Category Archives: Community Development
This week, GOVERNING magazine will hold its second Summit on Healthy Living, in Atlanta, Ga. The summit will focus attention on healthier living and aims to provide leaders with model policy and outcome-based programs to help make a difference in their own communities.
>>Read more on what works to create healthy communities.
Key goals include:
- Engaging state and local leadership in building a healthier America across the generations from childhood to old age
- Providing leaders with tools, information and relationships to build and sustain healthy communities
- Creating a network of leaders from various communities and sectors to establish a national movement for healthier living
During the meeting, the American Institute of Architects (AIA) will present a new report, Local Leaders, Healthier Communities Through Design, which is an examination of the positive impacts design can have on health. The report looks at eight U.S. communities that are in the midst of design and architectural projects that create open spaces; offer easier access to recreation and transit; and provide ample opportunities for exercise.
NewPublicHealth spoke with Brooks Rainwater, director of public policy at the AIA, about the new report.
Stay tuned for continued NewPublicHealth coverage of the GOVERNING Summit.
NewPublicHealth: Can you tell me about the presentation you will be making at the GOVERNING Summit?
Brooks Rainwater: The presentation at the GOVERNING Summit is going to be focused on the release of our report, Local Leaders, Healthier Communities through Design. This report is part of a series stretching back to 2007 where we focused on livable and sustainable communities. What we’re really trying to do with this report is to tie design and health together, and demonstrate through the positive projects that cities are doing throughout the country exactly how this can be done. Oftentimes when people think of health, the first thing that comes to mind is the medical industry and treating illness when individuals aren’t well. However, architects can help create healthier communities and — through preventative strategies for improving health — these can be designed into our cities, helping people from becoming sick in the first place.
What we really see with this is that by promoting development patterns that are more compact and closer to transit, shopping, restaurants, social services and community amenities, that this is the first part of a comprehensive systems level solution. Active lifestyles rely in large part on expanding the options for when, where and how people can live, work and play. That’s really what we see that design can do—it can offer options for people, whether that’s being able to walk to school or walk to a corner store or have a park nearby. All of these things — sidewalks, active design guidelines — can really set up a situation where design makes a difference in how people live their everyday lives.
NPH: What are some of the cities you will be showcasing at the summit?
Brooks Rainwater: We’re going to be talking about New York City and the citywide conversation happening there about promoting healthier designs with active design guidelines. They’ve been holding city conferences for a number of years now and they’ve also been focused on innovative urban design. The city’s High Line is a very clear example of that. The High Line is a public park built on a 1.45-mile-long elevated rail structure. Previously, the area the High Line was built on was a freight rail track, in operation from 1934 to 1980. What’s interesting about the Highline is that the economic benefits that it brings to the city through redevelopment surrounding it are enormous, and at the same time it’s offering people a way to improve public health.
>>Editor’s Note: The city of Paris has converted a rail line into an elevated park called the Promenade Plantée. Similar projects are in early the stages in St. Louis, Philadelphia, Jersey City, Chicago and Rotterdam.
We’re then looking at Los Angeles and what they’re doing there to advance active mobility and healthier growth through living streets, public transit and healthier community design with innovative policies and initiatives. They’ve been investing in transit programs there and have been really trying to redevelop the core of the city and kind of create those connections between the sprawling city that is Los Angeles. Architects out there have really been pushing active design as something that needs to be integrated into the core of the city.
NPH: What are some of the significant features of the High Line that make it new and significant?
Brooks Rainwater: I think one of the significant features of it is that it created green space in a highly urban area by taking what was an elevated rail bed that was no longer in use, so it was kind of taking space that existed but wasn’t getting used to its best ability and turned it into something that was able to improve public health. In New York there’s not a great deal of park land or trees or ways for urban dwellers to interact with nature, and so I think by creating that space it really offers residents, as well as visitors, a good opportunity to have this new kind of place.
NPH: What is happening in other areas? What factors into the decision of where to create these green spaces? Clearly, people who are higher income and middle-to-higher income also need to exercise and prevent heart disease, but what are the questions that go into who to serve when some of these new projects are created?
