How Cities Can Support & Finance a Culture of Health

What does it take to ensure cities are healthier places to live, learn, work and play? A strategy that engages the right stakeholders.

(Getty Images)

Cities can create a Culture of Health by implementing a comprehensive approach that puts the health and well-being of all residents front and center. (Getty Images)

This post was co-authored by Kevin Barnett, Colby Dailey and Sue Pechilio Polis.

When leaders in local government, community development, and the health care system came together to develop a plan for rehabilitating a historic building – the Swift Factory in North Hartford, Connecticut – they viewed the building as a potential hub for community health.

Community Solutions partnered with the city, state, Saint Francis Hospital, and others to engage the community in dialogues about their health needs and concerns. Using resident feedback as a guide, they began the process of designing a building that will serve as a neighborhood hub for job creation, food production and health promotion. “We have the opportunity to reinvigorate one of the poorest communities in Connecticut,” said Rick Brush, CEO of Wellville and Director at Community Solutions. “Support from the city and state government was critical to bring together the collective vision, resources and innovative financing needed for success.”

Now more than ever – given tight budgets and fiscal constraints in cities – it’s critical for leaders and stakeholders to work together. Community anchor institutions such as hospitals are often one of the largest employers in communities and are essential partners in community health improvement efforts. Likewise, community development financial institutions (CDFI’s) also play a key role in financing strategies to improve neighborhoods and ensure better access in vulnerable communities to health improving resources, services and supports.

Here are two specific strategies cities can use to engage with these stakeholders:

Engaging Hospitals as Partners

The following strategies can help city leaders expand the depth and breadth of their existing relationships with hospitals to build healthier communities.

  1. Review Hospital Community Health Needs Assessments (CHNA’s). Give attention to how hospitals define their geographic communities (required by the IRS) and the degree to which their geographic parameters are inclusive of census tracts where poverty and associated health disparities are concentrated. In their analysis of population health dynamics, do they identify disparities by race and ethnicity only, or do they identify the communities where these populations are concentrated? An excellent public access tool to assist in the identification of these census tracts, hospital locations and other relevant factors is the Vulnerable Populations Footprint (VPF) tool.
  2. Compare CHNAs to Other Assessments. Review other assessments conducted by a variety of organizations (e.g., local public health agencies, United Ways, Community Action Agencies, Federally Qualified Health Centers) to identify opportunities for alignment of priorities and programs.
  3. Review Hospital Implementation Strategies (IS). Determine whether the programs outlined in the IS indicate a focus in communities where disparities are concentrated, or are they framed as “serving the community at large,” with broad dispersion of limited resources at the city, county or other broad geographic parameters. This provides an invaluable entry point for dialogue and analysis into ways in which resources of multiple organizations and entities may be better aligned and focused in order to produce a measurable impact.
  4. Focus on the Social Determinants of Health. Develop a matrix of priorities across organizations to identify potential alignment with city efforts to address various social determinants of health, including land use, affordable housing, food systems, transportation, planning with a focus on links to jobs, and livable wages.
  5. Build a Shared Sense of Ownership for Health. In an environment of increased transparency and public scrutiny, it is important to communicate an ethic of shared ownership for health in the engagement of hospital leaders. Communicate an interest in coming together to solve complex problems and optimally leverage the limited resources of diverse stakeholders including nonprofits, community development financial institutions (CDFI’s), city agencies, etc. Hospital leaders need to understand that the city and other stakeholders will be partners in the allocation of resources, including the development of public policies that offer the potential to scale and sustain positive outcomes.
  6. Build Capital to Support Community and Economic Development Projects. City leaders can set the tone for hospitals to consider investments in community infrastructure through tax incentives, loans, assistance with the permitting process, and informing development to ensure it meets the concerns of residents.

Engaging Community Development Financial Institutions

As city leaders look for ways to spur and leverage resources to ensure improvements in neighborhoods to promote improved health and safety, another key partner are Community Development sector actors, including Community Development Finance Institutions (CDFI’s) that bring investment capital and Community Development Corporations (CDC) that bring deep knowledge of a community needs and assets. The Community Development sector is in the leveraging business and can often help stretch limited resources through innovative financing including tax credits (e.g. new market tax credits), investment products (e.g. Healthy Futures Fund), and low-interest loans. As city leaders and staff consider outreach to local CDFI’s and CDCs, some good initial steps include:

Mayors, city leaders, hospitals and CDFIs can leverage and bolster each other’s efforts. By engaging with one another, identifying common ground, and collaborating across sectors, they can join forces to advance health equity and opportunity, creating communities where all people can live rewarding and healthy lives.

About the authors:

kevin-barnett-headshot_125x150Kevin Barnett, DrPH, MCP is a senior investigator with the Public Health Institute. Kevin has conducted applied research and fieldwork on two distinct but related issues: the charitable obligations of nonprofit hospitals and the diversity of the health professions workforce. Email him at kevinpb@pacbell.net.

colby_dailey-headshot-125x150Colby Dailey is the Managing Director of the Build Healthy Places Network and has worked for over a decade spearheading local, national, and global initiatives while cultivating and guiding cross-sector collaborations for collective measurable impact. Email her at cdailey@buildhealthyplaces.org.

sue_polis_125x150Sue Pechilio Polis is responsible for directing the health and wellness portfolio for the National League of Cities (NLC) as part of the Institute for Youth, Education and Families. Email her at polis@nlc.org.

Kitchen and Farm Incubators Support Access to Local Food Systems

NLC’s newest municipal action guide provides an overview of food incubator programs as well as guidance on how local governments can support these emerging strategies to promote local entrepreneurship and strengthen local food systems.

(photo: A Muse Photography, courtesy of Union Kitchen)

Union Kitchen, a food incubator in Washington, D.C., provides food businesses with a professionally maintained commercial kitchen space as well as services to help grow and accelerate their business. (photo: A Muse Photography, courtesy of Union Kitchen)

As the American Heart Association kicks off national American Heart Month, we are reminded about the importance of accessing healthy and affordable food. Whether it’s from a local grocer, food truck, or farmer’s market, the freshest and most nutritious meals are most often sourced, prepared, and served locally. In addition to the obvious health benefits, there are also economic gains when cities support access to local food systems and local food entrepreneurs. That is why so many communities are supporting food-based businesses, particularly through the creation of food business incubator programs.

