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Redesigning the Hospital as a Community Health Network

Sep 10, 2015, 3:35 PM, Posted by Shannon Kraus

Cleveland's MetroHealth Medical Center has reimagined itself to embrace community and build in thoughtful improvements to its programs and design that focus on everyday wellness and well-being.

Graphic of the MetroHealth Medical Center Image via HKS Architects

In a room filled with architects, acting Surgeon General Rear Admiral Boris D. Lushniak shook up the common definition of our profession by saying that “if you are an architect, you are a public health worker.

And many architects were already with him. We have been expanding our thinking beyond typical individual buildings to create healthy blocks, corridors and neighborhoods by shaping what they do within the property line so it’s responsive to what’s happening outside the property line. This in itself is not new, but doing so to improve health and wellness, while leveraging the resources of large civic-minded institutions, is a new approach to a traditional problem.

MetroHealth Medical Center in Cleveland, Ohio has taken on this mindful, responsive approach while morphing from an isolated hospital into an inclusive community health center. This process flips the paradigm of health delivery; instead of focusing on the hospital as the first line of defense in the care and wellbeing of a population, it is now the last stop.

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Community Development For and By the Community

Jul 13, 2015, 12:37 PM, Posted by Jasmine Hall Ratliff

Many families face rising rents they can’t afford. One local developer revamped an aging historic hotel into affordable housing to transform: "community development being done TO us.. to development done BY us."

Boyle Hotel before and after renovations. Before: The Boyle Hotel in disrepair. After: The Boyle Hotel-Cummings Block Apartments bring 51 new apartments to the neighborhood, all priced for people making between 30 to 50 percent of the area’s median income.

Ten years ago, Los Angeles’ Boyle Hotel was more than down on its luck. The grand old Victorian dame, built in 1889 by an Austrian immigrant and his Mexican wife, was uninhabitable. Over the years neglect had turned the stunning building with intricate period details into a ramshackle apartment house with shared bathrooms and communal kitchens. The wiring was faulty and the pipes leaked. Mold bloomed up walls. Rats scurried along the hallways. Absentee landlords racked up housing code violations, ignoring the residents’ repeated requests for basic protections of their safety and health.

Most of the tenants were older, single men: many of them mariachi musicians scraping by from gig to gig. They’d spend their weekends across the street in the plaza, as generations had going back to the 1930s, exchanging news and waiting for word of a quinceñeara or wedding where they might play. The musicians were a cultural anchor for the neighborhood, so much so that the residence was nicknamed the Mariachi Hotel.

The hotel sits at the peak of a steep hill, and if you look just beyond it you can see the full glory of downtown LA glinting in the sun. Maria Cabildo, Co-Founder and President Emeritus of the East LA Community Corporation (ELACC) and current Chief of Staff to the LA County Supervisor, saw the writing on the wall: The Boyle Hotel was bound to be snapped up by developers, and replaced by luxury rooms with a view if nobody attempted to save it. With plans for the LA Metro to extend its new light rail into the heart of the plaza, she knew that new development wouldn’t be far behind. What would the influx of business mean for the residents – mariachi musicians and families alike – who’d long called the neighborhood home?

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Crafting Win-Win Solutions with Health Impact Assessments

Jun 22, 2015, 3:01 PM, Posted by Pamela Russo

Health impact assessments are a powerful way to help communities think broadly about the health implications and equity aspects of policies and projects, so that a comprehensive approach to health becomes routine.

Prison Alternatives Boosted by Health Impact Assessment

Last week, almost 500 attendees arrived in the nation’s capital for the 2015 National Health Impact Meeting. The impressive turnout is a testament to the growing importance of health impact assessments (HIA) as a tool to improve community health outcomes.

As this year’s meeting attendees know, an HIA is a process that helps evaluate the potential health effects of a plan, project or policy outside of the traditional health arena. The findings from a completed HIA can provide valuable recommendations to help communities more effectively foster better and more equitable health among their citizens.

The use of HIAs has grown rapidly from just a few dozen in 2000 to more than 350 completed HIAs today. Dozens more are in the works. The earliest HIAs were mostly applied to the built environment, such as zoning, land use and transportation decisions. However, today the field has expanded to include such areas as energy policies, criminal justice and living wages.

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Building Healthier Places In Birmingham and Beyond

Jun 1, 2015, 11:46 AM, Posted by Susan Dentzer

How a section of Birmingham, Alabama is redeveloping and offering greater opportunities for people at multiple income levels. The secret? Engaging the community throughout the process.

With its elegant homes, pleasant park and bustling stores, the Woodlawn section of Birmingham, Alabama was described in a 1950 news article as “a really great section of Birmingham...typical of the fine things in life." Then came the racial unrest of the 1960s, disruption from urban renewal gone awry and white flight to Birmingham’s suburbs. Joblessness and poverty took root; the housing stock decayed. Today, median income in Woodlawn is just $21,000, less than half the level for Birmingham as a whole.

But now Woodlawn is in the midst of a turnaround, aiming to become not just a neighborhood that prospers economically, but also one where people live healthier lives.

