals, seven address community health and service priorities (G1 through G7), and one, G8, establishes the governance and accountability infrastructure that holds the full plan together. Each goal includes a confirmed or pending baseline, a measurable target with a named completion date, a lead partner, phased implementation milestones, and a description of how progress will be measured and reported. The Goals at a Glance table on the following page provides a quick-reference summary. Each goal is then presented in full, in the order it appears in that table. Together, these goals represent the City of Elizabeth’s formal, time-bound commitment to the residents who shaped this plan.

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Goal 1

Priority Area: Housing Stability and Health

Ready

Goal Statement Lorem ipsum dolor sit amet, consectetuer adipiscing elit. Aenean commodo ligula eget dolor. Aenean massa. Cum sociis natoqueresidents penatibus et magnis dis By December 2028, reduce the percentage of Elizabeth who report that parturient montes, nascetur ridiculus mus. Donec quam felis, ultricies nec, housing in their neighborhood is unaffordable from 67.12% to 55% or lower, as pellentesque eu, pretium quis. measured by the annual City of Elizabeth Community Health Survey.

Why This Matters When community members were asked in 2025 and 2026 to name the conditions most affecting their health, housing appeared in nearly every conversation. Forty-two percent of respondents report living in overcrowded conditions. Residents described mold, rodents, and structural disrepair in their homes as daily health hazards: conditions that drive asthma, chronic stress, and childhood developmental delays. Housing instability is not separate from health; for Elizabeth residents, it determines whether everything else works. A housing affordability survey, a dedicated navigator, and targeted landlord engagement address the problem where it originates: in the conditions of the housing stock and the systems residents must navigate to improve them.

Implementation Milestones Milestone ID

Action Item

Lead Partner

Due Date

M1.1

Establish Housing Health Navigator position within the Health Department

City of Elizabeth Health Dept

3/2027

M1.2

Launch landlord engagement pilot targeting 50 properties with code violations

Elizabeth Housing Authority & Code Enforcement

6/2027

M1.3

Conduct baseline overcrowding census in ZIP codes 07201 and 07202

Elizabeth Housing Authority

9/2027

M1.4

Implement integrated case navigation linking housing, health, and social services for 200 households

HANDS Inc. & Health Dept

12/2027

M1.5

Administer Year 2 housing affordability survey and compare to baseline

City of Elizabeth Health Dept

6/2028

M1.6

Assess progress toward 55% target; recalibrate if needed

Community Health Council

12/2028

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To Be Determined

Goal 2 Priority Area:

Environmental Health Response

Goal Statement Lorem ipsum dolor sit amet, consectetuer adipiscing elit. Aenean commodo ligula eget dolor. Aenean massa. Cum sociis natoque penatibus et magnis dis By December 2027, reduce the number of resident-reported rodent complaints in parturient montes, nascetur ridiculus mus. Donec quam felis, ultricies nec, Elizabeth by 25% from the confirmed 2026 baseline, as measured by GovPilot pellentesque eu, pretium quis. complaint data.

Why This Matters Residents in the 2025-2026 listening sessions named rodent infestation, poor air quality, and structural deterioration as the environmental conditions they most wanted the City to address. Elizabeth receives a disproportionately high volume of environmental complaints relative to comparable Union County municipalities, and the majority are concentrated in a small number of census tracts. These are not nuisance complaints. They are indicators of housing stock failure and neighborhood disinvestment that directly increase asthma hospitalizations, stress-related illness, and food safety risk. An environmental health response that reduces these conditions is a health intervention, not a maintenance task. Targeted remediation in high-volume tracts, paired with landlord accountability requirements, applies resources where the burden is greatest rather than spreading them across the city uniformly.