Brooks Rainwater: I think that’s one of the things that we wanted to focus on within this report, is to make sure that equity was a large consideration. The way we did that was by also looking at a number of cities. Boston was a clear case study that they’ve designed healthier, high performance, green, affordable housing within the city, and that was a key aspect of their 2007 green building law they passed. And so what they’re trying to do there is focus specifically on lower income individuals and they’re looking at things like indoor air quality — which tends to be terrible — and lower-income, dilapidated housing. They’re also trying to help redevelop the communities surrounding…affordable housing, buildings that are being designed, and so I think we’re seeing some exciting things happen there. With Milwaukee we looked at how they’re revitalizing blighted brownfields for healthier buildings, neighborhood access and paths of recreation with thriving light industry.
So the community that they’ve revitalized there — the brownfield site — was in an area of the city that, as you can imagine, wasn’t one of the better areas, and now they’ve been able to kind of recreate that and you see people biking and walking through there. You have some thriving light industry on the edges of it as well, and it’s kind of providing that access to all members of the community.
The other area that we’ve tried to look in on was equity across age groups. We looked at Portland and what they’re trying to do to create communities for all ages, through policy decisions that promote mobility, accessibility and other options.
NPH: Given the emphasis on livability and green space, do you think community needs are changing architecture?
Brooks Rainwater: I think that the goal of architects has changed somewhat, but I think what’s really happened is we’re seeing a strong focus on development patterns where people are moving back to cities, people are wanting to live in inner-ring suburbs that are walkable, and even farther out suburbs where they’re building town centers in creating spaces for people to walk to things and to have transit options. So, I think it’s a mixture of architects who have always been focused on kind of serving society and designing what works best for the people who will inhabit the buildings and the communities that are designed. But, at the same time I think because you have such a strong groundswell of individuals who want to live in these types of communities that it’s kind of a push/pull situation that’s happening right now and it’s exciting to see. I think we’re moving back toward this idea that people want to really be closer to nature, while at the same time having the walkability and availability of stores and transit…
I really think architecture can make a difference when design professionals serve as these great collaborators. You know, we’re key stakeholders in planning public health and other disciplines, and I think we can all imagine a future where designing for health is just the way design is done, and we’re very focused on that right now. We really see health and design as our core commitments outside of just this report we’re about to release. For example, we’re currently working with the Clinton Global Initiative on design focused on public health. We’re working with architecture programs at universities to fund research and really figure out the best ways going forward to create healthier cities.
Also, we’ve convened a few programs between architects and public health officials to learn from one another and to really figure out the best ways that public health can be brought into architecture, and at the same time public health officials can start to see architecture as a key way to help fix this problem. Richard Jackson, [professor and chair of environmental health sciences at the UCLA School of Public Health], has been a member of our board of directors and has really focused on this issue. We’ve worked with him a number of times over the years. He is a very important proponent of the importance of public health and design.
Our slogan is “ good design makes a difference” and we really think that architects working together with public health officials and others can do a great deal to make America healthier in years to come.
Will we ever see the end of poverty in the United States? An “Investing in What Works for America’s Communities” event held December 4 in Washington, D.C., looked at the evidence and leading examples toward doing just that. The event, sponsored by the Low Income Investment Fund, the Federal Reserve Bank of San Francisco, and The Citi Foundation, convened top community and economic development experts, analysts, financiers, researchers, philanthropists, and public policymakers from across the nation to share their findings and efforts for improving communities and discussing the next steps toward reversing record high rates of poverty. Reducing poverty, said participants, also goes hand in hand with making communities more sustainable and healthy places to live, learn, work, play, and grow.
The event was a showcase for the book, Investing in What Works for America’s Communities, in which essays from more than 40 experts in a variety of fields provide innovative ideas and concepts that are transforming community involvement and providing sustainable and healthy neighborhoods across the nation. More than 500 people from all backgrounds of public health to private sectors of the government were in attendance, either in person or through the live webcast.
A new op-ed in the Minneapolis Star Tribune makes clear the connection between improving the economy and improving public health — especially when it comes to children. One can’t be accomplished without the other, according to authors Risa Lavizzo-Mourey, MD, MBA, the president and chief executive officer of the Robert Wood Johnson Foundation, and Arthur Rolnick, PhD, a senior fellow at the University of Minnesota and former senior vice president and director of research at the Federal Reserve Bank of Minneapolis.