For years, co-working spaces and incubator programs have accelerated the growth of technology-based startups. Now, this concept of providing entrepreneurs with shared working space, mentorship, and education is increasingly being translated into food-based business incubators. The type of assistance provided to food entrepreneurs includes access to a shared workspace, education programs on how to run a business, and mentors who can deliver industry-specific guidance.

Kitchen incubators and farm incubators are two programs for food-based entrepreneurs. These food-centric programs support individuals in their efforts to launch or grow a business in the food industry, which could include opening a restaurant, food truck, or catering service, as well as selling products at grocery stores, farmers’ markets, and online.

A new action guide from the National League of Cities, “Food-Based Business Incubator Programs,” provides an overview of kitchen and farm incubator programs, as well as guidance on how local governments can support these emerging strategies to promote local entrepreneurship and strengthen local food systems.

Below is a Q&A with several of the practitioners and experts who helped inform the guidebook. Read on to learn more about why food-based incubators are so important for their communities.

Why are food incubators important?

Cullen Gilchrist, CEO of Union Kitchen: Food incubators allow startup businesses to gain access to the resources, tools, and connections necessary to launch a successful business. At Union Kitchen, we build successful food businesses. We provide the professionally maintained commercial kitchen space that all food businesses need, but we differentiate ourselves by offering the services that businesses need to grow and accelerate their business. Our distribution company and retail outlets reduce the risk of failure for these businesses and supports them in establishing a strong baseline of success. We define our success by the revenues and profits we create, the businesses we grow, the jobs we create, the economic impact we have, and the employment training we deliver.

Chris Hiryak, Director of Little Rock Urban Farming: Food incubators are where the next generation of agriculturally informed citizens will be inspired, educated and instilled with the principles and values necessary to meet the challenge of creating a just and equitable food system in the 21st century.

New York City Department of Small Business Services (SBS): Food incubators provide food entrepreneurs with critical resources for building their businesses. Securing a private space to produce food commercially is a major financial and logistical barrier for start-ups. Financing the renovation of a production space with specific capabilities is even more costly and more of a risk. Incubators help food entrepreneurs avoid these hurdles by providing access to a licensed and regulated commercial kitchen space. This allows these small businesses to scale up to larger orders, receive assistance from qualified incubator staff, and network with other entrepreneurs utilizing the space.

What was the biggest challenge in launching the program/incubator?

Cullen Gilchrist, CEO of Union Kitchen: The greatest challenge has been to create an effective local food system that promotes supply and demand for local products, but that also delivers on the logistics necessary to be a successful operator in the food industry. We are creating the demand and supply for local products through our Grocery stores, and we need our distribution company’s operations to be strong enough to support this demand.

Chris Hiryak, Director of Little Rock Urban Farming: The biggest challenge in starting our urban farm project was learning to manage a small business.

New York City Department of Small Business Services (SBS): Through community outreach, the New York City Housing Authority (NYCHA) identified a trend of residents having food business backgrounds and interest in jumpstarting food-related businesses. At the same time, NYCHA recognized it would need support in gaining the necessary business education, funding, and accessing a regulated commercial kitchen space. SBS was able to address these challenges by creating the NYCHA Food Business Pathways program, in partnership with other key supporters. NYCHA resident participants in Food Business Pathways receive 8 weeks of training on business practices and food industry specific topics. The program teaches participants about kitchen incubators, provides assistance to participants on applying for space in incubators, and offers grants that allow graduates to rent space at the incubators for no cost. Grant funding also covers the cost of required licenses and permits for the training graduates.

(photos courtesy of Union Kitchen)

(left) Chris Hiryak of Little Rock Urban Farming. (center and right) Union Kitchen in Washington, D.C.

How did your local government support or assist the creation of your program/incubator?

Cullen Gilchrist, CEO of Union Kitchen: The local D.C. government has been essential in supporting us through the permitting and licensing process. They have played an integral role in training D.C. residents to work for us and our Member businesses through subsidized training programs and initiatives.

Chris Hiryak, Director of Little Rock Urban Farming: Mayor Mark Stodola of Little Rock appointed me to the Little Rock Sustainability Commission, where as the Chairman of the Urban Agriculture committee, I have been able to make recommendations to the City of Little Rock Board of Directors related to urban agriculture policy. This has allowed us to have an ongoing dialogue with city staff and officials to ensure that all urban agriculture projects in Little Rock are supported.

New York City Department of Small Business Services (SBS): The Department of Small Business Services (SBS) works to help small businesses, launch, grow and thrive in New York City through various services and initiatives. SBS’ Food Business Pathways program works directly with NYCHA to meet the recognized needs of residents. This collaboration grew to include several other entities; Citi Community Development provided funding for the program, the New York City Economic Development Corporation provided funding and connections to NYC kitchen incubators, and Hot Bread Kitchen provided technical assistance and access to their commercial kitchen incubator.

What are one or two success stories of businesses created in your incubator program?

Cullen Gilchrist, CEO of Union Kitchen: Over the past four years, current and alumni Union Kitchen Members have collectively opened and operated nearly 70 storefronts in the D.C. region and have developed over 400 unique products. Approximately one third of our current Member businesses are distributing their products with Union Kitchen to nearly 200 retail locations in the region, including 25 Whole Foods Stores. We have seen our Members grow their businesses rapidly and successfully and are proud to support their ongoing success as distribution and retail partners. One of Union Kitchen’s first Members, TaKorean now has three storefronts and a fourth one on the way in 2017. What started as a food truck peddling unique Korean-inspired tacos has become one of D.C.’s most popular fast casual concepts.

New York City Department of Small Business Services (SBS): Joann Poe, owner of Joann’s Elegant Cakes, participated in the Food Business Pathways program and won a grant that provided her with free use of the kitchen incubator, Hot Bread Kitchen, in Harlem. Use of the food incubator led to Joan building up the capacity of her business which ultimately catalyzed growth and allowed her to contract with clients such as the City of New York, Citibank, and Kate Spade.