Implementation Milestones Milestone ID

Action Item

Lead Partner

Due Date

M2.1

Pull 2024-2026 rodent complaint data from GovPilot; confirm baseline

City of Elizabeth Environmental Health / IT

12/2026

M2.2

Launch targeted remediation in the five census tracts with highest complaint volume

DPW / Environmental Health

3/2027

M2.3

Conduct landlord notification campaign in affected areas; require remediation within 90 days

Code Enforcement / Housing Authority

6/2027

M2.4

Administer resident environmental quality survey in targeted tracts

City of Elizabeth Health Dept

9/2027

M2.5

Pull Year 2 GovPilot data; calculate complaint reduction against baseline

Environmental Health

12/2027

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Goal 3 Priority Area: Cultural and Linguistic Responsiveness

Ready

Goal Statement Lorem ipsum dolor sit amet, consectetuer adipiscing elit. Aenean commodo ligula eget dolor. Aenean massa.theCum sociis natoque penatibus magnis By December 2028, increase average cultural and linguistic respect et rating that dis parturient montes, nascetur ridiculus mus. Donec quam felis, ultricies nec, Elizabeth residents report receiving from health and social service providers from 1.8 pellentesque eu, pretium quis. out of 5 to 3.0 out of 5 or higher, as measured by the annual City of Elizabeth Community Health Survey.

Why This Matters A score of 1.8 on a 5-point cultural respect scale does not describe a gap in customer service. It describes a system most Elizabeth residents do not trust, do not feel welcomed by, and, in many cases, have stopped using. Thirty-two percent of survey respondents reported experiencing discrimination when seeking care. When residents avoid care because they do not feel safe in the system, every other health investment the City makes operates at reduced effectiveness. This goal is the plan’s direct response to that finding, and it is the most consequential goal in the document. Without progress here, every other goal's outcomes become harder to reach.

Implementation Milestones Milestone ID

Action Item

Lead Partner

Due Date

M3.1

Hire or contract two bilingual Community Health Workers (Spanish and Portuguese)

City of Elizabeth Health Dept

3/2027

M3.2

Launch Cultural Humility Training for 75 health and social service providers across 10 partner agencies

Health Dept / Trinitas / CUMAC

6/2027

M3.3

Administer mid-point cultural respect survey; compare to 1.8 baseline

Health Dept

12/2027

M3.4

Expand translated materials to include Haitian Creole and Arabic in top-used health resources

Health Dept / Public Information

3/2028

M3.5

Expand Community Health Worker program to 4 FTE across all four ZIP codes

Health Dept

9/2028

M3.6

Administer Year 3 cultural respect survey; assess progress toward 3.0 target

Health Dept

12/2028

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Goal 4 Priority Area: Mental

To Be Determined

Health and 988 Awareness

Goal Statement Lorem ipsum dolor sit amet, consectetuer adipiscing elit. Aenean commodo ligula eget dolor. Aenean massa.theCum sociisof natoque penatibus By December 2027, increase percentage Elizabeth residents whoet aremagnis aware of dis parturient montes, nascetur ridiculus mus. Donec quam felis, ultricies nec, the 988 Suicide and Crisis Lifeline from the confirmed 2026 baseline to 40% or higher, pellentesque eu, pretium quis. train 150 community members and service providers in Mental Health First Aid, and launch a multilingual community mental health resource directory, as measured by the 2027 City of Elizabeth Community Health Survey and training records.

Why This Matters Mental Health and Emotional Well-Being ranked first among all eight priorities, with 48.42% of respondents naming it a top-three concern. Residents described a shortage of bilingual providers, long wait times, and uncertainty about where to turn in a crisis. The 988 Lifeline remains largely unknown in communities with limited English proficiency and historic distrust of crisis systems. Mental Health First Aid training builds capacity through the community members residents already trust. A multilingual directory removes the barrier of not knowing where to go once a crisis passes. No single intervention closes the full gap, and this goal requires all three.

Implementation Milestones Milestone ID

Action Item

Lead Partner

Due Date

M4.1

Establish 2026 resident 988 awareness baseline via Community Health Survey

Health Dept

12/2026

M4.2

Launch bilingual 988 awareness campaign (Spanish and English) across social media, transit, and community sites

Health Dept & Public Information

3/2027

M4.3

Train Cohort 1 of 75 community members and service providers in Mental Health First Aid

Elizabeth Mental Health Alliance

6/2027

M4.4

Publish multilingual mental health resource directory (print and digital) in Spanish, English, Portuguese, and Haitian Creole

Health Dept & Community Partners

6/2027

M4.5

Train Cohort 2 of 75 community members and service providers in Mental Health First Aid

Elizabeth Mental Health Alliance

9/2027

M4.6

Administer resident awareness follow-up survey; compare to 2026 baseline

Health Dept

12/2027

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Priority Area: Maternal Goal 5 Health Access

Ready

Goal Statement Lorem ipsum dolor sit amet, consectetuer adipiscing elit. Aenean commodo ligula eget dolor. Aenean massa. Cum sociis natoque rating penatibus et magnis By December 2028, achieve an average resident-reported of at least 3.5 out ofdis parturient montes, nascetur ridiculus mus. Donec quam felis, ultricies nec, 5 for access to maternal health services and provide at least four maternal health pellentesque eu, pretium quis. events annually.