By improving early education for kids — and even for parents before birth — we can dramatically improve the chances that kids will grow up to lead longer, healthier and more financially successful lives. This will benefit them individually and all of us collectively. The obstacle standing before public health officials and policymakers is to recognize this connection, the authors write.
“For many years, we have missed this connection because we tend to create policy in silos –with education under one roof, housing and economic development under another, and health under yet another roof. In reality, these policy areas are all interconnected and influence one another.”
>>Recommended reading: Read the full story.
>>Recommended viewing: Life Expectancy Disparities along I-94.
Also watch a video with Arthur Rolnick about the return on investment for investing in early childhood education.
Several sessions at this week’s American Public Health Association meeting in San Francisco urged nonprofit hospitals and public health departments seeking national accreditation to join forces on community assessment reports that both are required to file.
Assessments can reveal critical needs in a community, such as asthma trends that could point to poor housing conditions. In a growing number of cities, such reports are providing the evidence needed to marshal resources and action such as dispatching case workers to make home visits to help prevent and reduce asthma emergencies. Such expenditures can reduce the cost burden of paying for emergency care and prevent more health crises in the first place.
In San Francisco, the health department and the city’s non-profit hospitals have been collaborating on community benefit and needs assessments reports since 1994 and have achieved much more than “just a sheaf of papers that sits on a shelf,” says Jim Soos, Assistant Director of Policy & Planning at San Francisco Department of Public Health. The collaboration has resulted in a number of critical efforts to improve health here, including San Francisco’s Community Health Improvement Plan (CHIP), which will be launched by early in 2013.
The city of Philadelphia and the Pennsylvania Horticulture Society are seeing positive results as they continue to grow their Philadelphia Green program. The program has taken on the vacant lots in Philadelphia neighborhoods and transformed them from embarrassing eye sores to points of pride – and made the community safer in the process.
“The city owned the problem even if we did not own the land” said Robert Grossmann, Director, Philadelphia Green. “We decided to use horticulture to build community and improve the quality of life in Philadelphia’s neighborhoods and downtown public spaces.”
The goal was to help build equity for the people living in the neighborhoods so they felt a sense of pride – the result was crime prevention through environmental design.
With the help of community activists and landscape contractors the program has “cleaned and greened” more than 7,000 lots. The impact is a reduction in gun crimes, lower rates of vandalism and residents even report experiencing lower stress rates and an increased urge to get out and exercise.
Ingrid Gould Ellen, a professor of urban planning and public policy at New York University’s Wagner Graduate School of Public Service and co-director of the Furman Center for Real Estate and Urban Policy, is one of several critical thinkers who contributed to Investing in What Works for America’s Communities. The book, a joint project of the Federal Reserve Bank of San Francisco and the Low Income Investment Fund, offers a hard and experienced look at what it will take to help build strong communities that support the opportunities for people to live healthy and productive lives.
In “Crime and Community Development,” Ellen writes about what she calls an often-overlooked element of community development: public safety. NewPublicHealth spoke with Ellen about the link between crime and community development.
NewPublicHealth: What is the link between high crime neighborhoods and the health of the people who live there?
Ingrid Gould Ellen: I think there is growing evidence that living in a high crime—and particularly a very violent—environment can be very harmful to kids, to children’s development in terms of even their ability to learn, their outlook on the world. They’re obviously more likely to be injured and harmed themselves. But I think we’re also seeing increasing evidence of the profound psychological damage that living in a very violent community can have, and I think the evidence is strongest on children.
NPH: What’s the connection between crime and the way a community is developed? Are some neighborhoods inherently safer than others?
Ingrid Gould Ellen: I guess it’s three things. There may be just pure design elements and how a community is designed to make sure that spaces are visible and can be patrolled and monitored, number one. Number two, the “broken window” theory says physical deterioration may be a signal to potential offenders about how much people care about this neighborhood and how much people are going to be monitoring behavior—and therefore how easy it is to get away with a crime there. The third thing is I think there’s lots of evidence that the level of social organization within a neighborhood—social or collective efficacy——can profoundly affect levels of violence in a community. That’s really the willingness of residents to work together to collectively solve problems.