About the Author: Emily Robbins is Principal Associate for Economic Development at NLC. Follow Emily on Twitter @robbins617.

Seven Cities Activate Strategies to Connect Kids to Nature

“Imagine a city known for excellent environmental education because its parks are natural classroom. As a city, we are creating greater access to nature for all of our younger residents.” -Grand Rapids, Michigan, Mayor Rosalynn Bliss

City leaders address disparities in children’s opportunities to play, grow, and learn in the outdoors through Cities Connecting Children to Nature (CCCN), a partnership between NLC and Children & Nature Network.

In November, seven Cities Connecting Children to Nature (CCCN) sites began implementing strategies for connecting children to nature more equitably in their cities. Mayors like Rosalynn Bliss of Grand Rapids, Michigan, seek to restore childhood to the outdoors and commissioned eight months of community dialogue, policy scans, nature-mapping, and network building to inform strategies for action, such as:

  • Developing green schoolyards and enhancing access to nature at public elementary schools and early childcare facilities
  • Connecting to nature through out-of-school time programming
  • Cultivating youth leadership and stewardship
  • Bringing more diverse groups of residents in regular contact with natural features in city park systems

The chart below indicates priority strategies among the pilot cities: Saint Paul, Minnesota; Madison, Wisconsin; Grand Rapids; Providence, Rhode Island; Louisville, Kentucky; Austin, Texas; and San Francisco.

(NLC)

(NLC)

Over the next three years, each of these cities will execute its priority strategies with peer exchange, learning and technical assistance from the CCCN partners and $50,000 grants to kick start city efforts for at least the next nine months. Prominent strategies rely on involvement of key partners such as parks and recreation agencies, school districts, out-of-school time networks, conservation and youth development organizations, and elected and community leaders, as well as adult and youth residents. A metrics framework drawing upon cities’ initial assessment practices and indicators will inform a broader field of cities and partners seeking to measure both systems-level change and direct impact on children. CCCN partners will offer additional resources for municipal action in the coming months, including in-person opportunities detailed below.

Join Us to Learn More

Representatives of the seven-city cohort will share its implementation and planning experience at the 2017 International Conference and Summit of the Children & Nature Network (C&NN), April 18-21 in Vancouver, British Columbia. C&NN extends an open invitation to a wide variety of additional participants to attend the Conference and Summit including other city leaders, planners, public health advocates, field practitioners and thought leaders committed to advancing policies, partnerships and programming for connecting children to nature.

Additionally, city parks professionals can learn more from Austin and the other CCCN cities at a May 17-19 National Recreation and Park Association (NRPA) Connecting Kids to Nature Innovation Lab.

The CCCN webinar series begins with “Emerging City Strategies to Connect Children to Nature” on Thursday, February 23, from 2:00-3:00 p.m. EST. Register here to learn more about the priority strategies adopted by CCCN pilot sites.

Cities Connecting Children to Nature is a partnership between NLC and Children & Nature Network. Connect with CCCN through upcoming conferences, webinars, and our newsletter.

priya_cook_125x150About the author: Priya Cook is the Principal Associate for the Connecting Children to Nature program, the newest program of NLC’s Institute for Youth, Education, and Families.

Meet Your City Human Development Advocate

“Policy in the human development sphere is all about improving quality of life.”

With a new administration and a new Congress, the National League of Cities’ (NLC) Federal Advocacy team will be busy raising the voices of cities throughout 2017. As part of our initiative, we wanted to introduce you all to our Federal Advocacy team members and share what’s on their minds for 2017. Every week leading up to the Congressional City Conference, we will feature a “Meet Your City Advocate” spotlight as part of a series. This week, I sat down with our human development lobbyist, Stephanie Martinez-Ruckman.

stephaniemr

Stephanie Martinez-Ruckman is the program director for human development advocacy at the National League of Cities. (NLC photo/Brian Egan)

Hey Stephanie, thanks for sitting down with me today. I wanted to make sure I interviewed you early on in the process given the discussion around healthcare, but we’ll get to that in a minute. To get started, why don’t you tell us a little bit about yourself? Where you’ve been? What you’ve done? And most importantly, why you are passionate about cities?

Well, I’m originally from D.C., and then I moved up to Massachusetts for college. I came back to Washington to work on the Hill — in both the House and the Senate. That was in the early 2000s, and it was definitely a hectic time. September 11th had just happened, and then there was the anthrax scare.

I started working in the office for the newly-elected Senator Hillary Clinton, and then went on to work for Representative Payne, whose district covered the Newark and parts of North Jersey area. I mostly focused on transportation policy.

Oh your background is starting to sound very similar to Matt’s: transportation policy, working on the Hill, Jersey. 

Ha-ha, I know – but transportation just was not my thing. I then switched over to the Senate to work with Senator Landrieu of Louisiana, and I started to focus more on health and education — topics like social security, healthcare, etcetera. So that’s where I really laid the foundation for the policy area I work on today. Senator Landrieu was very passionate about adoption issues; both her children and her husband were adopted. While working through those case issues, I deepened my interest in how federal policy impacts individuals.

I left the Hill and headed to New York to go to Columbia for graduate school – and ended up staying for 12 years! I spent some time working for the Bloomberg administration, as the policy director for the city’s workforce investment board. We were responsible for the oversight and implementation of the federal Workforce Investment Act at the local level in New York City.

It was fascinating to come from a world of working on crafting federal policy, and then be afforded the chance to see how it is implemented at the local level. You can work on a lot of fancy things in Washington, but you really measure a program or an initiative based on how well its being implemented and the results you see at the local level.

Immediately before coming to NLC, I did government relations for the New York Public Library. I dabbled into all different policy areas there because of the amazing mandate and reach of libraries, and gained a broad swath of policy experience there — including a front row seat to the city budgeting process. And then I came back to D.C.! Partially to return home, but also [because] NLC was an amazing opportunity to continue my work with cities.

Very cool! You already answered a lot of my second question just now, but why human development policy? Anything else you wanted to add?