Why This Matters Elizabeth’s maternal mortality and morbidity rates reflect the same structural conditions driving health disparities across the city: limited insurance coverage, language barriers, and service gaps that fall hardest on immigrant and low-income families. The 2025-2026 engagement process surfaced specific concerns about prenatal care access, postpartum support, and the absence of culturally responsive maternal health programming in community settings. Doubling the event cadence addresses access in practice, not just on paper. Pairing it with a bilingual maternal health navigator ensures that families can actually use what the events offer. Showing up to an event and understanding what is available in your language are two different things, and this goal requires both.

Implementation Milestones Milestone ID

Action Item

Lead Partner

Due Date

M5.1

Confirm 2026 maternal health access rating baseline via Community Health Survey

Health Dept & Trinitas

December 2026

M5.2

Launch first quarterly maternal health event series (Q1 2027) in community-based setting

Trinitas Regional Medical Center

March 2027

M5.3

Establish bilingual maternal health navigator position at Trinitas

Trinitas & Health Dept

June 2027

M5.4

Conduct Year 1 mid-point participant satisfaction survey at events

Trinitas & Health Dept

Septembe r 2027

M5.5

Expand event series to a second ZIP code; partner with WIC and SNAP outreach

Trinitas & CUMAC & Health Dept

March 2028

M5.6

Administer Year 3 maternal health access survey; assess progress toward 3.5 target

Health Dept

December 2028

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To Be Determined

Goal 6 Priority Area: Harm

Reduction and Cannabis Education

Goal Statement Lorem ipsum dolor sit amet, consectetuer adipiscing elit. Aenean commodo ligula eget dolor. Aenean massa.theCum sociisof natoque penatibus magnis dis By December 2027, increase percentage Elizabeth residents whoet report parturient montes, nascetur ridiculus mus. Donec quam felis, ultricies nec, familiarity with naloxone use by 30 percentage points from the confirmed 2026 pellentesque eu, pretium quis. baseline, and deliver cannabis health education to at least 500 residents across all four ZIP codes, as measured by the Opioid Fatality Review Team’s annual survey and session attendance records.

Why This Matters Overdose deaths in Union County have risen steadily over the past three years, and Elizabeth residents in the 2025-2026 engagement process described limited access to harm reduction supplies, stigma around seeking help, and a lack of plain-language information about both opioid safety and cannabis use following legalization. Pairing naloxone training with cannabis education reflects what residents asked for directly: not a single-issue campaign, but a community equipped to respond to overdose emergencies while making informed decisions about a newly legal substance. Addressing both together makes use of the same community infrastructure and reach rather than building parallel efforts for each.

Implementation Milestones Milestone ID

Action Item

Lead Partner

Due Date

M6.1

Conduct OFRT community survey to establish naloxone familiarity baseline

Opioid Fatality Review Team

9/2026

M6.2

Launch Naloxone Know-How training series in 8 community sites (libraries, churches, community centers)

OFRT & Health Dept

3/2027

M6.3

Distribute 200 naloxone kits with training to community members

OFRT & Pharmacy Partners

6/2027

M6.4

Deliver Cannabis Health Education sessions at 10 community sites across all four ZIP codes

Health Dept & Cannabis Reinvestment Partners

9/2027

M6.5

Administer follow-up naloxone familiarity survey; compare to 2026 baseline

OFRT

12/2027

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Goal 7 Priority Area: Service

To Be Determined

Navigation and Resource Hub

Goal Statement Lorem ipsum dolor sit amet, consectetuer adipiscing elit. Aenean commodo ligula eget dolor. Aenean massa. Cum sociis natoque penatibus et magnis dis By October 2027, 60 days after the multilingual resource hub launches, reduce the parturient montes, nascetur ridiculus mus. Donec quam felis, ultricies nec, percentage of pellentesque eu,Elizabeth pretiumresidents quis. who report difficulty finding appropriate health and social services from the confirmed 2026 baseline to 25% or lower, as measured by the City of Elizabeth Community Health Survey.