So to combat crime, it’s important to partner with law enforcement to make sure that the community is being well-monitored and patrolled and that complaints are being responded to, obviously. Also jumping on and remedying any kind of decline and decay in a neighborhood is important. And finally, efforts to build collective efficacy in a community are really important.
NPH: Why is it important to build collective efficacy in a community?
Ingrid Gould Ellen: Any attempts to build the collective efficacy of the community can be tremendously helpful and there’s very good research supporting that idea. I do think there is promise in the budding system of community courts in certain cities around the country. These courts try to engage residents in participating and having some ownership over the safety of their communities and the criminal justice system, at least for less serious offenses.
NPH: Can you give some background on community courts?
Ingrid Gould Ellen: They’re part of the court system, but they’re actually housed in communities, in particular neighborhoods, and they only will hear cases that are for non-serious crimes that have taken place in that community. The idea is that community members can decide on what the appropriate punishment is. Often the punishment is things like doing community service projects that will benefit that community. The courts also have relationships with local service providers and work to connect court-involved youth to services and programming.
NPH: What are some specific examples of solutions that are related to the community development field, such as improving affordable housing, and how they’ve been shown to impact crime in communities?
Ingrid Gould Ellen: That’s a good question. Some of my own work right now is showing that an increase in the number of foreclosed homes in a community actually increases crime. One could infer from that that if you can keep homes in private ownership and keep homes from deteriorating and becoming abandoned, that ought to in turn reduce crime.
The Moving to Opportunity project represents a seminal study in this area. They randomly assigned a group of folks who were living in high-poverty public housing developments, to get vouchers to move out to low-poverty neighborhoods. When they were asked just qualitatively why they wanted the chance to move to a higher opportunity neighborhood—the number one response was about avoiding violence and crime. That’s really what mattered to them, and I think that at the time researchers were actually quite surprised because I think economists were very focused on job access and maybe schools as secondary. But it turned out that for many of these households, it was just they wanted to escape the fear and the stress and the violence—living in these highly violent environments. And so I think that is very telling evidence as well just in terms of what matters to households and what they say matters to them in their communities.
Risa Lavizzo-Mourey, MD, MBA, President and CEO of the Robert Wood Johnson Foundation, is among several critical thinkers who have authored essays in a new book, Investing in What Works for America’s Communities. The book, a joint project of the Federal Reserve Bank of San Francisco and the Low Income Investment Fund, includes chapters on policy, finance and education, offers a hard and experienced look at what it will take to help build strong communities that support the opportunities for people to live healthy and productive lives.
In her essay, “Why Health, Poverty, and Community Development Are Inseparable,” Lavizzo-Mourey writes about the growing need for collaboration across disciplines to revitalize low-income communities and create opportunities to make choices that enable all people to live a long and healthy life, regardless of where they live. Read an excerpt:
In order to improve health in this country, the health sector must work closely with those who plan and build communities, especially the community development and finance organizations that work in low-income neighborhoods to build child care centers, schools, grocery stores, community health clinics, and affordable housing. From the health perspective, our interest is less about the buildings and more about what happens in them. Are the schools providing healthful food and eliminating empty-calorie snacks? Is there daily physical activity during and after school? Are grocery stores providing and promoting healthful foods? Are health clinics providing “prescriptions” of healthy lifestyles and services such as the Supplemental Nutrition Assistance Program, in addition to medications? Is affordable housing situated in proximity to safe places to play and be physically active? Is the neighborhood walkable, with well-lighted sidewalks that lead to public transportation, jobs, and services?
Other key essays in the new book include:
· Fighting Poverty through Community Development—by Shaun Dovonan, U.S. Secretary of Housing and Urban Development; Arne Duncan, U.S. Secretary of Education; and Kathleen Sebelius, U.S. Secretary of Health and Human Services. In their essay, the Secretaries call for the empowerment of federal, regional, and local officials with a wide range of responsibilities to break barriers, effectively meet community needs, and spark economic development.
· America’s Tomorrow: Race, Place, and the Equity Agenda—by Angela Glover Blackwell, founder and CEO of the poverty action advocacy group PolicyLink. Blackwell argues that equity-driven policy change is essential to transforming poverty-driven communities into high-opportunity communities. She says this requires broad-based alliances across fields and an inclusive agenda that focuses on those left behind. This also means building public infrastructure, growing new businesses and jobs, and preparing workers for the jobs of tomorrow.