Yeah, for me, human development — and all of the services designed to help people that fit under this umbrella term — is a bit of a nexus of all different policy areas. Your citizens need quality healthcare, great, but they also need reliable transportation to access that healthcare.

And ultimately, it’s the people connection. Policy in the human development sphere is all about improving quality of life. I think you see the fruits of labor here — perhaps more so than in most policy areas — because you see the people who benefit from the policies. That’s always been very important to me.

Yeah, definitely. Well along the lines of policy, what do you see in store for human development policy and cities in 2017? 

There are really three pieces to watch. The infrastructure bill should be coming soon, and hopefully there’s a workforce component to it. Any infrastructure investment will create jobs, but I’m also looking for a focus on training that leads to more sustained job creation with career pathways. There are people out of work, and I’d love to see how this bill could reengage and support them, even after the funding runs out. On the education front, we have the implementation of the Every Student Succeeds Act (ESSA). There may be some examination into college affordability and federal financial aid. And then the Affordable Care Act (ACA).

Ah yes, the white elephant in the room.

Yes. Earlier this month, Congress passed a budget proposal instructing the committees of jurisdiction to come up with language that would repeal the ACA. And President Trump has signed an executive order on his first day in office calling for its repeal.

We are in a waiting period at the moment, but NLC has made it very clear that any repeal of the ACA must include a simultaneous replacement. We need to make sure that the financial burdens of healthcare reform don’t fall onto local governments. Whether that’s resulting in an overload of local health resources from millions of additional American’s becoming uninsured, or local healthcare initiatives losing their funding.

Twelve percent of the Center for Disease Control’s budget is appropriated through the ACA. We’re mostly talking about public health programs and vaccination programs. And there’s also grant money through the CDC that flows directly to local areas. Most of the time public healthcare is not administered by a city, but the impacts of health policy often fall on local governments. We’re following this one particularly close.

That’s really interesting about the CDC budgeting. Well, I have my favorite question next. What is your spirit city? With which city do you identify the most?

Oh, don’t judge me.

I would never.

I know it sounds cliché, but I have always been a New York City kind of a person. I’ve always wanted to live there and I had the amazing opportunity to do it. It’s a very interesting place to innovate and try things and then replicate. I think about the first lady of New York’s Thrive Initiative on mental health. New York has the financial ability to experiment with these municipal projects that, if they work, can grow to other cities.

And I mean, you have all that, and then you have great food and great theater as well.

Join us at CCC and meet Stephanie and the rest of your City Advocates. Visit the CCC website to register now!

brian-headshotAbout the author: Brian Egan is the Public Affairs Associate for NLC. Follow him on Twitter @BeegleME

Urban Parks Transcend National Politics

The benefits of public green spaces within, or accessible to, urban areas are much greater than are often immediately understood. Here’s how cities stand to gain from increasing access to parks.

The High Line is a public park built on an historic freight rail line elevated above the streets on Manhattan’s West Side. (Getty Images)

The High Line is a public park built on an historic freight rail line elevated above the streets on Manhattan’s West Side. (ferrantraite/Getty Images)

This is a guest post by Jaime B. Matyas.

As the nation seeks to unite after a contentious presidential election, areas of shared commitment should be prized and pursued. One of those areas is the increasingly important role of public lands in or near urban areas. President Donald Trump previously donated land in the New York City metropolitan area for a state park, and Hillary Clinton had called for the revitalization of more than 3,000 city parks within 10 years. Their actions highlight the value of public land and its growing importance in proximity to urban areas, and they could form the foundation for productive community engagement.

The benefits of public green spaces within, or accessible to, urban areas are much greater than are often immediately understood. They include, of course, the spiritual renewal that comes from experiencing the beauty of natural habitats, the joy of recreation, and the opportunity for relief from the daily stresses of life – but other benefits are even more profound.

Public parks have an extraordinary capacity to reveal individual passions for discovery and open up career opportunities. Monique Dailey, Youth Programs Manager for the Washington, D.C. Area at the Student Conservation Association (SCA), was 10 years old before she saw her first “real park” and says that she didn’t realize at the time that “it would be my salvation from the drugs and violence that were ravaging my community.” She became a Junior Ranger in the National Park Service, then a volunteer at the Rock Creek Park Nature Center, and finally an SCA crew member in Rock Creek Park before volunteering on a national crew at Salmon Challis National Forest in Idaho and interning for a summer. When it came time to apply for college, she had 750 volunteer service hours with SCA and a glowing recommendation to the Admissions Director.

AmaRece Davis had a similar experience in Homewood, one of Pittsburgh’s poorest neighborhoods. When two of his older brothers went to prison for murder, he saw himself “heading down that same dark path.” Then he got a break. He started working with the SCA, building trails, clearing brush and planting trees around Pittsburgh. That enabled him to join an SCA crew at Sequoia National Park in California, surrounded by giant sequoia trees.

“I sat at the base of one of these giants on my 18th birthday,” he writes, “and thought about all of my friends and relatives who had never been out of Pittsburgh and of others who hadn’t even survived to be 18. I came home a different person. I had found something larger than myself, figuratively and literally. I never used to care about litter, for example, and based on all the trash on the streets where I lived, neither did anyone else. When I got back from the West, I immediately organized a recycling program at Westinghouse High School and became known as Recycling Rece.” He has gone on to attend community college and complete several SCA internships, and recently became a Pittsburgh city park ranger.

The conservation of parks also provides skills that can enhance job and career opportunities. Research conducted by the renowned Search Institute revealed that SCA participants develop such valuable traits as “expressing ideas, engaging others to reach a goal, responsibility for the greater good, sense of purpose, openness to challenge, perseverance, awareness of their strengths and weaknesses, and more.” These skills all enhance one’s ability to succeed in life and in careers. That’s why it’s so important that urban residents as well as rural ones reap the benefits of America’s public lands.

