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New Health Affairs: Community Development Sector Helping Build Healthier Neighborhoods

November 8th, 2011

The community development sector –a network of real estate developers, banks, city planners, and non-profit groups — has traditionally focused on promoting jobs, affordable housing and improved quality of life in low-income communities.  Now it is increasingly taking on the role of improving public health, and building healthier, more prosperous communities with nutritious food, clean air, safe sidewalks and other attributes that can affect how well and long residents live.

A series of articles in this month’s Health Affairs, explores how key actors in community and economic development, housing, finance, public health and even community health centers are forging partnerships to transform neighborhoods and improve health.  The November issue of Health Affairs, produced with support from the Robert Wood Johnson Foundation, suggests that these new relationships will soon begin to make the kind of improvements in health that no one sector has been able to achieve in the past.

Partnerships Tackle Complex Health Problems

Three papers assess budding partnerships and components of successful collaborations:

  • Sandra Braunstein of the Federal Reserve Board and Risa Lavizzo-Mourey of the Robert Wood Johnson Foundation write that a number of local and national collaborations are beginning to create healthier conditions in low-income neighborhoods.  These collaborations include a public-private partnership in Seattle that aims to reduce exposure to allergens in the home that can cause asthma attacks in children, and a federal partnership that will spur the operation of grocery stores in urban areas that lack access to healthy foods
  • An analysis by David Erickson of the Federal Reserve Bank of San Francisco and Nancy Andrews at the Low Income Investment Fund describes the work of the community development sector.  The sector is actually a network of nonprofit service providers, real estate developers, financial institutions, foundations, and government working to transform impoverished neighborhoods and advance health and social issues.  For example, developers might partner with public health officials to create affordable healthy housing for seniors, an outcome that might keep older people at home longer and reduce high rates of placement in costly nursing homes, they say.
  • David R. Williams at the Harvard School of Public Health and James Marks at the Robert Wood Johnson Foundation note that the evidence shows that good health has far more to do with living in a healthy home or neighborhood  than it does with having access to medical care.   As the community development, public health, and health care sectors forge new partnerships, they say, it will be critical to evaluate the interventions they undertake rigorously to build the financial case for further investments and partnerships of this type.

Cross-Sector Collaborations Are Helping Build Clinics and Revitalize Housing

Two examples of encouraging health and community development partnerships are profiled:

  • Ronda Kotelchuck of the Primary Care Development Corporation in New York City and coauthors report that community health centers are beginning to partner with community development lenders and private investors to finance expansion of federally qualified community health centers in New York, California, and increasingly throughout the country.  Such collaborations will help community health centers treat an influx of newly insured patients expected under the Affordable Care Act, the authors say.
  • Researchers and a developer in San Francisco will assess the health impact of a planned effort to revamp Sunnydale, the city’s largest public housing project, according to Douglas P. Jutte at the University of California, Berkeley and coauthors.  A collaborative effort is under way to use the estimated four-year period before groundbreaking to establish baseline measurements of residents’ social and physical well-being, plan initiatives in collaboration with community members and stakeholders, and seek funding for the initiatives’ implementation.

Federal Urban Policy, Job Creation Programs Could Address Health Factors

Authors explore the potential health gains of smarter urban policies and job training programs:

  • Mariana Arcaya at the Harvard School of Public Health and Xavier de Souza Briggs at the Massachusetts Institute of Technology write that the implementation of the Affordable Care Act of 2010 and the Obama administration’s urban policy create an opportunity to link community development with community health in new ways. But fragmented congressional jurisdiction and budget “scoring” rules pose challenges.  They argue that government agencies need to adopt comprehensive efforts to innovate and support testing new models to advance community development as a public health priority.
  • Nicholas Freudenberg and Emma Tsui at the City University of New York examine the prospect that creating new entry-level jobs in fields such as health care or environmental remediation could both boost local economies and improve health.  In struggling communities, such jobs could provide individuals with health benefits and the wages to pay for cleaner, safer housing and health care.  Meanwhile, employees’ work effort could help to reduce exposures to environmental hazards and making healthier, safer food more available.
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  1. Gary Christopherson Says:

    Let me applaud Health Affairs, the Federal Reserve and The Robert Wood Johnson Foundation for this session on connecting the dots between community development and health.

    A few thoughts.

    As I indicated during the session, words matter in making large, positive change. To bridge these two communities and produce the best outcome for communities (neighborhood, local, State, national), let me suggest the term “Thrive!”. It brings together the aspirations of both the health and community development communities as well as other communities. This is the term of art that I have begun using and comes from a long body of analysis.

    On the several discussions around medical homes, let me suggest this is not the right term or framework. Person-centered health homes or Personal health homes or just person-centered health are better terms. They focus on the person rather than the provider and imply a partnership between person and provider. They focus on health and all its determinants rather than just on formal medical care. It restores openness on where health gets improved – health care facilities, through public health, in the home, in the schools, at the workplace. Health can be improved wherever the person is throughout the community.

    On Uwe’s recommendation for considering an “all-payer” approach, let me suggest he is right. An all-payer payment system simplifies the payments and payment system and creates a fairer payment system across providers, across payers and across persons/patients/enrollees/etc. However, the payment system should be set up in a way that all payers pay the full fair rate rather than trying to shift cost to another, less powerful payer. My Chairman and I introduced such an approach back in our bill in the mid-80s.

    Finally, on the mandate for insurance. There are benefits and costs to the mandate. It was never needed to proceed with health reform. It should have been left out of ACA from the beginning. Again, my Chairman I introduced a non-mandated, full health reform bill in the mid-80s.

    Again, thanks for the good work.

    Gary Christopherson

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