Category Archives: Community development
NewPublicHealth is on the ground at the NACo 2014 Healthy Counties Initiative Forum. The theme of the forum this year is “Improving Health in a Climate of Change.” Ahead of the meeting we spoke with James McDonough, county commissioner in Ramsey, Minn., and chair of the Healthy Counties initiative about the meeting and the health changes he is seeing at the county level.
NewPublicHealth: Can you tell us how the NACo Healthy Counties Initiative got its start?
James McDonough: Three years ago the president of NACo at that time, Lenny Eliason, from Athens County, Ohio, really was concerned about how the majority of health care dollars were being spent on treating preventable conditions and the whole issue of the wellbeing of our constituents and our employees. So he elevated the issue of wellness and health in counties as a presidential initiative. Typically those are short term and last for a year or two, but NACo has embraced this and has continued this on as a task force to really embed it in the work that we do—elevating how counties can have an impact on wellness in communities.
NPH: What are the current goals?
McDonough: To really elevate and get the county commissioners and county managers throughout the country to just pause and take a look at what they're doing and what they could be doing. We’ve been talking about how we can do a better job supporting counties that are already doing great work in this area and helping share those best practices, and then helping counties that haven’t really taken a look at what their role is. That can help us have a better impact on getting ahead of some of the major preventable diseases in our communities.
NPH: How important is county-level action when it comes to health?
McDonough: For the most part, counties really are responsible for the public health departments within their communities. Throughout the country we operate almost 1,000 county hospitals and close to 700 county nursing homes, so we have a lot of responsibility for public health and—just as important—we employ more than 30 million people throughout the country.
Action, responsibility and efforts vary county to county, but for example, in Ramsey County, Minnesota, where I’m the County Commissioner, we run the public health department working with our cities, the state and with the federal government. So for us it’s a really big opportunity to be the convener as well to lead the Healthy Cities Initiatives as well to a larger regional more focused and concentrated effort.
NPH: The focus of the forum includes some critical topics such as behavioral health and key health issues in jails. How much of a financial burden do these health issues place on counties?
New Report by RWJF Commission to Build a Healthier America Calls for Funding Changes to Help Improve the Health of the Nation
Recommendations released by the Robert Wood Johnson Foundation’s Commission to Build a Healthier America yesterday call for three areas of change essential to improving the nation's health:
- Increasing access to early childhood development programs;
- Revitalizing low-income neighborhoods;
- Broadening the mission of health care providers beyond medical treatment to include the social problems their patients face that keep them from living healthy lives.
The Commission, which reconvened last June after four years, deliberated over the past several months and determined that these areas have the greatest potential for improving the health of the population, especially for low-income families.
The independent, non-partisan Commission was chaired by Alice M. Rivlin, PhD, former director of the Office of Management and Budget, and Mark McClellan, MD, PhD, the former head of the Centers for Medicare & Medicaid Services. Commission members included journalists, physicians, academics, policymakers, public health experts and people engaged in community development.
The new recommendations are part of a new report, Time to Act: Investing in the Health of Our Children and Communities.
“We cannot improve health by putting more resources into health care alone," McClellan said. "We must find ways to help more Americans stay healthy and reduce the health care costs that are crowding out other national priorities."
"To achieve a healthier America, we must change our approach to investing in health to affect the actual determinants of health, not just the consequences of ill-health," said Rivlin. "If carried out, these recommendations will build a foundation of lifelong health for generations to come."
Speaking at the release of the recommendations in Washington, D.C., yesterday RWJF President and CEO Risa Lavizzo-Mourey, MD, MBA, said, “we must join forces to foster a culture of health in which everyone—regardless of where they live, their race or ethnicity, or how poor or wealthy they may be—has the opportunity to lead a healthy life."
The Commission’s members all spoke about the findings and recommendations during panel discussions at an event at the Newseum to release the report. Suggested next steps include engaging both citizens and policymakers to advance the issues. “Often aspiring policymakers are looking for an issue and we’re trying to hand them one,” said Rivin. Anne Warhover, a member of the Commission and president and CEO of the Colorado Health Foundation, pointed out that turning the recommendations into successful actions will include helping each community determine both what it needs and what it can do, and realizing that “one size does not fit all” when it comes to these changes.
The Robert Wood Johnson Foundation, said Lavizzo-Mourey, “will make the [Commission’s report] our compass going forward to allow everyone to live a healthy life. It’s not going to stay on the shelf. We’re going to use this every day.”