At present, visitors to our national parks are, in the words of former Interior Secretary Sally Jewell, “older and whiter.” And a 2015 report by the Outdoor Foundation revealed that 73 percent of outdoor participants generally are Caucasian. But public parks can benefit all Americans – and a broadly diverse population can relate effectively to parks, which leads to more public support. Some methods that are valuable in broadening outreach in urban areas include the following:

  • Overnight Camp-Outs, which have been conducted by The White House and many governors in association with Great Outdoors Month with much success
  • Day Camps, which can provide single-day or week-long environmental education programs that introduce youth to nature-in-the-neighborhood as well as ways to be more ecologically friendly
  • Afterschool Programs, which can provide environmental education for younger children while engaging older youth in assisting with the program and with park restoration

When public parks and their conservation contribute so much to people and their communities, they are worthy of broader engagement and support – especially when so many young people need the work experience and career-enhancing opportunities that the conservation of parks can provide. In September, the unemployment rate for teenage youth (16 to 19 years old) was 15.8 percent, according to the Bureau of Labor Statistics. At the same time, our national parks alone have a maintenance backlog of nearly $12 Billion.

Enhancing our nation’s parks and ensuring that their upkeep benefits everyone can become a point of community and national unification.

jaime_matyas_125x150About the author: Jaime B. Matyas is the president and CEO of the Student Conservation Association, the national leader in youth service and stewardship.

Improving Community Health in the Garden State

Guest author Deborah Levine shares with mayors and community leaders her city’s blueprint for coordinating better overall health outcomes in their communities.

The city of Trenton holds a weekly farmer’s market at Trinity Cathedral, a safe and accessible location for West Ward residents. (photo: New Jersey Health Care Quality Institute)

The city of Trenton holds a weekly farmer’s market at Trinity Cathedral, a safe and accessible location for West Ward residents. (photo: New Jersey Health Care Quality Institute)

This is a guest post by Deborah Levine.

New Jersey is geographically, economically and ethnically diverse. We are also diverse in terms of health outcomes. Life expectancy, for example, varies widely across the state, ranging from 73 years in Trenton to 87 years in neighboring Princeton Junction. So how do we address the varying health needs of our residents?

At the New Jersey Health Care Quality Institute, we help communities bring their resources and residents together to create healthier places for people to live and thrive, and our Mayors Wellness Campaign gives New Jersey mayors tools and strategies to champion healthy and active living. The Mayors Wellness Campaign celebrates its 10th anniversary this year, and serves over 380 mayors and communities across New Jersey.

A new and exciting project of the Mayors Wellness Campaign, supported by a three-year partnership grant with the United Health Foundation, allows us to work intensively with civic leaders and health care providers in three specific communities: Jersey City, Trenton, and Cumberland County. We are helping these communities address pressing health challenges identified in their Community Health Needs Assessments (CHNAs). CHNAs are created by tax-exempt hospitals every three to five years to monitor and improve community health outcomes. Here is our blueprint for mayors and community leaders to coordinate better overall health — a framework we believe can help any community.

Cumberland County offers free health screenings and healthy recipe ideas to residents. (photo: New Jersey Health Care Quality Institute)

Cumberland County offers free health screenings and healthy recipe ideas to residents. (photo: New Jersey Health Care Quality Institute)

The Blueprint

  • Read the CHNAs of hospitals in your community to identify pressing health challenges. As we looked at CHNAs from hospitals across New Jersey, the CHNAs from Jersey City, Trenton, and Cumberland County stood out, as each identified the need for improved health literacy and chronic disease management, and increased access to healthy lifestyle initiatives.
  • Connect with existing community partnerships. Through our work with Jersey City, Trenton, and Cumberland County, we focused on strengthening existing partnerships among public and private entities. In Jersey City we partnered with Jersey City Medical Center and the Jersey City Department of Health and Human Services. In Trenton we partnered with the Trenton Health Team. In Cumberland County we partnered with Inspira Health Network and the Cumberland County Health Department.
  • Identify community goals. Jersey City, Trenton, and Cumberland County are strikingly different from each another, and so are their health goals. Jersey City is the second largest city in New Jersey, and one of its top priorities is increasing access to healthy food. Trenton is the state capital and was once a major manufacturing center. One of its top priorities is to improve health literacy. Cumberland County is a large rural county that boasts sweet New Jersey produce, and is home to a large migrant farmer population. In 2010, Cumberland County was ranked 21st out of 21 New Jersey counties on the Robert Wood Johnson County Health Rankings and Roadmap. This sparked the creation of the Cumberland Salem Gloucester Health and Wellness Alliance, which prioritizes healthy corner stores and workplace wellness programs.
  • Invest in no-to-low cost sustainable programming. Jersey City, Trenton, and Cumberland County were all making strides in addressing health challenges, but with limited staffing and financial resources the sustainability of these programs was questionable. The Quality Institute’s Mayors Wellness Campaign supports educational opportunities for residents of Jersey City, Trenton, and Cumberland County, and funds educational materials in languages unique to each community’s populations. We have also formed a relationship with Aunt Bertha, a social services search engine, to create unique search engines for Jersey City, Trenton, and Cumberland County.
  • Maintain the momentum. Once you have identified the health needs of your community, establish ongoing partnerships with local champions like hospitals, health departments, and volunteers who can identify opportunities for health and wellness activities. Through the Mayors Wellness Campaign, the Quality Institute harnesses partnerships between civic and provider leaders in Jersey City, Trenton, and Cumberland County to drive change at the local level. It is through these partnerships that true change happens.
Jersey City conducts a supermarket education tour. (photo: Jersey City Mayor Steven Fulop)

Jersey City conducts a supermarket education tour. (photo: Jersey City Mayor Steven Fulop)

Healthy Partnerships

In response to recent CHNAs, Jersey City, Trenton, and Cumberland County are harnessing local partnerships and taking action by investing in their residents at a grassroots level. Jersey City Medical Center and the Jersey City Department of Health and Human Services partner to hold health fairs and educational supermarket tours. The Trenton Health Team partners with more than 50 local organizations including two hospitals, a Federally Qualified Health Center, and the City of Trenton Department of Health and Human Services to improve the health care experiences and outcomes of its residents. Inspira Health Network and the Cumberland County Health Department collaborate through the Cumberland Salem Gloucester Health and Wellness Alliance to improve community health education, physical activity, and chronic disease management among Cumberland County residents.

