place matters presentation by david williams
DESCRIPTION
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
RWJF Commission to Build a Healthier America
Place Matters Presentation
October 3, 2013
David R. Williams, PhD
In 2009,the Commission was charged broadly with identifying actions to improve the nation’s health outside of the doctor’s office.
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).
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.
This year,the Commission is focusing its deliberations on recommendations to support health in communities and during early childhood.
Meet the 2013 Commissioners
Click icon to add picture
Click icon to add picture
Site Visit to Educare Center, D.C. Promise Neighborhood and Marvin Gaye Park
Click icon to add picture
Public Meeting with Expert Testimony
Preview of Commission Recommendations: Early Childhood
• 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
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
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
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
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
“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
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)
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
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
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
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
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
• 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
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
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.”
Preview of Commission Recommendations: Healthy Communities
ZIP Code vs. Genetic Code
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.
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
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
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
“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.
“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.
“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.
“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.
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
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
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
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.
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
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
What’s Next?
• 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