- Resources created to accompany the release of the recommendations of the Commission to Build a Healthier America include video interviews with key leaders who are already helping to change the health of their communities.
Earlier this week, the Robert Wood Johnson Foundation held its first ever “Culture of Health Hangout,” a new series meant to explore what communities across the country are doing to advance and transform public health. This first foray looked at how public health departments have evolved in recent years, and are continuing to evolve to meet the changing needs of the communities they serve. The panel was moderated by Paul Kuehnert, RWJF senior program officer and Public Health team director.
According to Muntu Davis, Public Health Director and County Health Officer of Alameda County, the core role of public health hasn’t really changed—public health departments and officials continue to gather and analyze data to explain what’s happening to the health of a community. However, what has changed is where they put their focus. Now, in health departments across the country, the focus is not simply on individual decisions, but on social and economic factors that dictate which options are truly available.
“Although it does boil down to an individual choice, if there’s no opportunity there for communities, then ‘health’ is definitely not an easy choice to make,” said Davis.
One of the more innovative approaches his health department has undertaken is utilizing maternal and child health workers to provide, in addition to their traditional work, financial coaching to people who may be of lower incomes. “Studies have shown link between income, wealth and life expectancy,” said Davis, and that’s what makes it important for public health to help support not just the immediate health need but also “the full picture of what might be shaping their health.” These workers are able to provide education and assistance, while also linking them to financial coaching and tools that can help them manage the money they have.
Karen DeSalvo, City of New Orleans Health Commissioner, spoke extensively on the importance of community partnerships when it comes to advancing community health. She said Hurricane Katrina was, in a way, a “catalyst for change” that enabled the entire community to hit the reset button, assess where they were and determine how best to move forward together. One of the first realizations was that the city simply did not have a strong enough local health department.
“It allowed us to begin planning, and to decide to move away from an expensive, hospital-based system to one that was more about prevention and primary care,” she said. “And over the course of years, once we stabilized that infrastructure at the frontline of primary care and moved more toward prevention, the glaring need to have a strong public health department became obvious.”
At the recent Place Matters: Exploring the Intersections of Health and Economic Justice conference in Washington, D.C., David J. Erickson, PhD, was a key member of a panel called “What Works for America’s Communities?” Dr. Erickson, who is director of the Center for Community Development Investment at the Federal Reserve Bank of San Francisco, has been a key leader in a Healthy Communities collaboration between the Federal Reserve and the Robert Wood Johnson Foundation. The joint effort has convened more than ten conferences around the country and released numerous publications, including an article in Health Affairs about partnerships to improve the wellbeing of low-income people.
>>Read more reporting from the Place Matters conference, in a Q&A with David Williams of the Harvard School of Public Health and the RWJF Commission to Build a Healthier America.
NewPublicHealth spoke with Dr. Erickson at the Place Matters meeting.
NewPublicHealth: Are the Healthy Communities conferences continuing?
David Erickson: We still have what we call “consciousness raising” meetings planned in Ohio, Florida, Louisiana and other cities, and these are initial meetings that get together the health and community development world. But then there is another phase, we call it phase two—how do you operationalize this idea? What do we do tomorrow? Who do I call? How do I structure the transaction? Who’s my partner? And that’s harder to answer so we’re trying to figure that out. So we need phase two meetings to get hospitals together with banks to talk about how they might blend some of their community benefit dollars with community reinvestment dollars to help alleviate some of the upstream causes of bad health [like poverty and poor housing].
NPH: What would be examples of such a collaboration?
At the recent Place Matters conference in Washington, D.C., David Williams, PhD, the Norman Professor of Public Health at the Harvard School of Public Health and staff director of the reconvened Robert Wood Johnson Foundation Commission to Build a Healthier America, talked about the need for cooperation between the community development industry and health leaders.
“Community development and health are working side by side in the same neighborhoods and often with the same residents but often don’t know each other or coordinate efforts.”
NewPublicHealth recently asked Dr. Williams about how synergies between the two fields can help improve population health.
>>View David Williams' PowerPoint presentation from the conference:
NewPublicHealth: Is there progress on the community development and health fields working together to help improve the health of communities?
