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.”
A Critique of the Proposed National Education Policy Reform
Place Matters Presentation by David Williams
1. RWJF Commission to Build a
Healthier America
Place Matters Presentation
David R. Williams, PhD
October 3, 2013
2. In 2009,
the Commission was
charged broadly with
identifying actions to
improve the nation’s health
outside of the doctor’s office.
3. 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).
4. 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.
5. This year,
the Commission is
focusing its deliberations
on recommendations to
support health in
communities and during
early childhood.
10. Early childhood is critical for
lifelong health
• 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.
11. Science Has Evolved, Our
Approaches Have Not
Jack P. Shonkoff, Director, Center on the Developing Child, Harvard University
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
12. Science Has Evolved, Our
Approaches Have Not
Jack 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
13. Helping Children by
Transforming Adults
Elisabeth D. Babcock, President and CEO, Crittenton Women’s Union
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.
14. Helping Children by Transforming Adults
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.
15. Helping Children by
Transforming Adults
Elisabeth D. Babcock, President and CEO, Crittenton Women’s Union
“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.”
16. 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)
17. Helping Children by Transforming Adults
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).
18. Helping Children by Transforming Adults
Key Aspects of Career Family Opportunity Program:
Mobility mentor
Personal goals
Feedback and evaluation
Cash incentives
Social networks
Hanging on to the bridge
19. Helping Children by Transforming Adults
Sample Outcomes:
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
20. Done Right, Early Childhood
Development Programs Can
Change Communities
Jessie Rasmussen, President, Buffett Early Childhood Fund
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.
21. 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
22. Investments in Young Children
= Economic Development
Arthur J. Rolnick, Senior Fellow and Co-Director, Human Capital Research
Collaborative, University of Minnesota Humphrey School of Public Affairs
• 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.
23. 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
24. 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.”
27. New Partners in the “ZIP CodeImproving” Business
David Erickson, Federal Reserve Bank of San Francisco
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.
28. New Partners in the “ZIP Code-Improving” Business
Community development and health are working side-byside in the same neighborhoods and often with the same
residents, but we do not know each other or coordinate
our efforts.
29. 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.”
30. “Quarterbacks and Silo-Busters”
Nancy O. Andrews, President and CEO, Low Income Investment Fund
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
31. “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.
32. “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.
33. “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, mixedincome 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.
34. “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.
35. “Quarterbacks and Silo-Busters”
Community development field + health field
Break down silos
Evidence-based investment
Adaptive, entrepreneurial networks across divergent fields
Scaling up investments in what works
36. Investing in Poor Neighborhoods
Makes Good Business Sense
David 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
37. Investing in Poor Neighborhoods Makes Good Business Sense
Like Politics, All Health is Local
U.S. life expectancy by county compared to average of top 10
countries, 2007
Red counties are
60 years behind
blue counties.
38. o
tries
rics and Evaluation,
Investing in Poor Neighborhoods Makes Good Business Sense
Like Politics, All Health is Local
King County life expectancy by census tract compared to average of
top 10 countries, 2010
Lake
Shoreline Forest
Park
Bothell
Dark red census tracts
are 100 years behind
dark blue ones.
Duvall
Kirkland
Redmond
Carnation
Medina
Seattle
Bellevue
Sammamish
Mercer
Island
Issaquah
Newcastle
Burien
Normandy
Park
Snoqualmie
North Bend
Renton
Tukwila
SeaTac
Des Moines
Kent
Maple Valley
Covington
Federal Way
Auburn
of Health,
pment & Evaluation,
Woodinville
Kenmore
Black Diamond
Algona
Milton
Pacific
luation
ovisional: Subject to Revision
Enumclaw
Number of years ahead
or behind best
performing countries:
39. We’re all in this Together –
the Need for Collective Action
Laura J. Trudeau, Senior Program Director, Community Development/Detroit
Programs, The Kresge Foundation
Detroit Future City:
New job opportunities
Stabilization of neighborhoods and
employment centers
Improving city systems and
infrastructure
40. We’re all in this Together –
the Need for Collective Action
Laura 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
42. Get Involved
• Visit RWJF.org/goto/commission
• Visit buildhealthyplaces.org
• Follow @RWJFCommission on Twitter
• Tune into the webcast of the recommendations release
on January 13
Hinweis der Redaktion
GENERAL PROGRESSIncreased awareness of the social factors that impact health Decreasing childhood obesity ratesInitiatives to bring healthy food options to underserved urban and rural communitiesIncreased focus on the importance of early educationIncreased number of health impact assessments to make communities healthierSPECIFIC LEGISLATION1. Increasing focus on Early ChildhoodThe Patient Protect and Affordable Care Act (ACA) established funding for Maternal, Infant and Early Childhood Home Visiting programs, one of which, Nurse Family Partnership, an RWJF grantee, presented to the Commission. The ACA authorized $1.5 billion for these programs, with the amount of authorized funds increasing each year.2.Expanding Access to Healthy FoodsIn November 2010, the White House established the Healthy Food Financing Initiative (HFFI) as a multi-million-dollar public and private investment to improve access to healthy foods. HFFI brings grocery stores and other healthy food retailers to underserved urban and rural communities across the United States. In 2012, Congress provided funding to increase the number of farmers markets participating in the Supplemental Nutrition Assistance Program (SNAP)
2.Expanding Access to Healthy Foods (cont’d)The Healthy Hunger-Free Kids Act, signed into law in December 2010, creates an opportunity for the USDA to improve the nutrition and hunger safety net for millions of children by making real reforms to school lunch and breakfast programs. In February 2013, the USDA proposed updated nutrition standards aimed at providing healthier foods and beverages in school vending machines, cafeteria a la carte lines, and other places where foods and beverages are offered outside of school meals programs.3. Creating Healthy CommunitiesThe use of health impact assessments (HIAs)—flexible, data-driven tools that help decision-makers identify and address the health impacts of a non-health policy decision or project—has gained traction, and built directly on the Commission’s recommendation to develop health impact ratings of infrastructure projects. To date, more than 200 HIAs focusing on policies and programs across multiple issues have been completed or are in progress across the country, informing decisions on new housing projects, transportation plans, community improvements, and a range of policies.At the federal level, the Centers for Disease Control and Prevention (CDC) has launched the Community Transformation Grant Program. Grantees design and implement community-level programs that prevent chronic diseases such as cancer, diabetes, and heart disease, and promote health.
