place matters presentation by david williams

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RWJF Commission to Build a Healthier America Place Matters Presentation October 3, 2013 David R. Williams, PhD

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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.”

TRANSCRIPT

Page 1: Place Matters Presentation by David Williams

RWJF Commission to Build a Healthier America

Place Matters Presentation

October 3, 2013

David R. Williams, PhD

Page 2: Place Matters Presentation by David Williams

In 2009,the Commission was charged broadly with identifying actions to improve the nation’s health outside of the doctor’s office.

Page 3: Place Matters Presentation by David Williams

Progress since 2009 Recommendations

• The Patient Protect and Affordable Care Act (ACA) established funding for Maternal, Infant and Early Childhood Home Visiting programs.

• Healthy Food Financing Initiative (HFFI) brings grocery stores and other healthy food retailers to underserved urban and rural communities.

• Congress provided funding to increase the number of farmers markets participating in the Supplemental Nutrition Assistance Program (SNAP).

Page 4: Place Matters Presentation by David Williams

Progress since 2009 Recommendations

• The Healthy Hunger-Free Kids Act creates an opportunity for the USDA to improve the nutrition and hunger safety net for millions of children.

• To date, more than 200 Health Impact Assessments (HIAs) have been completed or are in progress across the country.

• At the federal level, the Centers for Disease Control and Prevention (CDC) has launched the Community Transformation Grant Program.

Page 5: Place Matters Presentation by David Williams

This year,the Commission is focusing its deliberations on recommendations to support health in communities and during early childhood.

Page 6: Place Matters Presentation by David Williams

Meet the 2013 Commissioners

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Page 7: Place Matters Presentation by David Williams

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Site Visit to Educare Center, D.C. Promise Neighborhood and Marvin Gaye Park

Page 8: Place Matters Presentation by David Williams

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Public Meeting with Expert Testimony

Page 9: Place Matters Presentation by David Williams

Preview of Commission Recommendations: Early Childhood

Page 10: Place Matters Presentation by David Williams

• Children most often in need of early childhood programs are least likely to have access to them.

• Compared with their counterparts who participate in high-quality early childhood interventions, at-risk children without such services are 25 percent more likely to drop out of school.

• Graduation from high school is the leading health indicator for adults, even when controlling for race and income.

Early childhood is critical for lifelong health

Page 11: Place Matters Presentation by David Williams

Creative, new approaches in early childhood policy and practice that are grounded in rigorous science and not driven by personal belief

More explicit attention to transforming the lives of the adults who care for vulnerable, young children

Science Has Evolved, Our Approaches Have NotJack P. Shonkoff, Director, Center on the Developing Child, Harvard University

Page 12: Place Matters Presentation by David Williams

A flexible investment strategy and a culture of innovation that support the value of strategic risk-taking, fast-cycle sharing, and a commitment to learn from strategies that don’t work

Science Has Evolved, Our Approaches Have NotJack P. Shonkoff, Director, Center on the Developing Child, Harvard University

Page 13: Place Matters Presentation by David Williams

Mobility Mentoring is the professional practice of partnering with clients so that over time they may acquire the resources, skills, and sustained behavior changes necessary to attain and preserve their economic independence.

Helping Children by Transforming AdultsElisabeth D. Babcock, President and CEO, Crittenton Women’s Union

Page 14: Place Matters Presentation by David Williams

CWU’s unique business model combines direct services to over 1,400 clients per year, with research, and advocacy, to create new program and public policy approaches designed to overcome obstacles to family stability and self-sufficiency.

Helping Children by Transforming Adults

Page 15: Place Matters Presentation by David Williams

“Poor families lurch between jobs that don’t pay the rent, to subsidies that do, but don’t last, to homelessness and temporary shelters, to work, but no child care, to job loss, to borrowing on credit, to not being able to get an apartment because they have credit card debt or have been evicted.”

Helping Children by Transforming AdultsElisabeth D. Babcock, President and CEO, Crittenton Women’s Union

Page 16: Place Matters Presentation by David Williams

Helping Children by Transforming Adults

40% of our clients report at least one significant mental health diagnosis such as bi-polar, anxiety, and/or depressive disorders

40% report a history of trauma

35% report a physical, cognitive, and/or mental health disability that serves as a barrier to work or school

37% report that when they turn to family or friends for support, their social networks are either non-existent or worse, create a drain on their own families

50% of families in our longer-term programs have at least one child with diagnosed special needs (including behavioral, mental health, learning, and physical disabilities)

Page 17: Place Matters Presentation by David Williams

Career Family Opportunity (CFO) Program

From the outset, CFO had the express intent of proving that within five years they could attain jobs that would fully support their families without public subsidies (for most families this was a target salary of approximately $50,000 per year) and that they would also have each saved $10,000 (of which $3,600 would come from their own savings and $6,400 from matching funds if they completed their other goals).