David Williams: I would say there is increasing recognition by individuals both in health and in community development that they are two groups working in many ways on the same challenges and often in the same communities and in many ways there can be there could be synergy from working together. But I would also say that this is all so new, and I don’t think the field has matured in terms of our full understanding of where the potential is. To me, one of the greatest hungers out there is for people to see examples of success and progress and initiatives that in fact have worked well together, and we’re still in the beginnings of seeing that—such as the Federal Reserve healthy communities conferences, which have raised awareness levels and have begun to help similar initiatives. But we’re still in the infancy of really capitalizing on the potential.
One of the key challenges is that this area of healthy communities is a broader issue. And that includes the need to recognize the importance of a health in all policies approach—that policies in many sectors far removed from health have health consequences. A good example is the education sector—and having teachers recognize that they are themselves are health workers in a certain sense because the work they do can have such an important impact on health.
A key session at the Second National Health Impact Assessment Annual Meeting held recently in Washington, D.C., was a panel discussion on several evaluations of the value and benefits of health impact assessments (HIAs). Andrew Dannenberg, MD, MPH, an affiliate professor at the University Of Washington School of Public Health, was a consultant on a recent evaluation of HIAs funded by the Robert Wood Johnson Foundation and a member of the evaluation panel at the HIA meeting. NewPublicHealth spoke with Professor Dannenberg about some recent findings.
NewPublicHealth: What have the recent evaluations of HIA as a tool told us about the value conducting health impact assessments?
Andrew Dannenberg: Essentially, HIA works. The tool does seem to promote health, and does have influence in some cases but not others. HIAs can influence the health component of [policy] decisions.
There are also indirect HIA benefits: by getting public health professionals talking with decision makers in other sectors—such as transportation and housing—HIAs create partnerships and collaborations for longer-term value. So a transportation department building a highway may then always realize that there are health implications of what gets constructed.
We also came away with a list of factors that influence HIAs to make them successful. The list includes:
- Timeliness is often a factor when doing an HIA (in that the HIA must be completed and recommendations made in time to support or influence the policy decision).
- Involving stakeholders and decision makers gives a better chance that the recommendations will be considered.
- It is important to have community engagement and feedback, or, particularly when it is an HIA being done rapidly, it is critical to have a well-informed health leader at the helm.
- It is critical to screen the topic to be sure it is appropriate for an HIA.
- Dissemination to stakeholders, decision makers and media is very important, using methods, length and language appropriately customized for those audiences.
- HIA recommendations need to be clear and actionable.
- The Australian evaluation found that a key to successful HIAs was getting the right people at the right time to work together.
NPH: Do you have an example of an HIA that showed that using the tool leads to better decision making?
Dannenberg: An HIA conducted in San Francisco several years ago is one of our clearest examples. A developer wanted to tear down some low-income housing to build more expensive apartments that would have displaced the low-income people living at the site. The Department of Health conducted an HIA, which made it clear that it is bad for health to take low income people in an expensive city and throw them out in the street with no housing.
“[Health Impact Assessments have] taught people how to think and speak differently, clearly, objectively,” according to Cleveland Councilman Joe Cimperman. “Suddenly we are saying those words we don’t say often enough in government: Are you comfortable with the environmental and health impacts of this decision?”
NewPublicHealth caught up with Cimperman soon after his plenary address at the second annual National Health Impact Assessment meeting held in Washington, D.C., this week. He is an HIA supporter and enthusiast who is already engaged in health impact assessments for the city of Cleveland.
NewPublicHealth: What was your impression of the HIA meeting?
Joe Cimperman: I was blown away by so many different things—the geographic diversity of the people attending, and the many ideas they presented in questions and in private conversations after I spoke.
NPH: In your opinion, what is the intrinsic value of health impact assessments?
Cimperman: HIA has been a model for how to get things done right. But the tool also allows us to get closer to people and their specific needs by going through the process—which is such an important component—to find out how we help individuals when we make policy-level decisions. If we want to restore our cities, we need to ask what problems we’re solving.
NPH: What’s a strong example of an HIA in your community that was innovative and beneficial?
Cimperman: We have completed an HIA on the health implications of proposed legislation to expand agriculture into urban areas. Cities like ours have enough land that we can think about the different and best ways to use some of it—and urban agriculture is a means of helping people use the land themselves, and use it for something other than home and industrial construction. I think we’ve been able to do so much good by applying an HIA because we’re answering questions right up front. The Urban Agriculture overlay district is a proposed piece of legislation that would introduce intense farm uses in an urbanized environment, including livestock, community gardens and commercial gardens. While the uses are thought to have positive impacts on human health—such as access to fresh fruits and vegetables, community cohesion through the establishment of gardens, potential economic opportunities and a productive reuse of vacant land—unintended adverse impacts to human health include increased animal waste, potential exposure to carcinogens created by insecticides, and increases in noise and odor levels.
