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2015 Population HealthCommunity Forum
March 2, 2015
Kate Kohn‐ParrottPresident and CEO
The Greater Detroit Area Health Council
2
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Average spending on healthper capita ($US PPP)
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USNETHFRGERCANSWIZUKJPNAUS
Total health expenditures aspercent of GDP
Notes: PPP = purchasing power parity; GDP = gross domestic product. International Comparison of Spending on Health 1980-2010Source: Commonwealth Fund, based on OECD Health Data 2012.
The U.S. pays far more for health care than any other country
3
BETTERBETTER
Yet the U.S. lags all other high‐income countries in terms of health outcomes
4
The Commonwealth Fund ranks the U.S. last in terms of health outcomes and cost
5
Clinical/medical care influences 20% of health outcomes; 80% driven by social determinants
Source: RWJF
6
Yet, in the U.S., clinical care is seldom integrated with social determinants
SOCIAL DETERMINANTSHEALTHCARE
Mental/ Beh Health
Health Behaviors Environment
Economics /Poverty
Housing, Transportation,
Etc.Education
7
The U.S. spends more on health care than on social determinants
020406080
Health Care = 64%Social Determinants =
36%
Spending on Health and Wellbeing—U.S.
8
Europe spends $2 on social determinants to every $1 on medical/clinical care
020406080
Health Care = 34%Social Determinants =
66%
Spending on Health and Wellbeing‐‐Europe
9
Michigan is 34th in America’s Health Rankings (UnitedHealth Foundation)
Challenges
• High prevalence of obesity • High prevalence of binge drinking • Low rate of high school graduation
‐ See more at: http://www.americashealthrankings.org/MI#sthash.Sh2W3fuM.dpuf
10
Michigan was just ranked 42nd in overall wellbeing (Gallup‐Healthway Rankings)
11
Wayne County ranks last in the “County Health Rankings”
Great Disparities in Care
12
Detroit statistics . . .
• Most polluted zip code (48217) in State• More fast food restaurants than sit‐down• Food deserts• Deadliest city for children
Compared to national averages• Rate of heart disease is twice as high• Rate of HIV/AID is nearly three times as high• Cancer rate is 20 percent higher• Diabetes rates is 35 percent higher• Infant mortality is more than double
But we are making great improvements!
13
How do we fix this? Start by breaking down these silos
SOCIAL DETERMINANTSHEALTHCARE
Mental/ Beh Health
Health Behaviors Environment
Economics /Poverty
Housing, Transportation,
Etc.Education
14
Agreed‐Upon, Unified
Community Health and
Economic Goals
Health Care Delivery
Behavioral Health
Education
Transportation
Environment and Safety
Economics (Poverty)Literary
Housing
Healthy Food Safety
City Planning
Policy Development
Coordinate efforts and endorse common goals supported by “Health in All Policies”
15
Thanks for being here today and helping develop solutions
Healthy people.Healthy economy.
1
Creating Health:
Redefining the Roles of Health Professionals
Detroit Wayne County Health Authority
March 2, 2015
Jonathan Heller
Co-Director and Co-Founder
2
Human Impact Partners
HIP is a national non-profit working to transform the
policies and places people need to live healthy
lives by increasing the consideration of health and
equity in decision making.
Core strategies:
Conduct research
Advocate
Build capacity
Bringing the power of public health science to
campaigns and movements for a just society
3
The Problem
Health Stats – Wayne County
4
Health Inequities
5
6
Why?
Health status is determined by:
Health care 20%
Behaviors 30%
Social circumstances 40%
Environment 10%Booske et. al. 2010. Different Perspectives for Assigning Weights to Determinants of Health
Reducing Children’s Death Rate
7
Zoning
Sanitation
Child labor laws
Worker safety
Penicillin
Immunizations
8
Social and Economic Stats – Detroit
Poverty level 38%
Unemployment rate 23%; ~4X national
High school graduation rate 65%
Pop with bachelor's degree 13%
Vacant properties ~60K (out of 380K parcels)
Homes at risk of foreclosure ~35,000
9
Worldview Spectrum
IndividualStructural
10
Resources for Improving Health
Bradley et al. (2011)
Total Healthcare and Social Service Expenditures, 2005
11
Why Solve These Problems?
