Kobe, Days 2 and 3: From Questions to Answers — The need for local leadership

This post is by Neil Bomberg, NLC’s Program Director for Human Development and Public Safety.

What appeared to be a conference without answers was rapidly transformed on the second day into a conference with significant answers on how governments can work toward improving the health of their residents and citizens.  The answers, the conferees agreed, lie with local elected officials, including mayors and city council members, and local governments, especially cities and towns.  There was agreement that:

* Local elected leaders can act as role models and champions for walking, cycling, active lifestyles and community designs that support these activities;

* Local elected leaders can enable collaboration between sectors by working with their city departments to develop an integrated urban health strategy;

* Cities and towns have the capacity to partner with their citizens and community-based organizations, as well as the private sector, so that local health care professionals provide health care to all citizens, share information and educate all residents in procedures for maintaining their health, and gather and distribute relevant data necessary for good and sound policymaking.

As the second day progressed, national leaders and mayors and city council members came together in increasingly smaller sessions to discuss the ways in which they are using their powers to lead, enable collaboration, and work with citizens to address citizen health, whether in El Paso, Texas, where the city is working with latino youth to address obesity and unhealthy eating; in Harare, Zimbabwe, where the local government is attempting to reduce substantially traffic related accidents by improving roads; in Male, Maldives, where the government is confronting daily the impact of global warming which threatens water supplies; or Udine, Italy, where the mayor is responding to the plight of Roma who are among the poorest and least able to access services within the community.

On the final day of the Global Forum, the focus once again was on political commitment and leadership. Discussions focused on environmental challenges, ways of reducing violence, and the important of political will in addressing the health and well-being of all residents.  Each of these topics provoked a spirited debate among the delegates on the challenges that local elected leaders are facing.

Then came the formal closing of the conference, as a group of mayors took the stage to present the three key principles of the Call to Action:

1. as a first priority, local governments must focus on uncovering and responding to urban health inequities to ensure that all residents have access to adequate and appropriate health care and services;

2. show leadership by including health in all urban policies through intersectoral responses to the issue of community health; and

3. ensure broad community participation in urban policy and planning.

WHO Director-General Margaret Chan addressed the crowd and reinforced the need for governments at all levels to take the lead:  “Good urban health governance helps ensure that opportunities and advantages are more evenly distributed and that access to health care is more evenly distributed.”

Finally, the day closed with the global launch of the joint UN-HABITAT/WHO report, Hidden Cities: unmasking and overcoming health inequities in urban settings.  To download the report and to see pictures and personal stories from cities around the world, please go to www.hiddencities.org.

After a fruitful three days of inspiration for assembled leaders, the challenge for the delegates now is what action they will take to turn their cities into healthy cities.

For highlights and a recap of all three days and outcomes, please visit www.gfuh.org.

The View from The 45th Floor

This post is by Neil Bomberg, NLC’s Program Director for Human Development and Public Safety.

Last week while in Japan, I had the privilege of meeting with representatives from the Tokyo Metropolitan Government in their 45 story headquarters building in Shinjuku, Tokyo, Japan.  The twin towers and the adjoining Tokyo Metropolitan Assembly building are visible throughout the city, and the 45th floor provides a breathtaking view of Tokyo.

The meetings I went to focused on labor, employment, workforce development and health and how the Tokyo Metropolitan Government is responding to those issues.  And respond they are.

With unemployment at the “unacceptably record high level of 6.3 percent,” the City has embarked on an effort to match jobseekers with private sector jobs.  But the task has not been easy.  There is a mismatch between workers’ expectations and the job market.  Workers, for reasons of prestige, want to work for the largest companies, but jobs in large companies are disappearing as the Japanese economy continues to contract and deflate. Those workers who might otherwise be able to find work in smaller companies are not becoming employed or re-employed because of the desire to work for the Sonys, Toshibas, Mitsubishis and Toyotas of the Japanese world.

In response, the City of Tokyo has come up a three tiered system not unlike the US.  The first is to improve the workplace in all companies — large and small — to make them equally as attractive to all workers.  The second is to establish a system of reemployment services to help individuals find the right jobs in the right companies regardless of size or perceived prestige.  The third is to provide job training and retraining so that unemployed workers can maintain their skills or learn new ones so that they continue to be relevant to employers. But what is different from ours is that trainees receive funds while in grainy as an incentive to stay in job training. 

As for health care, the Japanese are light years ahead of us with a three tiered National Health Insurance that provides private and public health services ranging from care through city-sponsored health and wellness centers; private physicians who provide routine and illness-specific health care; and acute care through a network of specialty and general  hospitals.  While Japan’s health care system is experiencing many of the problems we have — skyrocketing costs, end of life care issues, and increased demand for technology driven health care — what they are not experiencing is the crisis of access to health care or disparities in access to or delivery of health care.  Even the nation’s homeless have access to health care equal to that provided to any other resident of Japan.