One of the most sought-after experts at the second national Health Impact Assessment (HIA) meeting, currently underway in Washington, D.C., is Arthur Wendel, MD, MPH, team lead for the Healthy Community Design Initiative at the U.S. Centers for Disease Control and Prevention (CDC), which is a sponsor of the HIA meeting. Health impact assessments are decision-making tools that help identify the health consequences of policies in other sectors.
NewPublicHealth caught up with Dr. Wendel just after the first plenary session.
NewPublicHealth: How’s the meeting so far?
Arthur Wendel: The first plenary speaker, councilman Joseph Cimperman form Cuyahoga County in Cleveland, was just an outstanding speaker and made such a good impression for the whole conference. When you have a policymaker come in and provide a fresh perspective about how health impact assessments can make a difference, that sets the stage for attendees.
>>Editor’s Note: NewPublicHealth will be speaking with Councilman Cimperman later this week about his championing of HIA work in Cleveland, including a health impact assessment on the city’s budget, the first time the tool has been used that way.
NPH: How long has CDC been involved in health impact assessments?
Arthur Wendel: CDC has been involved with health impact assessments, through the Healthy Community Design Initiative, since 2003. The initiative is part of CDC’s National Center for Environmental Health, and initially we were just kind of trying to figure out the field of health impact assessments, learn a little bit about it from some domestic and international groups that conducted health impact assessments. Some of the initial steps were just trying to provide technical assistance for a few HIAs. That gave us a little bit of flavor for how health impact assessments were done, and from that initial effort we started to compile some research. One of the initial papers that came out of our group was identifying the first 27 HIAs that were conducted in the United States and some of the common characteristics among them.
>>Looking for examples of successful HIAs? Read stories from the field from CDC grantees.
NewPublicHealth has written extensively about community development—how financial investments can in time make the places we live, learn, work and play healthier. To truly be successful, it’s a course that no one organization or institution or person can take alone. It’s about partnerships. Community developers, public health officials, foundations and bankers must all come together to determine a strategy for investing and reinvesting in communities.
On Tuesday, September 3, from noon to 5:15 p.m. EST, SOCAP Health will bring together in a live webcast an array of experts to explore this new “health impact economy” and discuss real-world examples of successful partnerships that are improving health in low-income neighborhoods. The event is being held by the Federal Reserve Bank of San Francisco, and additional sponsors include Social Capital Markets (SOCAP) and the Robert Wood Johnson Foundation.
Before Tuesday’s online event, take a look back at NewPublicHealth’s coverage of community development. Some of our biggest stories include:
This week’s International Making Cities Livable Conference brings together city officials, practitioners and scholars in architecture, urban design, planning, urban affairs, health, social sciences and the arts from around the world to share experience and ideas. We spoke with some of those diverse attendees to find out: what do they want the public health community to know about working across sectors to make communities healthier and more livable?
Alain Miguelez, City of Ottawa, Program Manager for Zoning, Neighbourhoods and Intensification
NewPublicHealth: What do you want public health to know about making communities more livable?
Miguelez: I want public health to know they’re at the heart of what we do. Usually urban planning is a pretty arcane thing. We’ve done a good job of making it tough for people to understand and relate to. They don’t have the patience. Public health brings it home. As we heard in a session this week, it’s not necessarily people who are disabled—it's the built environment that’s disabling.
It comes down to how you see yourself functioning in your daily life. We've made it impossible to function any way other than with a car. For some people that’s okay, but for those who’ve had a taste of something different, there’s no going back. As planners people don't trust us anymore. We’ve done a lot of things in the name of progress. We’ve disconnected people from the built environment and forced them into places that make people fat and depressed and disconnected and not well-functioning. People coo about Portland and its trams and light rail and walkability. That’s how cities are supposed to be. Everywhere else has got to come up to that standard.
When you see statistics on obesity or depression, it becomes critical, especially with kids. I have two kids and I see very clearly how the environment we build around us impacts how they grow up. It gives kids the tools to function as independent human beings. The right type of city building and suburban repair [with an eye toward public health] can do that.