Why This Matters Service fragmentation was among the most consistently named barriers in the 2025-2026 engagement process. Residents described hours spent navigating phone trees, referrals between agencies, and appointments that yielded no services. For residents who are not fluent in English, language barriers compound the problem and close entire service categories. A centralized, multilingual hub, co-designed with community members, addresses the structural cause rather than asking individuals to navigate a broken system alone.

Implementation Milestones Milestone ID

Action Item

Lead Partner

Due Date

M7.1

Establish service-finding difficulty baseline via Community Health Survey

Health Dept

9/2026

M7.2

Complete community co-design sessions for hub content and navigation structure

Health Dept & Community Advisory Group

3/2027

M7.3

Complete hub content development in Spanish, English, Portuguese, and Haitian Creole

Health Dept & Translation Partners

6/2027

M7.4

Staff training and soft-launch testing with 3 partner agencies

Health Dept

7/2027

M7.5

Launch multilingual resource hub (public, full access)

City of Elizabeth Health Dept

8/2027

M7.6

Administer post-launch service-finding survey; compare to 2026 baseline

Health Dept

10/2027

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Goal 8

Confirmation Required

Priority Area: CHIP Governance and Accountability

Lorem ipsum dolor sit amet, consectetuer adipiscing elit. Aenean commodo ligula Goal Statement eget dolor. Aenean massa. Cum sociis natoque penatibus et magnis dis By March 2028, increase the average agency rating felis, amongultricies City of nec, parturient montes, nascetur ridiculus mus.collaboration Donec quam pellentesque eu,partner pretium quis. Elizabeth CHIP organizations from the confirmed October 2026 baseline to 3.5 out of 5 or higher, as measured by the annual CHIP Partner Collaboration Survey.

Why This Matters A Community Health Improvement Plan is only as strong as the accountability infrastructure that holds it together. The community engagement process revealed that residents and partners have experienced coordination failures before: initiatives that launched and disappeared, commitments made but not tracked, and data collected but never shared back. This goal does not simply organize this plan's governance. It commits the City to building the kind of inter-agency collaboration that makes every other goal in this document achievable and sustainable beyond the 2029 plan period.

Implementation Milestones Milestone ID

Action Item

Lead Partner

Due Date

M8.1

Administer baseline CHIP Partner Collaboration Survey (agency collaboration rating)

To be confirmed by December 2026

2/2027

M8.2

Adopt CHIP Implementation Matrix, naming lead partners and milestone owners for all eight goals

Health Dept

1/2027

M8.3

Convene inaugural Community Health Council meeting; confirm composition, quorum rules, and reporting cadence

Health Dept

11/2026

M8.4

Launch public-facing CHIP Dashboard with Goal G1 through G8 progress indicators

Health Dept & IT

1/2027

M8.5

Complete Year 1 annual recalibration review; publish results publicly

Community Health Council

12/2027

M8.6

Administer Year 2 CHIP Partner Collaboration Survey; compare to October 2026 baseline

To be confirmed by December 2026

3/2028

Page 58

Conclusion Vision for a Healthier Elizabeth The City of Elizabeth Community Health Improvement Plan reflects the voices, concerns, and aspirations of residents across neighborhoods, generations, cultures, and life circumstances. Through surveys, listening sessions, stakeholder interviews, and data review, residents affirmed what the evidence has long confirmed: health is shaped not only by healthcare but by the conditions of everyday life. Housing stability, environmental quality, economic security, language access, food, transportation, education, and community trust all determine whether a resident can be well, stay well, and get help when they need it.

From Community Voice to Collective Action

Those conditions do not operate in isolation. Unstable housing disrupts access to care and compounds chronic stress. Mold, rodents, poor air quality, and water interruptions are not neighborhood inconveniences. They are health exposures that fall hardest on the residents already carrying the greatest burden. When health systems fail to communicate in a resident’s language or treat them with cultural respect, the system itself becomes a barrier. Across every priority area, residents described the same underlying need: services that are easier to reach, better coordinated, and grounded in dignity. A healthier Elizabeth is a city where every resident can live in safe, stable housing, breathe clean air, receive culturally respectful care, and get trusted health information in a language they understand. It is a city where youth are protected and prepared; seniors are supported and connected; families can seek care without fear; and residents experiencing homelessness, behavioral health challenges, or economic hardship are met with dignity and coordinated support.