A Conference Burdened by Questions and an Apparent Lack of Answers: Day One of the World Health Organization’s Global Forum on Urbanization and Health

This post is by Neil Bomberg, NLC’s Program Director for Human Development and Public Safety.

The first day of the Global Forum on Urbanization and Health was filled with questions that seemed unanswerable.  The presentations by representatives from sub-Sahara Africa, the Middle East, North America, Latin America, Europe, East Asia and South Asia raised numerous and important questions including: 

  1. What is the impact of poverty and social marginalization on health?
  2. How do we make visible those citizens who are otherwise invisible?
  3. How do we deal with the emerging health care needs of recent immigrants?
  4. What is the impact of governmental decentralization on health care?
  5. What must happen if we are to overcome the disparities in health that exist within urban areas?
  6. Why do nations and localities only act on health care after a major conflict or as the result of a manmade or natural disaster?

These questions and others were asked over and over but no answers were given and repeatedly the answers seemed out of reach.  The first day of the conference would have had anyone attending believing that there are no real answers.

What I did conclude from the first day’s discussion is that these questions are not questions for the developing world alone.  They apply equally to the United States and America’s cities and towns. Unless we commit to answering these questions, we Americans will be unable to solve our own health crisis — a crisis brought on by obesity, diabetes, increasing heart disease, disparities in the delivery of health care and the outcomes that result — despite the recent success realized through the passage of legislation meant to improve our health care delivery system.

Heading to WHO Global Forum on Urbanization and Health

It was just a short while ago that the World Health Organization’s Global Forum on Urbanization and Health in Kobe, Japan was month’s away. It is now less than a week away, and the excitement about the meeting appears to be growing.

The agenda has been set, the National League of Cities’ role in the agenda determined, and World Health Organization leaders, national government ministers and local government officials including city representatives are about to engage in a meaningful discussion about the impact of urbanization on residents’ health and the ways that cities and towns can address this issue.

Importantly, as a matter of policy, the World Health Organization has determined that to talk about this issue one must engage sub-national governments, including cities and towns. For that reason, the National League of Cities has been engaged as an active partner involved in the drafting of the final report that will be issued during the Forum and the declaration that member states are expected to endorse, as well as a facilitator during a peer-to-peer discussion on how local governments can best address their citizens’ health care needs.

Forum organizers expect to achieve three things:

The first is to provide attendees with information on the issues surrounding urbanization and health. For developed countries the focus will be on disparities in health care based on income and access and provide solutions that may be implemented locally to address this problem.

The second is to provide attendees with examples of what cities and towns around the world are doing to address the problems arising from increased urbanization. This will be done through a series of workshops highlighting these efforts, including presentations by elected and appointed city leaders and health care providers on the second day.

The third is to adopt a declaration on urbanization and health that will provide member states, and cities and towns, with guidance and information on how to address health care disparities that arise in urban environments.

You can follow each day’s activities either her through a series of blogs that I expect to post or via Twitter @neilbomberg or @leagueofcities. If there is anything you would specifically like to know about the conference, please feel free to raise the question in the comments section, and I will attempt to respond as quickly as possible either through a follow-up blog or via Twitter.

Housing Needs for the Next Decade

For local policy makers anticipating the economic landscape in the post-recession and post-foreclosure period, there are three factors that will influence decisions about new housing development – the number of homeless families; the slowdown in household formation; and the severe cost burden that so many face for housing. The combination of these factors means that there will be a much greater need for rental housing than for ownership opportunities in the next decade.

According to figures by the Department of Housing and Urban Development, the number of homeless families increased from 2007 to 2008 and then again from 2008 to 2009. Families constitute 34 percent of the 1.56 million homeless counted in 2009.

Data from the Census Bureau show that the prolonged recession has taken its toll on the number of people starting a household. The 10-year average of new households being formed has been 1.3 million per year. This number has declined significantly to 772,000 in 2008 and to only 398,000 in 2009, impacting rates of rental vacancies and new housing starts, as young singles and couples wait out the worst of the recession in shared living arrangements.

The share of U.S. households that are severely burdened with housing costs (spending more than half of their income) increased to 16 percent in 2008 rising from a steady 12 percent in both 1980 and 2000.  Numbers from the Census Bureau show that a record 18.6 million households faced high housing cost burdens in 2008. Living within these households were 44.2 million Americans including 13.7 million children.

These severe cost burdens for housing exist side-by side with a national vacancy rate for both owned and rental housing units that stand at a record of 14.5 percent in 2009. In this instance, an excess of supply is not having a significant impact on lowering prices for housing except in the cases of buildings with 10 or more units or with expensive rentals.