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Clearing the Air in Louisville through Data and Design

May 13, 2015, 12:44 PM, Posted by Alonzo L. Plough

Louisville, Kentucky ranks among the poorest in air quality and highest in asthma rates among U.S. cities. A new art installation from Propeller Health shows residents real-time changes in the city's air quality, equipping them with the data to reach their goal of becoming one of the healthiest cities by 2020.

Airbare air quality installation in Louisville, Kentucky

I stand in front of an intriguing art installation on a busy street corner in downtown Louisville, KY, and visualize the invisible. It’s a bright orange steel kiosk outfitted with an interactive touch screen that allows passersby to “see” how air pollution levels change around the city in real time while also learning how these pollutants impact the severity of asthma symptoms. Called AirBare, the installation project was funded by RWJF and represents a unique collaboration between visual artists, big data analysts and local health advocates. By “popping” virtual bubbles on the screen, users find out what causes air pollution and what it will take to reverse it. This is relevant information for residents of Louisville, a city that consistently ranks among the lowest in air quality in the nation and has one of the highest rates of asthma and other respiratory conditions.

My visit to the AirBare installation coincided with a conference held in Louisville in March that brought together economists, health policy folks, food experts and, remarkably, Charles, the Prince of Wales, to examine the issue of air quality and the larger concept of sustainability in this Ohio River Valley city. The Prince, a longtime advocate for environmental issues with connections in Louisville, added star power to the Harmony & Health conference, sponsored by the non-profit Institute of Health Air Water & Soil. But there is plenty else to be excited about in Louisville. Under the leadership of Mayor Greg Fischer, city agencies have collected reams of data on air quality, health outcomes, life expectancy, income inequality, and unemployment, among many other measures. What has emerged is a far better picture of the tough environmental and socioeconomic issues impacting the health and wellbeing of Louisville’s 600,000 residents, and a serious and concerted commitment to build a culture of health.

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Design That Heals: The American Institute of Architects Rewrites the Rules

Apr 9, 2015, 9:27 AM, Posted by Sheree Crute

The South Bronx's Via Verde, an award-winning affordable housing complex designed around equity and social cohesion, shows us a new era of healthy design is here—and it's contagious.

Via Verde residents plant vegetables in the rooftop community garden in the Bronx, New York. (Image credit: David Sundberg/Esto)

Each winter, Raquel Lizardi and her heartiest garden club members brave the New York City cold to tend their community’s apple trees. “They are very delicate,” Lizardi says, sharing her training at GrowNYC, a nonprofit that seeks to create a healthier environment in the city, block by block. Their efforts ensure that the small orchard yields barrels of sweet Red Delicious, Gala, and slightly tart McIntosh apples for Lizardi and her neighbors in the fall.

Come spring, the group turns its attention to planting enough organic spinach, collards, kale, berries, tomatoes, other vegetables, and herbs to keep all of their tables filled with free, fresh produce.

The orchard, gardens, and grove of evergreens where Lizardi and her neighbors come together are a center of community activity at Via Verde/The Green Way, an award-winning, affordable housing development that rises above a quiet street just off bustling Third Avenue in the South Bronx. Built on a former garbage-strewn lot and Brownfield in 2012, Via Verde is now an international symbol of healthy design achievement.

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Research Designed Through the Eyes of Youth

Mar 17, 2015, 12:30 PM, Posted by Alonzo L. Plough, Dwayne Proctor

There's power in giving youth the means to document what they see as the barriers to their community's health. This project from Charlotte, N.C. shows us how this innovative research design can be a step to addressing local disparities.

Last year, we at the Robert Wood Johnson Foundation asked our community a bold question: What was considered the most influential research around identifying and eliminating disparities? In our first-ever Culture of Health reader poll, a winning research paper emerged in Por Nuestros Ojos: Understanding Social Determinants of Health through the Eyes of Youth, published in the Summer 2014 edition of Progress in Community Health Partnerships. The research project equipped young people in Charlotte, N. C., with cameras to identify and document environmental factors that impact health in their Latino immigrant community. What really makes this paper resonate for us—and, it seems, for many of you—is that it provides a clear example of how community-based participatory research (CBPR) is an important approach to understanding the multiple factors underlying health disparities.

We wanted to learn more about this interesting example of participatory research and how the Por Nuestros Ojos project is helping advance health equity in Charlotte. Recently, our blog team had a conversation with three of the study’s authors to find out how employing a participatory research model can help enormously in understanding and eliminating disparities in marginalized communities. Below is an interview with Johanna (Claire) Schuch, research assistant and doctoral candidate at the University of North Carolina at Charlotte (UNCC); Brisa Urquieta de Hernandez, project manager at the Carolinas HealthCare System and doctoral student at UNCC; and Heather Smith PhD, professor, also at UNCC.