Health Impact Assessment
Democracy
Equity
Sustainable Development
Ethical Use of Evidence
Comprehensive Approach to Health
1) To improve people’s health and lives
1) To reduce health inequities
12
Solutions
Health in All Policies
13
Health in All Policies is the concept of incorporating
health considerations into the policies and
programs of sectors that are the root causes of
health.
14
Health Impact Assessment
How does a proposed
project, plan, policy affect
Determinants of Health
and lead to
health outcomes?What recommendations can be
made to improve health outcomes?
Example 1: Regional Planning
lorem ipsum dolor issue, date
1
!
!
SB375!Health!&!Equity!Metrics!
SB375:!Sustainable!Communities!Strategies!for!
Regional!Transportation!Planning!With%the%goal%of%reducing%greenhouse%gas%emissions,%SB375%requires%that%California’s%Metropolitan%Planning%Organizations%(MPOs)%prepare%a%Sustainable%Communities%Strategy%(SCS)%as%part%of%their%Regional%Transportation%Plan%(RTP).%The%SCS%process%is%an%opportunity%to%improve%the%health%of%all%communities%in%the%state,%truly%ensuring%our%sustainability.%
SB375!&!Health!As%California%continues%to%grow%over%the%coming%years,%we%will%need%to%accommodate%millions!of!new!households%and%jobs.%%%Currently,%the%cars!and!trucks%we%drive%account%for%almost%40%!of!our!greenhouse!gas!emissions.%How%will%further!growth%impact%our%climate?%%%%Transportation%and%land%use%decisions%impact%our%health%by%changing%air%quality,%noise%levels,%physical%activity%rates,%pedestrian%and%bicycle%injury%rates,%and%access%to%the%goods%and%services%we%need%to%live%healthy%lives.%%%%Children%born%today%are%expected%to%have%a%shorter%life%span%than%their%parents%due%to%obesity%and%respiratory%illnesses.%How%will%further!growth%impact%our%health?%!
· American%Lung%Association%in%California%
· Bay%Area%Regional%Health%Inequities%Initiative%
· Climate%Plan%· Fehr%&%Peers%· Healthy%Places%Coalition%· Move%LA%· Nelson%&%Nygaard%
%
· PolicyLink%· Public%Health%Institute%· Prevention%Institute%· Public%Advocates%· Public%Health%Departments%
in%Shasta,%Marin,%San%Mateo,%&%%Los%%Angeles%
· Public%Health%Law%&%Policy%%%
· Public%Law%Center%· Public%Policy%Institute%of%
California%· Raimi%&%Associates%· Reconnecting%America%· Safe%Routes%to%Schools%· TransForm%
!
Starting%with%metrics%proposed%by%many%organizations%and%agencies,%we%developed%a%final%list%of%13%metrics.%For%each%proposed%metric,%we%also%provide%a%review%of%its%links%to%health%and%a%description%of%how%it%can%be%measured.%!
Performance!Metrics!and!Planning!MPOs%use%a%variety%of%performance%measures%to%assess%different%scenarios%for%land%use%and%transportation%changes.%%As%we%have%seen%in%the%past,%if%those%metrics%don’t%include%health%and%equity%measures,%it%is%unlikely%that%the%final%selected%plan%will%lead%to%healthy%and%equitable%outcomes.%For%example,%if%MPOs%use%the%indicator%“Automobile%Level%of%Service%(LOS)%on%Roadways,”%their%decisions%will%focus%on%making%driving%easier,%which%might%not%be%the%best%for%health%given%the%many%ways%driving%can%harm%health.%If%instead%they%use%“Premature%Death%due%to%TrafficYRelated%Pollution,”%then%their%plans%are%more%likely%to%decrease%trafficYrelated%pollution%by%promoting%alternate%forms%of%transportation.%Our%goal%is%to%provide%MPOs%a%set%of%metrics%that%will%promote%health%and%equity%as%well%as%sustainability.%
Developing!the!Health!and!Equity!Performance!Metrics!To%develop%a%list%of%health%and%equity%metrics,%Human%Impact%Partners,%an%OaklandYbased%nonYprofit%that%strives%to%transform%the%policies%and%places%people%need%to%live%healthy%lives,%received%funding%from%the%Resources%Legacy%Fund%and%worked%in%collaboration%with:%%
!