An unstable and poorly regulated environment triggers excessive activation of stress response systems that increase the risk for lifelong impairments in both physical and mental healthCWU’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
At CWU, we see this distinct poverty imprint on the 1,400 women and children we serve each year. When we perform client intake and annual assessments we find:
Armed with the Bridge to Self-Sufficiency™ Theory of Change and the basic assumptions listed above, CWU created Mobility Mentoring and first deployed it in a very intensive five-year model known as the Career Family Opportunity (CFO) Program. With private philanthropic funding, CFO opened in 2009 with 21 families from South Boston public housing developments who voluntarily applied to join the program. From the outset, the program 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).
Sample Mobility Mentoring Outcomes for Non-CFO (Career Family Opportunity) Participants
Jessie Rasmussen, President, Buffett Early Childhood FundAbout 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.
Jessie Rasmussen, President, Buffett Early Childhood FundIn the past five years, the local partners working in Nebraska have: expanded funding for pre-Kinstitutionalized funding for at-risk four-year-olds through education state aid fundingestablished a $60 million dollar public-private endowment to create, support, and enhance birth-to-three services for children at riskprotected existing early childhood funding during the lean years of state cuttingpassed 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
Minnesota approach is one example of this approach
. Before LIIF’s renovations, Booth’s facilities were outdated, old, and caused health problems in children and staff alike. Asthma attacks were a common problem among Booth staff and children, thanks to the aging condition of the facility. However, a $70,000 investment arranged from LIIF along with matching contributions from philanthropy brought the total investment to $159,000.
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—Enterprise, LISC, the Opportunity Fund, and others. Private capital investors included Morgan Stanley and Citibank. The idea behind the TOD fund is to create not only more affordable housing but healthy, mixed-income, walkable communities, located near major transit nodes. Public transportation is crucial in urban areas, because one of the biggest barriers to jobs for low income people is literally being able to get to them. Good transportation is a key to jobs, employment, and opportunities.
A prime example of the type of “quarterback” we envision, Purpose Built’s results are stunning; 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—96 percent of Purpose Built students now perform at or above grade level, compared to 5 percent at the start. Purpose Built Communities is active in communities in Atlanta, New Orleans, Indianapolis, and Charlotte, among others. LIIF has committed $10 million in New Markets Tax Credits to the Drew Charter School in East Lake.
In New Orleans, one of the worst “food deserts” in the country, LIIF worked with Goldman Sachs, JPMorgan Chase, and L+M Development partners to fund an $18 million “healthy food hub.” This is a mixed-use commercial facility with a small-format Whole Foods offering lower prices, kitchens and facilities for local healthy food enterprises and culinary educational institutions, office space for a local charter school, and 10,200 square feet of retail space. Tulane University’s Medical School will use the ReFresh facility for nutrition education.
Although disquieting, it turns out that focusing on our average national life expectancy masks the real underlying problem. IHME next imagined that each county in the United States was its own country and calculated how each county would fare relative to the top 10 performing countries
However, even regional remedies may not be local enough. For example, take King County, Washington, home of Seattle and Starbucks. In IHME’s county-level analysis, King County fares well, only a couple years behind the top performing countries, reinforcing the region’s reputation as a place of great recreation opportunities, plentiful local food and a relatively robust economy. But, if we repeat the IHME county analysis at the census tract—if we imagine that each census tract in King County is its own country and calculate how each is doing relative to the best performing countries—it turns out that the county’s overall “good” average hides huge underlying disparities. While some census tracts in King County are as much as 40 years ahead of the best performing countries’ average life expectancy, there are others, not further than a bicycle ride away, that are almost 60 years behind. In fact, there is substantially more variation by census tract within King County than there is by county within the U.S. At the pace of best performing nations, it would take 100 years for the census tract with lowest life expectancy in King County to catch up to where the highest ones already are today.