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Creating Open & Sacred Spaces To Improve Health

Jan 21, 2015, 7:23 PM

In 1995, Tom Stoner and his wife Kitty discovered a tiny urban park in the middle of a busy London neighborhood that had been used as a refuge during World War II. On the backs of many of the park’s benches, the Stoners found loving thoughts and peacetime memories that had been etched by Londoners during the horrors of war. They realized that if an urban park could be a source of quiet and solace during a time of bombing and destruction, then similar natural environments could certainly offer spaces for reflection, recovery and respite for people dealing with the stress of modern life. With that idea the Stoners created the TKF Foundation to support the creation of urban green spaces.

“The speed, violence and alienation that characterize our current period in human history create an important need for open spaces, sacred places,” says Tom Stoner.

In 2010 Tom and Kitty began the National Nature Sacred Awards Initiative, designed to support the creation of public greenspaces to serve as demonstration and research sites to study the impact of nature on the human spirit. NewPublicHealth recently spoke with Tom Stoner about the intersection of green space and improved health and lives.  

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Healthy Community Planning Means Healthier Neighbors

Nov 17, 2014, 3:44 PM, Posted by Helene Combs Dreiling

5716 Wellness is housed in a historic Albert Kahn-designed cigar factory. 5716 Wellness is housed in a historic Albert Kahn-designed cigar factory.

Too often, U.S. public health policy focuses on treating illnesses after they are diagnosed, instead of encouraging healthy lifestyles to prevent illness in the first place. But architects—my profession—are engaged in a wholesale effort to reverse this focus. Throughout the U.S., right in the buildings where we live and work, architects are incorporating design techniques that can help prevent illness and benefit the local communities that live with their designs.

One of the best examples of this effort—even amidst bankruptcy and a historic unraveling of a once-dominant American city—is the Detroit Collaborative Design Center (DCDC), a nonprofit architecture and urban design firm that offers proof that neighborhoods that facilitate holistic wellness and preventative care are as valuable as doctors who make house calls.

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RWJF Pioneering Ideas Podcast: Episode 6 | What if? Shifting Perspectives to Change the World

Oct 20, 2014, 9:00 AM, Posted by Pioneer Blog Team

Please note that this podcast player might not work in some versions of Internet Explorer. Please view this page in another browser, such as Chrome, Firefox or Safari. You may also access the episode via SoundCloud.

RWJF's Pioneering Ideas Podcast is on iTunes! Don’t miss an episode—click to subscribe.

Welcome to the sixth episode of RWJF’s Pioneering Ideas podcast, where we explore cutting edge ideas and emerging trends that can help build a Culture of Health. Your host is Lori Melichar, director at the foundation.

Ideas Explored in This Episode

Sharing Health Care Providers’ Notes (3:08) OpenNotesTom Delbanco and Jan Walker talk with RWJF’s Emmy Ganos about why they decided getting health care providers to share their notes with patients was an essential innovation–and where their work is headed next. Here’s a hint: what if the  3 million patients who now have easy access to their clinician’s notes could co-write notes with their providers?

Rethinking How We Solve Poverty (18:46) Kirsten Lodal, founder and CEO of LIFT, talks with RWJF’s Susan Mende and shares some simple ideas with the potential to revolutionize our approach to helping people achieve economic stability and well being. In a thought-provoking conversation, Lodal connects the dots between improving the well being of those living in poverty and building a Culture of Health.

A Historian’s Take on Building a Culture of Health (27:58) – Princeton historian Keith Wailoo and RWJF’s Steve Downs discuss how deeply held cultural narratives influence our perceptions of health, and how today’s “wild ideas” are often tomorrow’s cutting edge innovations.

Sound bites

...On opening up health care providers’ notes and what’s next:

“What I would like to do is spread the responsibility for health beyond the health care system. The health care system is good; I hope that it gets better, but there are so many other parts of our lives that contribute to our well being.” – Jan Walker, OpenNotes 

“It will be a very different world in the future. And we do think that OpenNotes is kind of giving people a peek into it. It's a first glimmer that this kind of transparency, this kind of approach to things, while it's passive now, it just opens up an enormous amount of possibilities for the future. And that's what really excites us.” – Tom Delbanco, OpenNotes

...On rethinking how we solve poverty:

“People's lives are like rivers... they flowed before coming into contact with us, and they will flow after having contact with us. And so the opportunity that we have, the privilege that we have is of most positively affecting the trajectory and the velocity of that flow. But if we forget that–if we get too swept up in having to own everything that happens in a person's life–then we won't build the best solutions, because we won't build solutions that provide people with the support they need to navigate the flow of that river over the long term.” – Kirsten Lodal, LIFT

...A historian’s take on building a Culture of Health: 

“Our concern with aggregate trends is an important one in tracing the shifting demographics of health in our country, but to understand what health actually means involves actually putting the data aside and thinking about lives and thinking about individuals and thinking about what these trends mean on an individual level.”– Keith Wailoo, Princeton University

Your Turn

Now that you’ve listened – talk about it! Did anything you heard today get you thinking in new ways about how you can help build a Culture of Health? Do you have a cutting-edge idea you’d like to discuss? Comment below or tweet at me at @lorimelichar, or consider submitting a proposal. Be sure to keep the conversation and explorations going at #RWJFpodcast.

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