No two communities have identical health needs – but when municipal leaders and community providers join together and put forth a mighty effort to address the overall health of their residents, real advances become possible.

deborah_levine_125x150About the author: Deborah Levine is the Director of Community Heath at the New Jersey Health Care Quality Institute. In this role, Ms. Levine directs the Mayors Wellness Campaign, serving as a resource for mayors who wish to promote health and wellness initiatives in their towns.

Connecting the Dots: Leveraging Community Benefit Programs with City Leadership

 “When you look at maps of neighboring communities and ZIP codes and see significant disparities in life expectancy within a couple of miles – sometimes blocks – you’re compelled to advance policies to address those gaps in a meaningful way.” – Mayor David Baker of Kenmore, Washington.

Mayors and other city leaders address health issues every day, and they need a variety of strong partnerships to fully leverage the assets in their cities. (Getty Images)

Mayors and other city leaders address health issues every day, and they need a variety of strong partnerships to fully leverage the assets in their cities. (Getty Images)

This is a guest post by Nancy Zuech Lim and Sue Pechilio Polis. The post was originally published on Health Progress, the journal of the Catholic Health Association of the United States.

We know community benefit programs work with a variety of local partners, including faith-based organizations, nonprofits, local health departments, even other hospitals. But another type of critical partner is often overlooked: local city leaders.

Where we live, work, learn, grow, play and pray impacts our health and well-being. These, and the wider set of forces and systems shaping the conditions of daily life, are known as the social determinants of health. According to the World Health Organization, “conditions such as environment, housing, economy and policies impact the health and well-being of our communities.” Access to meaningful educational and economic opportunities vary by place and ultimately affect how long and how well we live – and mayors and city leaders play a pivotal role in ensuring access to those opportunities.

To be truly healthy, one not only needs high quality health care but also access to high quality early childhood programs, good schools, good jobs, affordable housing, safe and active transportation options, places to play, and healthy foods. Mayors and other city leaders address these issues every day, and they need a variety of strong partnerships to fully leverage the assets in their cities.

Hospitals and city officials can work together to address the social determinants of health and well-being through policy, structural and environmental changes in order to ensure sustainable improvements for city residents. Here are the steps they can take on three different levels:

  1. Individual and family level: build awareness of healthy behaviors, address barriers, and support ways that basic needs can be met.
  2. Neighborhood and community level: build communities that decrease barriers to ensure the healthy choice is the easy choice in every neighborhood.
  3. Policy level: promote policies that support healthy choices and healthy behaviors. Because community benefit programs are moving beyond hospital walls, the time is ripe for hospitals to further align efforts with city leaders and departments. Conducting Community Health Needs Assessments (CHNAs) together to identify priority health needs and develop implementation strategies is one way for hospitals and city leaders to build a fruitful and ongoing partnership. Some hospitals already are collaborating with city leaders and other community partners. A few examples:
  • Baton Rouge, Louisiana Mayor Melvin L. “Kip” Holden, through his Healthy City Initiative, brought together area hospitals such as the Baton Rouge General Medical Center, Lane Regional Medical Center, Our Lady of the Lake Regional Medical Center, the Surgical Specialty Center of Baton Rouge, and Woman’s Hospital to conduct a joint CHNA and implementation strategy, putting them on a course for greater collaboration to address systematic issues that influence health.
  • Spartanburg Regional Healthcare System municipal leaders and community partners took a holistic view of health in South Carolina and worked together to address all health indicators, including education, housing, access to healthy food, and economic stability. Together, they won the 2015 Robert Wood Johnson Culture of Health Prize in recognition of their progress in making changes that led to improvements in the health and well-being of local residents.
  • Vincent Hospital Frankfort in Indiana works with city and county leaders and community partners as part of the Healthy Communities of Clinton County Coalition. The coalition works to improve health through policy, system and environmental changes, complete streets and tobacco-free programs.
  • The D.C. Healthy Communities Collaborative is a local partnership among four District of Columbia hospitals (Children’s National Health System, Howard University Hospital, Providence Health System and Sibley Memorial Hospital), four Federally Qualified Health Centers (Unity Health Care Inc., Community of Hope, Mary’s Center and Bread for the City), and two ex-officio members (the D.C. Primary Care Association and the D.C. Hospital Association) that conducted a joint CHNA in the nation’s capital. In collaboration with the D.C. Department of Health, the collaborative is developing an implementation strategy to address the priority health needs in the District of Columbia.
  • Saint Thomas Health, Nashville, Tennessee, collaborates with Metro Nashville Public Schools to provide the Saint Thomas Health Scholars Program, a free program for selected high school seniors to promote health care careers through mentoring and training for the medical assistant certification exam.
  • Trinity Health, based in Livonia, Michigan, created the Transforming Communities Initiative that uses a wide variety of funding mechanisms for direct community health improvement in awarded locations.

Further examples of health systems working with city leaders to address affordable and healthy housing are: Bon Secours Baltimore Health System, Saint Agnes Healthcare in Baltimore, Nationwide Children’s Hospital in Columbus, Ohio, and Children’s National Health System in Washington, D.C.

Successful efforts in this arena start by developing key partnerships that include city officials. Here are a few tips for community health care organizers:

  • Share with your mayor/city leaders. Share your CHNA, implementation strategy and community benefit report with your mayor, councilmembers, local school superintendent, and health department director. Offer to provide key city officials with an overview of your CHNA process, community benefit programs, and the community support you provide.
  • Know your city’s plans and priorities. Become familiar with your city’s master plan, school wellness plan, and health department plan. Listen to your mayor’s State of the City address. Lincoln, Nebraska’s “Taking Charge” program is an example of a city using its budgeting process to improve community health and well-being. The program uses an outcomes-based budgeting and evaluation process that identified community priorities and set outcome goals.
  • Meet and discuss. Meet with city leaders to learn more about their efforts to improve health and well-being. Share and discuss how social determinants affect the health and well-being of your community. Consider using key resources like County Health Rankings & Roadmaps and Community Commons to map by ZIP codes the areas of greatest need. Highlight areas of focus that overlap and initiatives that complement city goals.
  • Assess together. Share information and assessment processes. Consider working towards one needs assessment for the city, and look for other ways you may be able to collaborate and leverage resources.
  • Align efforts to improve health and well-being. Build on each other’s strengths and expertise, and work together to address barriers to healthy lifestyle behaviors, health care and the social determinants of health. Look for ways your programs and efforts may support each other’s goals and initiatives.