· Crime and Community Development—by Ingrid Gould Ellen, professor of urban planning and public policy at New York University. Ellen’s thesis is that public safety is an important element of community development both because people subjectively care about it, but also because crime objectively destroys the fabric of neighborhoods and heightens stress. She suggests three strategies: increasing collective efficacy (the willingness of residents to monitor public spaces and intervene when those spaces or their neighbors are threatened); reducing physical blight and disorder; and community courts, which often also house a variety of social service programs.
A new article in the journal Shelterforce (the publication of the National Housing Institute) by Marjorie Paloma, MPH, senior adviser and senior program officer for the Health Group at the Robert Wood Johnson Foundation (RWJF), looks at collaboration among varied sectors—such as community development and health —to help create healthier housing options for diverse populations. Improvements have ranged from reducing allergens in low-income housing to improve asthma symptoms among children, to a new model of nursing home that groups just a few people in smaller facilities, resulting in better, longer and healthier lives.
Paloma says many of these collaborations are just a few years old and bring together groups such as RWJF and Federal Reserve Banks working on parallel tracks toward improving people’s lives. “These changes to housing are far less about bricks and mortar and more about creating stability for people, especially the most vulnerable,” Paloma says.
In an interview, Paloma pointed to a 2009 article, published in the Community Development Investment Review, about the Foundation’s Commission to Build a Healthier America and on the factors outside the health sector. “At that point,” says Paloma, “all of us saw that to create healthier, more vibrant communities, these sectors need to connect and collaborate with each other.”
The National Network of Public Health Institutes (NNPHI) Annual Conference in New Orleans, La., concluded late last month. Now that the conference materials and presentations are available for download, we caught up with some of the attendees and NNPHI leaders to get their thoughts on conference highlights.
Ellen Rautenberg, President and CEO, Public Health Solutions and NNPHI Board Chair:
“Dr. Jo Ivey Boufford, a keynote speaker discussed activities Institutes are currently doing at the intersection of public health and primary care and provided her thoughts as to how Institutes might expand on these. She felt that Institutes were perfectly poised to keep the attention of policy makers on population health as they address cost and quality of the health care system.”
Bob St. Peter, President and CEO, Kansas Health Institute:
“It was a great conference. NNPHI walked the talk of multi-sectorial partnership. What other public health conference could you go to where the three keynote speakers are from the New York Academy of Medicine, the Federal Reserve Bank and AcademyHealth? Thinking beyond our traditional partners in public health is becoming increasingly important as our health system hopefully moves to one that is more accountable and more effective.”
NewPublicHealth also spoke with Christopher Kinabrew, MPH, MSW, director of Government and External Affairs for NNPHI to capture conference themes and highlights of the hallway conversations.
NewPublicHealth: What were some of the themes you heard in conversations by attendees?
Christopher Kinabrew: In terms of some of the themes that came through, one important one was that now more than ever, neutral conveners are needed at the state and local level for so many different initiatives. This is critical now in areas such as building bridges between health care and public health. That came through in the keynote from Jo Ivey Boufford and the discussion on the Institute of Medicine report.
There’s also this concept of “backbone organizations.” For many of these initiatives, it’s not a one-time thing. For community health assessments, for example—there’s the assessment itself, but then after that there’s a whole community improvement process. There needs to be some accountability and structure for that to happen. More and more we’re seeing the need for a backbone organization to continue that work. In some cases it’s the public health institute, and in other cases it’s an organization that spun off. I heard in some of the hallway conversations, some examples in the area of health information exchange where the public health institute incubated the exchange, but then in the end it became its own separate entity.
NPH: What other themes did you hear?
Christopher Kinabrew: Health reform was also a big theme for us at the meeting. There were so many comments that regardless of the outcome, “the genie’s out of the bottle.” These changes are happening. The decision will have an impact, but in many of these initiatives the conversation has already changed, so prevention is going to move forward regardless.
Another theme was about funding being consistently under attack. There was a lot of conversation about public health institutes being a hub or a nexus for alternative funding mechanisms. We’ve known for a while that the institutes are good at leveraging federal funding, private foundation funding, and contracts with state and local funding health departments—they’re able to do some things that perhaps other organizations can’t do because of that funding mix. David Erickson from the Federal Reserve also got people thinking about even more alternative financing and funding mechanisms for public health, in terms of working with community development financial institutions.