The catastrophe in mortgage foreclosures, the rising tide of homeless families, the cost of housing for so many and the anticipated demand for rental housing by both the aging baby boomers and the echo boom generation has changed the fundamentals about the kinds of housing most needed in communities. The implications of these data point to a need for construction of more multi-family rental housing units.

Ode to Judges

Judges hold a special place in the American legal system. One might argue that they are in fact iconic, even if they don’t wear the traditional wigs of our British forbearers.

Although more people have probably heard of Judge Wapner and Judge Judy than have heard of Judge Isaac C. Parker – the real “hanging judge” for the Territory of Western Arkansas – it’s not surprising that many of these men and women have achieved the status of folk heroes.

Enter Judge Annette Rizzo and Judge Raymond Pianka of the local housing courts in Philadelphia and Cleveland, respectively. These two leaders are saving homes by ensuring mediation between mortgage lenders and borrowers before concluding a foreclosure proceeding. They are, in the truest sense, working to “establish justice” and “insure domestic tranquility.”

People of a different political perspective may argue about the value of activist judges versus those that exercise judicial restraint. The feature story in the November 9th Washington Post about judges who dismiss a bank’s foreclosure proceeding and return the home to the borrower free and clear is certainly a case for debate. But, regardless of one’s politics, it’s hard to argue with the court’s intent to ensure a process that is swift, certain and fair.

Both Judge Rizzo and Judge Pianka are featured speakers at conferences across the country. Their stories are compelling. Modesty prevents them from suggesting that they are doing anything other than their jobs. But even the most dispassionate observer has to acknowledge that the work they are doing goes above and beyond the call of duty.

Leaders are a diverse bunch. Some come to a task armed with significant governmental authority, such as judges and city elected officials. Other leaders have only their innate skills and the courage of their convictions. Maybe wielding governmental power for benevolent ends is what we expect of Judges Rizzo and Pianka. Nonetheless, society owes them a debt, which likely cannot be repaid, for the herculean effort they are undertaking to help countless homeowners during a time of crisis.

Leadership and Collaboration: Staples of Success

Discussions at a recent gathering of teams from 11 cities pursuing postsecondary success initiatives pointed once again to the centrality of twinning strong leadership and collaboration in order to launch and succeed on a large scale.

Jerry Abramson, outgoing mayor of host city Louisville, Kentucky, set the tone and a high bar in terms of leadership.  Indeed, Mayor Abramson speaks about postsecondary success with a fervor matching that of Philadelphia Mayor Michael Nutter.   If and as more mayors speak out similarly and exercise their leadership and convening powers – steps with which we at the National League of Cities have pledged to help – more scenes of concerted effort are likely to emerge around the nation.

Mayor Abramson recounted Louisville’s steps along the way to its current high level of activity, which he has consistently led.  Two such steps included:

  • The “Close the Deal” mentoring/advising initiative, in which the city and others recruited businesspeople, recent graduates, and higher education professionals to meet with high school students to explain the college application process and the benefits of pursuing higher education.  This effort alone increased the rate of applications in some high schools from 25% to more than 60%; and
  • The Mayor’s Education Roundtable – a meeting ground for the top leaders of local higher education institutions plus school superintendents and business and civic leaders, all focused on “growing the pie” of college grads.  This strategy group upped the ante from college admissions to persistence to completion and signed the Greater Louisville Education Commitment after 18 months’ effort.

The Roundtable and other previous efforts gave birth to Louisville’s brand new 55,000 Degrees initiative – the name expresses the goal – backed by $2 million in private funding for its first three years of operation.   The new initiative is the embodiment of the signed Commitment. As the Mayor says, the purpose of 55,000 Degrees is “not just to turn up the heat on us all,” but to put the pieces together locally that will lead to 40,000 more bachelor’s degrees and 15,000 more associate degrees over the next ten years.  A key early target for 55,000 Degrees:  the 90,000 Louisville residents who have completed some college and might benefit from assistance to finish – this consistent with the Lumina Foundation’s Adult Degree Completion.  Mary Gwen Wheeler, longtime education adviser to the mayor, will serve as interim director.

Notably, Louisville determined to establish 55,000 Degrees as an initiative outside government, its funding pooled in an account at the local community foundation.  Driving these decisions were the usual uncertainties surrounding a mayoral transition – de-linking from a particular mayoral administration greatly minimized the uncertainties.  With a board combining civic, education, and business leaders including at least one Fortune 500 CEO and small business leaders as well, the oversight and strategic connections for the initiative are strong.  It bears watching, along with several other new initiatives launched recently as part of the NLC-Bill & Melinda Gates Foundation’s Communities Learning in Partnership (CLIP) initiative – Bridge to Success in San Francisco, Mesa Counts on College in Arizona, and similar efforts in Riverside, CA and New York City.