Interested in learning more about social determinants of health? Click here to view a short video by Julie Trocchio, senior director, community benefit and continuing care, in CHA’s Washington, D.C. office.

About the authors:

nancy_lim_125x150Nancy Zuech Lim is a community health and benefit consultant with the National League of Cities on the Institute for Youth, Education and Families’ Early Childhood Success portfolio. She can be reached at lim@nlc.org.

 

sue_polis_125x150Sue Pechilio Polis is the Director of the Health and Wellness team in NLC’s Institute for Youth, Education and Families. She can be reached at polis@nlc.org.

The Secret to a Healthier City: Sharing Data

To be effective and strategic in their decision-making, city leaders striving to build a culture of health need diverse, usable, high-quality data sources that are integrated, timely, relevant and geographically precise.

“In Cincinnati, partnerships, shared expertise, and data integration have helped us as we seek answers to complex problems. Indeed, I have come to learn that seeking consultation from a housing expert may prove just as valuable to my patients and families as would a consultation from a cardiologist or gastroenterologist.” - Dr. Andrew Beck, pediatrician at Cincinnati Children’s

“In Cincinnati, partnerships, shared expertise, and data integration have helped us as we seek answers to complex problems. Indeed, I have come to learn that seeking consultation from a housing expert may prove just as valuable to my patients and families as would a consultation from a cardiologist or gastroenterologist.” – Dr. Andrew Beck, Cincinnati Children’s Hospital

This post was co-authored by Peter Eckart, Alison Rein and Nick Wallace.

Data can be a powerful tool for understanding issues, making smarter decisions, and improving results – and city leaders can help build a culture of health by supporting the collection, access and use of data to establish programs and policies that improve both economic and population health through education, transportation, housing and other critical issues.

However, collecting and using data from multiple sources and sectors is challenging, and is often hampered by the organizational, cultural, and budgetary silos that pervade municipal government. Data collected by local hospitals, the department of health, and the Mayor’s office are not often shared with one another due to real or perceived legal restrictions, turf issues, and lack of capacity. While opening access to data and allowing it to be integrated with other data types and sources is not yet the norm for city leadership, a few cities have modeled the extraordinary benefits of such efforts.

Community Health Peer Learning Program (CHP) grantee, Cincinnati Children’s Hospital Medical Center, has embarked on an effort to identify “hot spots” where the incidence of disease, such as asthma, is especially high. Between 2009 and 2011, children from low-income areas in Hamilton County were 88 times more likely to be admitted into the hospital for emergency asthma treatment than children from high-income areas. Pinpointing the disparities at the neighborhood level has allowed the hospital to partner with the Cincinnati Health Department to more effectively link at-risk children to home inspectors that can help to identify the existence of potential health hazards. The hospital has also built a medical-legal partnership with the Legal Aid Society of Greater Cincinnati to pursue legal advocacy when dealing with noncompliant landlords. Thus, home hazards like lead, pests, and mold have been mitigated, new roofs have been installed on several buildings and new heating and air-conditioning units have been put in. The community also recently received a $29 million grant from HUD to accelerate the rehab in one at-risk neighborhood.

Dr. Andrew Beck, a pediatrician at Cincinnati Children’s, notes, “Hospitals and social service agencies, public and private, seek to promote health and wellness among those they serve. We seek the same goal, but we generally work separately. In Cincinnati, partnerships, shared expertise, and data integration have helped us as we seek answers to complex problems. Indeed, I have come to learn that seeking consultation from a housing expert may prove just as valuable to my patients and families as would a consultation from a cardiologist or gastroenterologist.”

The example from Cincinnati makes it clear that leaders should be intentional about nurturing and encouraging a culture of data sharing across various organizations and sectors. Building these sometimes difficult but necessary data sharing relationships is core to All In: Data for Community Health, a nationwide learning collaborative that aims to help communities build capacity to address the social determinants of health through multi-sector data sharing. The two founding partners of All In, Data Across Sectors for Health (DASH) and the CHP Program recently presented together on NLC’s Culture of Health Web Forum Series. The BUILD Health Challenge and the Colorado Health Foundation’s Connecting Communities and Care have also become partners in All In, which now collectively represents 50 local data sharing projects across the country.

Here are just a few lessons from the All In learning collaboration that may be useful to cities in the early stages of multi-sector data sharing:

  1. Relationships are critical to moving data integration forward: Sharing data is as much about relationships as it is about technology. Everything that we know about making collaborations work – developing a shared understanding of the problem, willingness to work together, building trust, communicating clearly, creating a shared governance – applies even more to data sharing partnerships.
  2. Effective data sharing is a considerable time investment, and requires laser-like focus on the problem statement: It can take several years to get people to the table, build meaningful relationships, learn how other sectors operate, and develop data sharing agreements. Creating an environment for data sharing that supports and sustains this commitment requires gaining buy-in from partners and key community stakeholders to ensure their dedication to the driving purpose and continued participation over the long haul.
  3. Data can be used both to identify and characterize city challenges, and to effectively target limited city resources: City officials often know they have an issue, but data are critical for determining scale and scope, and for understanding root causes. Similarly, once these challenges are better understood, interventions are often based on the knowledge that integrated data permits better targeting of city services (e.g., lead poisoning abatement, falls prevention, city planning), and more efficient use of scarce resources.

While there is no roadmap for this complex work of building multi-sector partnerships to share data, there are several resources available to city leaders who want to learn from others who have been down a similar path.

  • Thirty cities nationwide are engaged in the National Neighborhood Indicators Partnership (NNIP), a peer network of open data intermediaries. The NNIP shares lessons from local partners to help strengthen capacity for data-driven decision-making.
  • Github is an open source hub that contains many technical tools for sharing data that can be adapted by others.
  • What Works Cities is a national initiative designed to accelerate cities’ use of data and evidence to improve results for their residents.
  • DASH’s Environmental Scan provides a nationwide snapshot of the current state of multi-sector data sharing initiatives for community health. AcademyHealth will soon release a scan of the national program offices supporting these initiatives.
  • The All In Data for Community Health learning collaborative regularly shares news and resources to help guide and advance the field of multi-sector data sharing for health. Sign up for the monthly newsletter to get updates.