A statewide coalition in CA developed 13 health and equity
metrics for inclusion in Regional Transportation Plans
Topics included: safety; access to goods,
jobs, services; transportation; future
growth; economy; pollution; equity
Sample metrics:
Daily amount (in minutes) of work-trip and non-
work trip related physical activity
Estimate premature mortality attributed to
traffic related ambient PM 2.5 and estimate
asthma incidence and exacerbation
attributed to traffic-related NO2
15
Result: Metropolitan Planning Organizations are now
incorporating some of these metrics in their plans
Example 2: Foreclosures
16
Alameda County Public Health and Causa Justa::Just Cause
Primary data collection, stories from community members
Wins:
Local and state legislation that
stopped water shutoffs when
landlords don’t pay bills
Local legislation that mandates
banks maintain foreclosed
properties
Built community capacity and
trust and transparency in
government
Example 3: Public Transit
17
https://www.youtube.com/watch?v=z_Tc3kYXBXI
18
Example 4: Minimum Wage
Income is a strong and consistent predictor of health
Mechanisms: ability to meet material needs, access to health
care, quality of neighborhoods in which people can afford to
live, child health and development, chronic stress, interpersonal
relationships
Outcomes: premature mortality, chronic disease, hunger, mental
health, ...
MN Health Commissioner Tweet: “Governor
Dayton signing the minimum wage bill into
law. A great public health achievement.”
Analyses completed in MN (2014), CA (2014), SF
(1999); public health became advocate and new
voice for raising the minimum wage
Many states and cities recently passed or are
considering minimum wage increases
19
Example 5: Incarceration
1 in 3 blacks, 1 in 6 Latinos, and 1 in 17 whites will be
incarcerated in their lifetime
“Tough on crime” policies have not improved public safety;
recidivism rates are over 50%
Those incarcerated are 6X more likely to be
mentally ill; 20X more likely to have a substance
abuse problem
Mental health and substance abuse programs
reduce recidivism
Criminal justice reforms being investigated across
the country
Public health lens has been used in WI (2012)
and CA (2014) to help win reforms
20
Example 6: Education Funding
Promising Practices
School-based mental health
programs
School-based health centers
Nutrition programs
Physical activity programs
Asthma programs
Dental care services
Parent engagement
Safe and supportive learning
environments (e.g.,
Restorative Justice)
Teacher training on social-
emotional needs
Additional HiAP/HIA Project Topics
21
Health Determinant Policy Issue
Education Discipline; Funding; Integration; Siting
Jobs Wages; Pay equity; Paid sick days; Wage
theft; Hiring practices
Housing Mixed-use housing development; Public
housing redevelopment
Transportation Freeway expansion; Public transit funding
Land use Planning and zoning; Waste facility siting;
Transit oriented development
Incarceration Diversion; Sentencing reform; Ban the box
Agriculture SNAP; Farm to school; Ag plans
Energy Natural resource extraction; Wind farms;
Cap and trade
Outcomes
Local and statewide wins to improve neighborhood, housing,
transit, criminal justice, education, and employment conditions
and policies for low-income communities and communities of
color
Increased participation in decision-making by community
residents and empowerment of community organizations
Explicit consideration of health inequities in decision making
Changes in how policies are framed and debated
Increased media coverage of the health and equity implications
of decisions
New collaborations between health professionals, public
agencies, community organizations, and other stakeholders
22
23
Elements of Success
Moving upstream: focusing on social inequities (causes)
rather than the health disparities (outcomes)
Process: building relationships and collaborations across
agencies, with communities, and with other
stakeholders
Community engagement: strengthening the ability of
communities facing inequities to change the conditions
that lead to poor health outcomes
Solution oriented: creating viable alternatives and
recommendations that provide an achievable vision
Changing worldview: use the work to raise awareness of
structural causes of health outcomes
24
So What Can Health Professionals Do? (I)
Research
Communications
Capacity Building
Relationship Building
Funding
…to help communities facing poor health
outcomes build their power to make change
25
What can Health Professionals Do? (II)
Who What
Public health
professionals
Provide data and research connecting public policy
and health
Non-profit
hospitals
Analyze SDOH in CHNA; use community benefit
spending on SDOH
Medical
professionals
Support community organizers and policy advocates
fighting for policy change by using their individual
and collective voices
Public health
nurses
Build social cohesion and strengthen social networks
when providing services in the community
All of us Build capacity of low income people and people of
color to advocate on their own behalf for policies
that improve living conditions
All of us Use the power of our positions to build relationships
between those facing the greatest inequities and
those who can change policy
26
Community Organization
An organization that:
• Helps a community identify common problems,
mobilize resources, and develop and implement
strategies to reach their collective goals;
• Brings people who identify as being part of the
community together to solve problems that they
themselves identify;
• Works to develop civic agency among
individuals and communities to take control over
their lives and environments.