Page 59

The 2026 - 2029 vision is to move: From fragmented services to connected systems From crisis response to prevention From translation alone to culturally grounded communication From resident input to shared community power From documenting disparities to changing the conditions that produce them Shared Call to Action Achieving this vision requires shared ownership. Municipal departments, Union County systems, healthcare providers, schools, housing and behavioral health organizations, community-based and faith organizations, businesses, funders, and residents each have a role. Partners are called to: align programs, funding, and staff capacity with CHIP priorities; strengthen referral pathways and culturally responsive access; share data responsibly and support public progress reporting; invest in trusted messengers, community health workers, and resident leadership; and participate in coordinated implementation and accountability. Residents are called to remain engaged through the Community Health Council, listening sessions, surveys, public meetings, and other feedback opportunities. Resident knowledge must continue to guide decisions, reveal emerging concerns, and help determine whether strategies are improving daily life. Moving from Plan to Action The 2026–2029 CHIP provides a roadmap for measurable action. Its SMART goals, implementation strategies, lead partners, timelines, and performance measures establish a structure for accountability. The Community Health Council, public CHIP dashboard, and annual progress updates will help the City and its partners track results, identify gaps, and make informed course corrections. The City of Elizabeth now has an opportunity to build a public health model rooted in community wisdom and sustained through coordinated action. By working together, Elizabeth can reduce barriers, strengthen trust, improve access, and create healthier conditions for all residents.

Our Commitment Health improvement in Elizabeth is informed by the people, guided by the data, and sustained through collective action.

Page 60

About Iona Concepts, Inc. Founded in 1994 and led by Maurissa Stone, Iona Concepts, Inc. advances equity through strategic planning, research, training, and organizational development. The firm translates resident engagement, community data, and public health findings into strategies that strengthen collaboration, accountability, and sustainable change. For the City of Elizabeth, Iona Concepts supported the 2023 Health Equity and Diversity Assessment and the 2026 to 2029 Community Health Improvement Plan, guiding a multilingual engagement process and producing the measurable goals and implementation framework in this report. This plan was facilitated and prepared by Iona Concepts consultants Maurissa Stone, Nicola Norman, and Tiffani Truss-Pryor.

Page 61

Formal Adoption and Approval City of Elizabeth Community Health Improvement Plan 2026–2029 The City of Elizabeth Department of Health and Human Services formally adopts the City of Elizabeth Community Health Improvement Plan 2026–2029 as the jurisdiction-wide framework for improving the health and well-being of Elizabeth residents. Residents, community-based organizations, healthcare and behavioral-health providers, educational institutions, government agencies, faith-based organizations, businesses, and other community partners developed this plan through a collaborative process. Community health data, resident surveys, key-informant interviews, focus groups, listening sessions, and an assessment of the social, economic, and environmental conditions affecting health in Elizabeth inform its priorities and strategies. By adopting this plan, the City of Elizabeth Department of Health and Human Services commits to:‌ Working collaboratively with residents and community partners to implement the identified strategies.‌ Centering health equity, cultural responsiveness, language access, and resident participation throughout‌ ‌implementation.‌ Tracking measurable objectives, performance measures, and health outcomes.‌ Reviewing implementation progress at least annually.‌ Sharing progress with residents, partners, City leadership, and other stakeholders.‌ Revising strategies when data, community feedback, or changing conditions indicate that adjustments are‌ ‌needed.‌ Coordinating the CHIP with the Department’s strategic plan, quality-improvement activities, and other‌ ‌relevant City, county, state, and community plans. The Department recognizes that responsibility for improving community health is shared across sectors. Adoption of this CHIP affirms the City’s commitment to coordinated action, public accountability, continuous learning, and measurable improvement in the health of all Elizabeth residents. Formally adopted on: __________________________ Effective period: __________________ through __________________ Date of next annual review: __________________________ Approval __________________________________ Krishna Garlic, Director, Department of Health and Human Services‌ Signature: ______________________________ Date: ______________________________ J. Christian Bollwage, Mayor Signature: ______________________________ Date: ______________________________