Not sure where to access data? Check out some useful data tools for cities, including Community Commons, County Health Rankings & Roadmaps, The National Equity Atlas, and the 500 Cities Project.

City leaders play a critical role in building lasting multi-sector partnerships that help unleash the full potential of local data. As city leaders innovate and experiment, it’s critical that they share their challenges and successes. If we are agile and open to learning from others, we can maximize data infrastructure investments to achieve greater collective impact.

About the authors:

peter_eckart_125x150Peter Eckart, M.A., is Co-Director of Data Across Sectors for Health at the Illinois Public Health Institute.

 

alison_rein_125x150Alison Rein, M.S., is Senior Director of the Community Health Peer Learning Program at AcademyHealth.

 

nick_wallace_125x150Nick Wallace is an Associate for Health and Wellness at NLC’s Institute for Youth, Education, and Families.

ADA Requirements Affect Your City. This Webinar Will Show How Seattle and San Antonio are Rising to the Challenge.

On Thursday, Jan. 12, the National League of Cities’ Institute for Youth, Education, and Families will host a webinar on how cities can comply with Americans with Disabilities Act (ADA) requirements and improve outcomes for young adults with mental illness.

The ADA places an obligation on government entities to provide mental health services in the most integrated setting appropriate for the individual. Jails rarely constitute “the most integrated setting,” yet have become the default location where many Americans receive mental health services. (Getty Images)

Nationwide, cities and their partners continue to experiment with ways to avoid taking young adults to jail, especially in cases where mental health or substance disorders lead to behavior that draws the attention of police officers and community members concerned about public safety. Absent these experiments, some people with serious mental illness frequently get arrested and go to jail, often repeatedly. Once in jail, individuals whose offenses stem from mental illness stay in jail longer, and during those jail stays, their condition may worsen. Meanwhile, most jurisdictions typically cannot receive Medicaid reimbursement for expensive and limited mental health services received in jail.

In addition to the evidence of harm to the individual, less than efficient application of police effort and questionable results for public safety, cities have yet another reason to keep people with behavioral health needs out of jail: the Americans with Disabilities Act (ADA). The ADA places an obligation on government entities to provide mental health services in the most integrated setting appropriate for the individual. Jails rarely constitute “the most integrated setting,” yet have too often become the default location where many Americans receive mental health services. A community’s lack of appropriate services does not remove this responsibility.

To learn more about how cities such as San Antonio, Texas and Seattle seek to meet the ADA obligation by collaborating with mental health departments and providers to divert people with mental illness away from jail and into community-based services, register here for an informative and frank discussion at 1:00 p.m. EST on Jan. 12. Speakers include:

  • Eve Hill from the Civil Rights Division of the United States Department of Justice
  • Officer Joseph Smarro of the San Antonio, Texas Police Department
  • Gilbert Gonzales, Director, Department of Behavioral and Mental Health, Bexar County,Texas
  • Daniel Nelson, Seattle Police Department

Heidi CooperAbout the author: Heidi Cooper is the Associate of Justice Reform within NLC’s Institute for Youth, Education, and Families.

The Opioid Epidemic: How Cities Are Fighting Back

The most notable success was achieved thanks to a considerable push from city and county leaders during the last days of the Congressional session.

One of the many resources available on NLC’s opioid action web page is profile of the city of Seattle’s diversion program for low-level offenders, which allows police officers to redirect individuals engaged in drug use or prostitution to community-based public health and social services rather than to jail and prosecution. (Getty Images)

Opioid overdoses and deaths continue to be the leading cause of accidental death in America. However, city leaders can take some comfort that 2016 closes with several significant successes that should ensure progress on this public health crisis in 2017.

The most notable success, the sum of $500 million appropriated by the federal government to support opioid addiction treatment, was achieved thanks to a considerable push from city and county leaders during the last days of the Congressional session. The bipartisan votes in both houses of Congress demonstrate that the scope of this public health nightmare extends to all parts of this country – urban, suburban, and rural – and impacts all ages, incomes, genders, races, and ethnicities.

The legislative advocacy success came quick on the heels of the November 17 release of, A Prescription for Action: Local Leadership in Ending the Opioid Crisis.” This joint report from the National League of Cities (NLC) and the National Association of Counties (NACo) is the culmination of a year of work by a task force of city and county leaders.

NLC and NACo agreed to launch the joint task force in February 2016. The membership included both elected and appointed city and county officials from across the Unites States. The members brought a strong background in medicine as well as criminal justice, among other fields.

Providing a perspective on behalf of the entire 22-member task force, the two co-chairs, Mayor Mark Stodola, Little Rock, Arkansas (NLC First Vice President) and Judge Gary Moore, Boone County, Kentucky said, “Although news outlets often provide little more than a running tally of the epidemic, leaders at the local level experience the human costs of this public health crisis one life at a time. It is our duty to act with urgency to break the cycles of addiction, overdose, and death that have taken hold in so many corners of this nation.”

 

As part of the launch of the task force report, NLC and NACo created a new web portal. In addition to providing resources to cities and counties, we are encouraging local officials to make a pledge to lead on opioid action in their communities and to work in partnership with other leaders at the local, state, and federal levels. The pledge campaign announcement is included as part of an archived webinar delivered by city and county task force members on December 15, 2016.

In addition to the special web portal created for the task force, NLC maintains a collection of resources on its own website. These resources include the drug control strategy from Huntington, W.V., the Seattle-King County Police Diversion Program, and the opioid report developed by the Massachusetts Municipal Association on behalf of communities in that state.

Brooks, J.A. 2010About the author: James Brooks is NLC’s Director for City Solutions. He specializes in local practice areas related to housing, neighborhoods, infrastructure, and community development and engagement. Follow Jim on Twitter @JamesABrooks.