27
Detroit Public Transit
28
Detroit Foreclosures
29
Detroit Future City
30
Michigan Sales and Gas Tax Ballot Initiative
31
Michigan Criminal Justice Reform
32
Michigan Prevailing Wage
Community Benefits Presentation EQUITABLE DETROIT COALITION, PEOPLE’S PLATFORM & THE SUGAR LAW CENTER FOR ECONOMIC & SOCIAL JUSTICE
The mission of the Equitable Detroit Coalition is to foster beneficial relationships between developers and the Detroit community
Open, transparent dialogue between Community & Developer
Residents are stake holders because their money subsidizes the projects and they must live with the projects.
Membership list in your folders
Support for CBA Ordinance growingu City-wide movement
u The People's Platform in alliance with Equitable Detroit and the Economic Justice Alliance of Michigan door knocked more than 3000 doors across the city of Detroit educating residents about the proposed CBA ordinance.
u Collected more than 2000 signatures of Detroit voters in support of the CBA ordinance
u Built strong alliance with the Black Chamber of Commerce who are growing small businesses support.
u CBAs not new to Detroitu Parkside Residents Council (PRC) worked with Detroit Housing Commission’s (DHC)
contractor on a $90 million housing project. They successfully negotiated a legal binding agreement for $350,000, sign off on all architectural designs, first right to move into the new development, and a United Way for $1,000,000 to provide funding for on-site service providers at Parkside. Residents would evaluate service providers and determine funding levels
Post-bankruptcy, the city of Detroit’s biggest asset is land. In the next few years, Detroit will be at the epicenter of urban land development. Projects without a CBA:
Bridge to Canadau $2 billion project
u 165 acres of Detroit land
u Close to 200 homes displaced, including churches and 43 businesses
u Received 301 properties for $1.4 million
u No legally binding agreement regarding jobs, air quality, housing, etc.
Henry Ford Medical Warehouseu Henry Ford Health Systems’ $500
million expansion
u Involves 300 acres in the West Grand Blvd neighborhood
u Agreed ONLY to a letter of understanding that is NOT binding
Without a CBA process, cont.
Marathon Oil Refinery Expansion
Largest refinery expansions in the U.S., $2.2 billionReceived $175 million tax breakPromised to hire 51% of Detroiters for the over 200 jobs createdONLY hired 15 DetroitersProcessing of the dirtiest crude oil, tar sands
Michigan State FairgroundsDevelopment of 157-acre Michigan State Fairgrounds Community proposals and ideas were ignored
Meijer’s in Brightmoor
Grand Rapids-based retailer Meijer is breaking ground on a second Detroit location at the corner of Grand River and McNichols roads on May 15. $3 million Brownfield Credit Hiring 500 peopleSmall business impact?
Events Arena & Hockey StadiumNew Arena/Hockey Stadium
u New $650 million entertainment and hockey stadium
u Received $284 million tax break & land transfer of 39 publicly owned parcels along the Cass Corridor for $1.00
u Olympia refuses to enter into a CBAu Received $284 million in tax
subsidiesu Does not include the deals on land
transfersu No legally binding agreement to
hire local residents or improve quality of life of host community.
