Place Matters: A Q&A With David J. Erickson, Federal Reserve Bank of San Francisco
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?
David Erickson: One example is an effort to provide enriched, affordable housing for high users of the medical care system, such as formerly homeless people with multiple diagnoses, or frail low-income elderly. For these populations, small interventions can help keep them out of the emergency room and drastically improve peoples’ lives.
NPH: How would it work?
David Erickson: To be honest, this is all very new, so we’re just getting a sense of it. We don’t have an example yet, but there is a lot of conversation and they have been very creative. There have been some conversations around housing and asthma interventions, which could include involving hospitals in efforts to remove of asthma triggers. Some preliminary work is in Fresno with the California Endowment, and quite a lot of other places are looking at it including King County in Washington State. A bank would have to be the process agent to make sure the social impact bonds can work. That’s a good example of where a hospital and bank could work together.
NPH: Is it still a bit uphill to get potential partners on board?
David Erickson: Being the unlikely messenger from the Federal Reserve has been helpful for being able to communicate the concepts, though I find a bit more progress at the health conferences than I do in the community development conferences. When I go to health conference, I feel much more openness toward learning about how community development and community reinvestment has a positive health effect. I think the Robert Wood Johnson Foundation has been very effective in getting the key concepts across to health groups such as “health is where you live, learn, work and play” and that a person’s zip code is more important to their health than their genetic code. These concepts carry the day. In community development, we’re still operating on an older premise, and they haven’t been exposed [enough] to the health messages yet.
NPH: How do you speed up make increasing inroads and who else do you need at the table?
David Erickson: The leadership in community development gets it. You see, for example, that Housing Secretary Shaun Donovan has said, “high quality housing is like being inoculated against disease.” But community development is hard. It’s not easy building apartment buildings and right now those involved can see our efforts as yet one more thing they have to do. We need to show that these efforts will make their work more impactful, and then we’ll see the rank and file come over, and we’re pretty close to that I think.
NPH: Who else needs to be at the table?
David Erickson: The connection between community development and health is not the end of the road. It’s the start of the journey. We need to bring in other sectors that are so important such as education, public safety and transportation. All of them have overlapping and related goals. And while just the coordination between community development and health is hard, we’ll soon go broader, and there are some preliminary efforts. One of my colleagues will be speaking at a conference called Rail-Volution in Seattle next week, which is looking at equitable transit. We’re starting to see investment in transit through a health improvement frame, and that’s exciting.