Helping Children by Transforming Adults

Page 18: Place Matters Presentation by David Williams

Key Aspects of Career Family Opportunity Program:

Helping Children by Transforming Adults

Mobility mentor

Personal goals

Feedback and evaluation

Cash incentives

Social networks

Hanging on to the bridge

Page 19: Place Matters Presentation by David Williams

Sample Outcomes:

Helping Children by Transforming Adults

99% of families exiting homeless shelters had retained their housing for more than one year

Working adults exiting CWU job-readiness, housing, and education programs experienced an average 85% increase in wages compared to intake

100% of high-risk mothers in supported transitional housing were on-time with rent payments

77% of GED graduates,

80% of job-readiness training graduates, and

100% of supported housing residents

were working and/or in school within six months of program completion

Page 20: Place Matters Presentation by David Williams

About 60,000 infants, toddlers, and preschoolers in Nebraska are growing up at risk of failing school.

Eleven counties account for 64 percent of all at-risk children between the ages of birth and 5 years.

Done Right, Early Childhood Development Programs Can Change CommunitiesJessie Rasmussen, President, Buffett Early Childhood Fund

Page 21: Place Matters Presentation by David Williams

Done Right, Early Childhood Development Programs Can Change Communities

In the past five years, the local partners in Nebraska have:

Expanded funding for pre-K

Institutionalized funding for at-risk four-year-olds through education state aid funding

Established a $60 million dollar public-private endowment to create, support, and enhance birth-to-three services for children at risk

Protected existing early childhood funding during the lean years of state cutting

Passed legislation to expand the Sixpence endowment cash fund, initiate a quality rating and improvement system for child care, and raise the eligibility standard for the child care subsidy

Page 22: Place Matters Presentation by David Williams

• Cost-benefit analyses of the Perry Preschool Program, the Abecedarian Project, and the Chicago Child-Parent Centers showed returns ranging from $3 to $17 for every dollar invested

• Intensive preschool interventions targeting disadvantaged children have been shown to yield significant gains that may last well into adulthood.

Investments in Young Children = Economic DevelopmentArthur J. Rolnick, Senior Fellow and Co-Director, Human Capital Research Collaborative, University of Minnesota Humphrey School of Public Affairs

Page 23: Place Matters Presentation by David Williams

Investments in Young Children = Economic Development

Children served by these programs are more likely to:

Stay in the regular classroom and out of special education

Go through school without repeating a grade

Complete high school without dropping out

Be employed and have higher earnings as adults

Page 24: Place Matters Presentation by David Williams

Investments in Young Children = Economic Development

“In Minnesota, we estimate that to ensure that all 3- and 4-year-olds living below the poverty line receive high-quality early childhood development, the state needs about an additional $90 million annually.

For children who aren’t already involved in an early childhood program, the scholarship would provide access. For children who are enrolled in a child care center or preschool, the scholarship would ensure that the quality is at the necessary level to meet school readiness goals.”

Page 25: Place Matters Presentation by David Williams

Preview of Commission Recommendations: Healthy Communities

Page 26: Place Matters Presentation by David Williams

ZIP Code vs. Genetic Code

Page 27: Place Matters Presentation by David Williams

David Erickson, Federal Reserve Bank of San Francisco

New Partners in the “ZIP Code-Improving” Business

There is an entire industry—community development—with annual resources in the tens of billions of dollars, that is in the zip code-improving business.

Page 28: Place Matters Presentation by David Williams

Community development and health are working side-by-side in the same neighborhoods and often with the same residents, but we do not know each other or coordinate our efforts.

New Partners in the “ZIP Code-Improving” Business

Page 29: Place Matters Presentation by David Williams

A “Wet Cement” Moment

“In the next 18 months we will build the new institutions and create new practices that will define the community development industry (and many of its allied sectors) for the next 20 years.

Kimberlee Cornett from the Kresge Foundation has been calling this time a “wet cement” moment, when we have the opportunity to create a new way of serving the needs of low-income Americans that can radically improve their life chances. In my opinion, we have never been closer to being able to fix zip codes.

But the cement is drying and creating these new systems will require leadership.”

New Partners in the “ZIP Code-Improving” Business

Page 30: Place Matters Presentation by David Williams

Community Development Financial Institutions (CDFIs): Bringing Wall Street to Main Street

Mission driven

Provides part of financial package that more traditional sources don’t cover

First responders

“Quarterbacks and Silo-Busters”Nancy O. Andrews, President and CEO, Low Income Investment Fund

Page 31: Place Matters Presentation by David Williams

“Quarterbacks and Silo-Busters”

People and Places: LIIF Projects Come to Life

Booth Memorial Child Development Center

Before LIIF’s renovations, Booth’s facilities were outdated, old, and caused health problems. Asthma attacks were a common problem among Booth staff and children. A $70,000 investment from LIIF along with matching contributions from philanthropy brought the total investment to $159,000.

Page 32: Place Matters Presentation by David Williams

“Quarterbacks and Silo-Busters”

People and Places: LIIF Projects Come to Life

Transit Oriented Development

In 2011, LIIF helped create the Bay Area Transit-Oriented Affordable Housing Fund, a $50 million capital pool formed in collaboration with several other community capital partners to create not only more affordable housing but healthy, mixed-income, walkable communities, located near major transit nodes.