Joe Louis Arena u In 1980, the Red Wings, then owned by
Bruce Norris, signed an agreement with the city to pay it 25 percent of any gross profits over $750,000 from any television rights revenue for events broadcast live at Joe Louis or adjacent Cobo Center.
u With the new arena, we get no shared revenue.
In your district, do you have a neighborhood that looks like this?
At the foot of the Ambassador bridge, no CBA
The neighborhood post-refinery expansion, no-CBA
CBA policies well-established in other cities
u Expansion of Columbia University in New York Cityu Casino & hockey arena in Pittsburghu Several mixed-use developments: the Staples Center expansion in
Los Angeles, the Cherokee-Gates development in Denveru Beltline development projects in Atlantau Milwaukee Park East Redevelopment Compactu San Diego BallPark Village mixed-used projectu Oakland’s Oak to Ninth housing projectu Municipalities such as St. Louis, Atlanta, Cleveland and Milwaukee
have adopted broad community benefits policies during public works projects.
Examples of CBAs in other cities
Penguins Pittsburgh Hockey Stadiumu $1 million for a Hill District grocery store. u Creation of a First Source Employment
Center that will give neighborhood residents the first chance to apply for jobs created at the arena.
u The creation of a master planning committee that has until Feb. 19, 2010, to come up with guidelines for development of the Hill District and Uptown.
u The city, county and URA agreed to work with Pittsburgh YMCA to build a community center in the neighborhood.
u The Penguins agreed to pay $500,000 a year for six to 12 years for a Neighborhood Partnership Program focused on development and social services such as treatment for drug and alcohol addiction.
Twitter in San Francisco
u Twitter obtained a tax exemption worth about $70 million in payroll & stock option taxes for six years.
u Required Twitter to purchase $500,000/per year worth of goods & services from small businesses
u $3 million each year for a neighborhood learning center
u $3 million per year to nonprofit organizations in the neighborhood
u 4,000 volunteer hours (Friday for Good program) by Twitter employees
u $50,000 (min.) a year donation of IT equipment to local schools
u $60,000 per year in free advertisement for nonprofit organizations on Twitter
Detroit Community Benefits Ordinanceu The latest version under discussion:uOnly applies to developments requesting public
subsidiesu Triggers involved: $300,000 tax break and $15-million
project then they are required to seat down with the community (Tier 1)
uNot one-size-fits-all: Specific agreements developedu Exemptions allowed – equivalent agreements or
impasse
QuestionsNext Steps:
Anti-CBA House Bill 4052
Detroit Ordinance Support
Contact:Rashida TlaibSugar Law Center for Economic & Social [email protected]
220 Bagley Ste. 212, Detroit MI 48226
313.962.5290www.mosesmi.org
Population Health ForumMarch 2, 2015
Why Congregation BasedCommunity Organizing?
“The center of our values in Congregation-
Based Organizing is belief that our values
SHOULD determine the policies and practices
of our government and our society.
We know with intentional intervention that
policies and practices will change when
people of FAITH put their VALUES into
ACTION”
“A true revolution of values will soon cause us to question the fairness and justice of many of our past and present policies. ... A true revolution of values will soon look uneasily on the glaring contrast of poverty and wealth”
Dr. Martin Luther King Jr.Riverside Church in NY April 4, 1967
Social Inequities
Health Inequities
Segregation Income & Employment Education
Housing Transportation Air Quality Food Access & Liquor Stores
Physical Activity & Neighborhood Conditions Criminal Justice
Access to Healthcare Social Relationships & Community Capacity
Social Inequities
Powerlessness is making People sick!
Kalamazoo Co. H.D.
ISAAC
Kent Co. H.D.
Various Partners
Ingham Co. H.D.
ACTION of G. Lansing
Saginaw Co. H.D.
Ezekiel Genesee Co. H.D.
Various Partners
Detroit/Wayne Co. H.A .Wayne County Health Dept
Institute for Pop HealthDetroit Health Depart
MOSES
Washtenaw Co. P.H.
WeROC
BerrienCalhoun
Eaton
Housing
Immigration
School closings
Transportation
Ban-the-box
Minimum Wage
Infant Mortality
Health in All Policies
Mass Incarceration
Building Networks of Power to impact Health Inequities