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CITATIONS Community Health Improvement Plan 2026 - 2029 1. United States Census Bureau. (2023). American Community Survey 5-Year Estimates, 2019–2023: City of Elizabeth, New Jersey (Tables DP02, DP03, DP05). U.S. Department of Commerce. https://data.census.gov 2 National Association of County and City Health Officials (NACCHO). (2017). Mobilizing for Action through Planning and Partnerships (MAPP): A Community-Wide Strategic Planning Tool for Public Health. Washington, DC: NACCHO. [Author to confirm exact PAR/methodology source from Appendix A] 3 Iona Concepts, Inc. (2025–2026). City of Elizabeth Community Health Survey Instrument. Prepared for the City of Elizabeth Department of Health and Human Services. Elizabeth, NJ. 4 New Jersey Department of Health. Emergency Department Utilization Data, City of Elizabeth. Trenton, NJ: NJDOH Center for Health Statistics. [Author to confirm; may consolidate with ¹¹] 5 New Jersey Department of Health, Office of Substance Use Prevention and Recovery. Union County Overdose Fatality Data. Trenton, NJ: NJDOH. [Author to confirm exact report title and year from Appendix A] 6 Trinitas Regional Medical Center and RWJBarnabas Health. (2025). 2025 Community Health Needs Assessment. Elizabeth, NJ: RWJBarnabas Health/Trinitas Regional Medical Center. 7 U.S. Department of Health and Human Services, Health Resources and Services Administration. (2022). Small Area Health Insurance Estimates (SAHIE): City of Elizabeth, New Jersey. https://www.census.gov/data/datasets/time-series/demo/sahie/estimatesacs.html

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CITATIONS Community Health Improvement Plan 2026 - 2029 8 City of Elizabeth. (2025). City of Elizabeth Consolidated Plan 2025–2029. Elizabeth, NJ: City of Elizabeth Department of Community Development and Housing. 9 U.S. Department of Housing and Urban Development. (2025). Fair Market Rents for the Newark-Union, NJ-PA HUD Metro FMR Area, FY 2025. Washington, DC: HUD Office of Policy Development and Research. https://www.huduser.gov/portal/datasets/fmr.html 10 [Author to confirm source from Appendix A — community ecosystem/health institutions paragraph, page 25. Likely the Trinitas CHNA (⁶) or a NJDOH county health profile.] 11 New Jersey Department of Health. (2021). Healthy Community Profile: Elizabeth City. Trenton, NJ: NJDOH Center for Health Statistics. 12 New Jersey Office of the Food Security Advocate. (2024). Food Insecurity in New Jersey: County and Municipal Estimates, 2023. Trenton, NJ: New Jersey Office of the Food Security Advocate. 13 New Jersey Department of Human Services, Division of Family Development. (2025). SNAP Participation Data, September 2025. Trenton, NJ: NJDHS. 14 New Jersey Department of Health, Office of Substance Use Prevention and Recovery. (2024). Harm Reduction Centers Biennial Report 2022–2024. Trenton, NJ: NJDOH. Source ² — Confirm the exact PAR/methodology reference used in the CHIP process. If a NACCHO MAPP document was not the source, provide the correct title and publication details. Source ⁴ — Confirm whether the emergency department utilization data on page 14 comes from the NJDOH Healthy Community Profile (Source ¹¹) or a separate report. If it is the same source, Sources ⁴ and ¹¹ merge into one entry and the final list runs ¹ through ¹³. Source ¹⁰ — Confirm which source underlies the community ecosystem paragraph on page 25. If it is the Trinitas CHNA, Sources ⁶ and ¹⁰ merge and the final list runs ¹ through ¹³ (or Page 64 ¹² if both ⁴ and ¹⁰ consolidate).

This plan is a public commitment. This plan was developed in partnership with Elizabeth residents, community organizations, health and social service providers, faith communities, and City of Elizabeth agencies who participated in the 2025 and 2026 community health improvement process. Their candor, expertise, and investment in this city made this document possible. For more information, visit elizabethnj.org.