Page 33: Place Matters Presentation by David Williams

“Quarterbacks and Silo-Busters”

People and Places: LIIF Projects Come to Life

Purpose Built Communities

Based on efforts in Atlanta’s East Lake district, Purpose Built Communities uses integrative strategies including cradle-to-college educational opportunities, mixed-income housing, early child development programs, and recreational opportunities.

East Lake in Atlanta has empirically demonstrated a 95 percent reduction in crime since its launch in 1995, a six-fold increase in employment and extraordinary improvement in school achievement.

Page 34: Place Matters Presentation by David Williams

“Quarterbacks and Silo-Busters”

People and Places: LIIF Projects Come to Life

Refresh

In New Orleans, one of the worst “food deserts” in the country, LIIF worked with partners to fund an $18 million “healthy food hub.” This is a mixed-use commercial facility.

Page 35: Place Matters Presentation by David Williams

Community development field + health field

“Quarterbacks and Silo-Busters”

Break down silos

Evidence-based investment

Adaptive, entrepreneurial networks across divergent fields

Scaling up investments in what works

Page 36: Place Matters Presentation by David Williams

Investing in Poor Neighborhoods Makes Good Business SenseDavid W. Fleming, Director and Health Officer, Public Health—Seattle & King County

Going beyond the walls of the clinic to improve health:

Invest in proportion to need

Use proven global health strategies

Leverage the Health Care Financing Reform and Community Benefit Provisions of the ACA

Page 37: Place Matters Presentation by David Williams

Investing in Poor Neighborhoods Makes Good Business Sense

Red counties are 60 years behind blue counties. 

Like Politics, All Health is LocalU.S. life expectancy by county compared to average of top 10 countries, 2007

Page 38: Place Matters Presentation by David Williams

Investing in Poor Neighborhoods Makes Good Business Sense

Like Politics, All Health is LocalKing County life expectancy by census tract compared to average of top 10 countries, 2010

S eattle

K ent

B e llevue

A uburn

K irkland

F ede ral W ay

S am m am is h

B urien

S hore line

S eaTac

Tukw ila

Is s aquah

B o the ll

K enm ore

C ovington

D es M o ines

S noqua lm ie

W oodinville

M aple Va lley

B lack D iam ond

E num claw

M ercer Is land

N ew cas tle

N o rth B end

D uva ll

P acific

M edina

L ake F ores t

P a rk

A lgona

N orm andy P a rk

R edm ond

C arna tion

M ilton

R enton

L ife E xp ec tan c y C o m p ared toth e Ten L o n g es t-L ived C o u n triesb y C en s u s T rac t2005-2009, K in g C o u n ty W A

D ate : 1 0/11/2011

L eg en d

C IT Y

C a le n d a r Y ears A h ead

S m all popu la tio n

C a le n d a r Y ears B eh in d

Y ea rs be hind o r ah ea d a re fro m 20 07 .D ata S o urc es : Inte rn ation a l life expe c tan cies : Ins titute fo r H e a lth M etrics a nd E va lua tion , U nive rs ity o f W a sh in gto nL o ca l life e xp ec ta nc y: W a sh in gto n S ta te D ep artm e nt o f H ea lth,C en ter fo r H ea lth S ta tis tic s D ea th F ilesA na lys is an d p re pa ra tion : A ss es s m en t, P o licy D e ve lo pm e nt & E va lua tion ,P ub lic H e a lth – S ea ttle & K ing C ou nty, 1 0/20 11

P rep are d by: A ss es s m e n t, P o licy D e ve lo pm e nt & E va lua tion

P ro v is io n a l: S u b jec t to R ev is io n

24 to 57

10 to 23

Zero to 9

1 to 1 4

15 to 30

31 to 42

    

Number of years ahead or behind best performing countries:

31 -

42

15 -

30

1 -

14

     

0 -

9

10 -

23

24 -

57

Dark red census tracts are 100 years behind dark blue ones. 

Page 39: Place Matters Presentation by David Williams

Detroit Future City:

New job opportunities

Stabilization of neighborhoods and employment centers

Improving city systems and infrastructure

We’re all in this Together – the Need for Collective ActionLaura J. Trudeau, Senior Program Director, Community Development/Detroit Programs, The Kresge Foundation

Page 40: Place Matters Presentation by David Williams

Detroit Future City:

Zoning reforms that accommodate modern and innovative land uses

Putting public land assets into more strategic and productive use

Civic engagement

We’re all in this Together – the Need for Collective ActionLaura J. Trudeau, Senior Program Director, Community Development/Detroit Programs, The Kresge Foundation

Page 41: Place Matters Presentation by David Williams

What’s Next?

Page 42: Place Matters Presentation by David Williams

• Visit RWJF.org/goto/commission

• Visit buildhealthyplaces.org

• Follow @RWJFCommission on Twitter

• Tune into the webcast of the recommendations release on January 13

Get Involved