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.

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.

Why Cities Must Keep Equity a Central Focus in Building a Culture of Health

“Economic development is integral to having a healthy community. If we can address the economic issues in our neighborhoods, we can help people live healthier lifestyles.” – Mayor Mark Holland, Kansas City, Kansas

Seeking to achieve health equity is the best way to ensure the health of all residents within your city. (Getty Images)

Access to high-performing schools, good jobs, affordable housing, viable transit options, and healthy food can predict both how long and how well people live. Seeking to achieve health equity is the best way to ensure the health of all residents within a city. (Getty Images)

This post was co-authored by Alyia Gaskins and Stephanie Boarden.

Where you live determines your health as well as your proximity to opportunity. However, deep patterns of discrimination, racial segregation, and decades of federal, state and local policies have dictated where people live and the opportunities to which they have access. Despite advances in public health and improved economic prosperity, poor health outcomes disproportionately affect low-income communities and communities of color.

“We all need to understand that racial disparities exist in every important aspect of life. From infant mortality to life expectancy, race has the power to predict and even determine success. And that presents society and local leaders with some unique challenges. Local government leaders are well positioned to make the policy, institutional, and structural changes necessary to reduce disparities and advance equity.”
– Leon T. Andrews, director of the National League of Cities’ Race, Equity, And Leadership (REAL) initiative

We cannot ignore how historical, systemic and structural racism has also shaped our nation’s cities and towns, resulting in disparities in education, housing, employment and health. Low-income communities and communities of color are still feeling the impacts of those decades-old decisions today. For these communities, the lack of key resources and services results in poor and costlier health outcomes, which are referred to as health inequities. Simply put, race and place matter when it comes to health and well-being.

In addition to having serious health consequences for individuals and families, health inequities negatively impact the economic competitiveness and vitality of cities through lost potential and productivity.

  • In 2000, the infant mortality among African Americans occurred at a rate of 14.1 deaths per 1,000 live births, which is more than twice the national average of 6.9 deaths per 1,000 live births that same year
  • Children who experience hunger are more likely to be in poor health and have behavioral and emotional problems in schools. Additionally, children experiencing hunger are more likely to repeat a grade and require special education services
  • Researchers estimate that childhood lead exposure in homes costs society over $50 billion per year due to lost economic productivity resulting from reduced cognitive potential
This graphic shows the average life expectancy by county in the Washington, D.C. metro area.

A graphic showing the average life expectancy by county in the Washington, D.C. metro area. (Robert Wood Johnson Foundation)

Now more than ever, municipal leaders have a responsibility to lead the way in partnering with communities to reimagine, design, and plan healthy places for residents to live, learn, work, and thrive. “Economic development is integral to having a healthy community. If we can address the economic issues in our neighborhoods, we can help people live healthier lifestyles,” says Mayor Mark Holland, Unified Government of Wyandotte County, Kansas City, Kansas.

The following steps can help local leaders address racial and ethnic health inequities and create healthier, more inclusive and prosperous cities:

  1. Increase the understanding of the systemic and historical policies that have exacerbated health disparities in your community by providing trainings for staff and local decision makers
  2. Collect and analyze neighborhood-level data on social, economic, and environmental factors such as race and ethnicity, crime, housing, small business development, and transportation to better understand the distribution of the social determinants of health across your city
  3. Invest in health promoting resources and services such as parks, early childhood programs, workforce development, and training programs that have direct and indirect benefits for health
  4. Create multi-sector partnerships that include public health and non-health stakeholders, community leaders, residents, and anchor institutions to advance health equity. For example, under the Affordable Care Act (ACA), health plans and hospitals are looking beyond their walls to identify opportunities to address the most pressing needs of their communities

To do this efficiently and effectively, it’s essential that residents be engaged in meaningful and authentic ways – especially those who are experiencing the poorest health outcomes – to inform the policymaking process from design to implementation. Only by including the voices and the stories of those most affected by health inequities can we advance policies, programs, and practices that promote health and advance equity.

This is the second blog post in our new Culture of Health series. Look for the next post in November. If you’re interested in learning more, check out the recording of our October 27 webinar, A Level Playing Field.

About the authors:

Alyia Gaskins is a Senior Associate for Health and Community Wellness at NLC’s Institute for Youth, Education, and Families. Follow Alyia on Twitter at @a_gaskins412.