NPH: From what you learned at the meeting and during David Erickson’s presentation, what are some of the ways public health institutes, health departments and community development institutions can work together?
Christopher Kinabrew: It’s really about putting the social determinants of health into action. He made the comment that community development folks might need to change their language and terminology to say “we’re in the health business.” In terms of the evaluation and measurement of these investments, public health partners could bring the type of robust evaluation that goes on in the health sector to the table for community development. There was a lot of interest in increasing capacity across our membership in health impact assessments. That’s an areas where we could all work together to put some health measures in community development investments and boost the evaluation capacity. That’s an area where our members do tend to be really strong.
>>Read more on community development work to improve public health.
It’s not new to see our members working across sectors, but to me in this conference there was a marked difference in really working upstream across sectors to advance a health in all policies approach. This is something that’s talked about in the National Prevention Strategy. We held a breakout on health in all policies around the intersection of agriculture, food systems and public health. That session was packed.
NPH: You moderated the Town Hall on community health assessment. What came out of this discussion?
>>Read up on community health assessment as part of community benefit initiatives.
Christopher Kinabrew: We featured two national organizations—The Hilltop Institute and United Way Worldwide. We know from our members that first and foremost they want to share what they do and are looking for best practices. Martha Somerville, director of Hilltop’s Hospital Community Benefit program, laid the groundwork on community benefit responsibilities for nonprofit hospitals and for how public health institutes could facilitate meaningful collaboration between hospitals, health departments and community-based organizations. In her presentation and throughout all of the presentations, there was a theme that it’s not just about the needs assessment—it’s also about the community health improvement planning and the structure for implementing those strategies.
From Sandra Serna Smith at the United Way, we heard about their massive coverage and the strength of their network, in terms of covering 95 percent of the population. What was also interesting was learning about the United Way’s three pillars—education, income and health. They made the point that if any one of these isn’t strong, the rest fall. That really resonates well with our members.
We had Kevin Barnett from the Public Health Institute moderating the session. That was a great opportunity because he’s a content expert in community benefit and community health assessment. Two of our members also shared their experiences from the ground—the Texas Health Institute, which brought one of the local public health departments they worked with, and they told the story of how they worked together. Laurie Call from the Illinois Public Health Institute compared and contrasted her experience with two different counties. All of these examples included robust partnerships with public health institutes, health departments and hospitals, and United Ways were often involved sometimes as a funder but also as a partner in implementation.
An interesting question from the audience was, what sector didn’t you include in the process that you would have looking back? Both local panelists mentioned transportation. Looking ahead, that’s maybe a key sector we want to involve next year.
>>Read the rest of our NNPHI Annual Conference coverage.
Jo Ivey Boufford, MD, president of the New York Academy of Medicine, was a keynote speaker this week at the National Network of Public Health Institutes (NNPHI) Annual Conference in New Orleans, La.
>>Watch Dr. Boufford in a video series on working together to make communities healthier places to live:
NewPublicHealth spoke with Dr. Boufford about the conference theme, “Leveraging Public Health Institutes for Systems Change.”
NPH: The theme of the conference is leveraging public health institutes for systems change. What systems do you think need changing to improve population health?
Dr. Boufford: I think there are really two major components to a public health system. One of them obviously is the governmental public health infrastructure—the public health agencies at state and local levels that are really charged to assure the health of the public, by detecting illness and promoting health information and trying to change environments so people can live in healthier communities. A lot of reports have shown that that part of the health system has historically been very under-invested in, and it needs to be shorn up. I think the national public health institutes should be strong advocates and partners of the governmental public health agencies in leveraging resources to improve population health.
The other part of the system is the personal health care system, which is and potentially will be undergoing dramatic change with the Accountable Care Act (ACA). There are a number of opportunities to get better population health impact out of the personal health care system, such as looking at the role of community health centers, of medical homes, of accountable care organization models to improve the health of a geographic community or particular population over time. So I would say those are the two big opportunities, and public health institutes in states need to work closely to take full advantage of the opportunities for populations.
NPH: What other key roles do you see public health institutes playing in improving population health?