 

Stephanie Boarden is an Associate Director at PolicyLink.

Prosperous Cities Are Healthy Cities

YEF Institute’s new grant spurs deeper city engagement in addressing key issues regarding health improvement and economic advancement.

young family on vacation

Getty Images

“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,” said Mayor David Baker of Kenmore, Washington.

With generous support from the Robert Wood Johnson Foundation (RWJF), the National League of Cities (NLC) through its Institute for Youth, Education, and Families (YEF Institute) is leading a national effort to build the capacity of city leaders to improve the quality of life where individuals live, learn, work and play.

“This is an opportunity to harness the leadership and political will of mayors and city leaders to improve the quality of life for all residents through cross-agency, cross-sector approaches to city policies, practices and programs,” said Clarence E. Anthony, NLC CEO and executive director.

RWJF’s vision is to advance a Culture of Health (CoH) in every community across the United States by creating a movement where health is a shared value and is an important factor in key policy decisions. In this model, a Culture of Health includes not only high quality health care, but also ensuring all residents have access to high quality early childhood programs, good schools, good jobs, affordable housing, safe and active transportation options, places to play and healthy foods. Rooted in this vison is the opportunity to work in cross-cutting ways using data to target and tailor high impact strategies and policies so that all resources are directed to improving health. Tools and guidance such as those available through the County Health Rankings & Roadmaps program, a collaboration between RWJF and the University of Wisconsin, can support community leaders who want to make this vision of communities where all families can thrive a reality.

Mayors and city leaders play a pivotal role in the overall health and well-being of the cities and towns they serve. Over the course of the next three years, NLC will partner with mayors and city leaders to advance cross-cutting approaches to promote a culture of health in America’s cities and towns through four major strategies, including;

  • Creating outcomes-based policies and practices through a series of Mayor’s Institutes to make sure health is considered and woven into their work across a wide array of key policy areas;
  • Collaborating and sharing knowledge, ideas and models with peers through an ongoing communications effort that includes web forums, blogs and workshops, among other efforts;
  • Using the latest data, sustainability strategies and equity frameworks to guide informed approaches that leverage all available assets and stakeholders; and
  • Leveraging and building upon the success of initiatives like Let’s Move Cities, Towns & Counties and the long-standing efforts within NLC to ensure integrated approaches to make healthy choices easy choices.

“City leaders have a critical role to promote a Culture of Health in our communities, and we must make smart planning decisions that ensure access to safe places to walk and play. This is important because healthier kids are better able to learn, which empowers them to ultimately reach their full potential,” said NLC President Melodee Colbert-Kean, councilmember, Joplin, Missouri.

Many cities are leading the way, and each year RWJF recognizes top performing communities through their CoH Prize. The CoH Prize recognizes the impact of communities that have placed a priority on health and who are creating powerful partnerships and deep commitments that enable everyone, especially those facing the greatest challenges, the opportunity to live well. NLC member cities,  including Kansas City, Missouri; Bridgeport, Connecticut; Cambridge, Massachusetts; Everett, Massachusetts; Minneapolis, Minnesota, New Orleans, Louisiana; Williamson, West Virginia; and Durham, North Carolina, have won the prize in previous years and continue to advance their healthy community efforts.  These cities have instituted a range of approaches to building a Culture of Health, including expanding access to early childcare, after school and summer learning programs; building partnerships between hospitals and jails to better address the health needs of repeat offenders and visitors; encouraging green jobs creation; creating safe environments and communities; and developing affordable housing.  Dr. Rose Gowen, Brownville, Texas, City Commissioner, speaks to her city’s efforts saying, “People in Brownsville want better… a better economy, education and health. We’re interested in building a community where healthy is the norm – not the anomaly.”  CoH winners are featured in short videos that highlight their successes.

For more information, check out the YEF Institute’s overview of the RWJF COH grant, or see how healthy your county is and how you can make it healthier by visiting County Health Rankings & Roadmaps.

This is the first blog post in our new Culture of Health series. Look for the next post in November. If you are interested in learning more, consider joining us at CitySummit for an in-depth training on the Culture of Health; scholarships are available for a limited time. Click here to view and and complete a scholarship application.

About the Authors:

julieJulie Willems Van Dijk is the Director of County Health Rankings & Roadmaps.

 

3cec31aSue Pechilio Polis is the Director of Health & Wellness in NLC’s Institute for Youth, Education, and Families.