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To achieve health equity would mean that everyone, regardless of their zip code, has access to the things they need to lead a healthy life. On April 18th, LISC NYC brought together people working across two quite distinct sectors—health care and community development—to explore ways they can join forces in pursuit of this social-justice objective.
For years now statistical heat maps have drawn a picture of stark geographical disparity in America, with disadvantages from substandard housing to lack of jobs and transportation clustering in certain neighborhoods. Disproportionately these places are home to low-income people of color. And one of the most inequitable results for residents is poorer health and lower life expectancy.
Those in community development have always seen neighborhoods as intricate, life-sustaining ecosystems, and worked to make them healthier. But only recently have they begun to focus directly on affecting health outcomes like diabetes and asthma, or on partnering with health care institutions.
Likewise, workers in the health care sector who care about equity increasingly see the need to reach beyond the clinic into the neighborhoods that so dramatically influence their patients’ health.
A major thrust of the LISC NYC convening was to share early experiences from this fast-developing area of practice. “This is about field-building,” said LISC NYC executive director Sam Marks. “And if we’re not building a field that draws its best practices from what’s happening on the ground, we’re not moving in the right direction.”
A Greener, Leafier Food Environment
The first panel at the convening looked at LISC NYC’s Communities for Healthy Food (CfHF) initiative. Launched in 2014 just as the food-justice movement was showing real momentum, CfHF has helped five community development corporations (CDCs) across the city bring nutritious, affordable, culturally appropriate foods to neighborhood tables.
In the Bronx, New Settlement Apartments partnered with local schools to improve lunchtime meals, give cooking and gardening classes as part of the regular school day, and open a youth-run farm stand to entice kids as they leave at dismissal. Taisy Conk, director of New Settlement’s Community Food Action initiative, said connecting with schools proved an auspicious approach, in part because educators “get” why food and wellness matter. “Kids who are hungry can’t learn,” she said. “That’s a baseline of understanding for schools. And it has evolved to a deeper understanding.”
In Brooklyn’s Bedford Stuyvesant, the Northeast Brooklyn Housing Development Corporation (NEBHDCo) has been hiring and training “community chefs” to lead cooking and nutrition demonstrations at its busy food pantry and in other places where families gather. NEBHDCo has made its food initiative a robust community-building project in at least two ways—by employing chefs who bring an authentically local food culture to the work, and by developing curricula that stimulate thinking about food systems as much as teach culinary techniques. “Changing diets isn’t where this work begins—or ends,” observed Bianca Bockman, director of NEBHDCo’s Food Justice Program.
Participating CDCs have been quite successful in establishing a healthier “community-constructed” food environment, but less so in influencing neighborhood stores embedded in the traditional food system, “where profits come from shelf-stable, high-fat, high-sugar, high-salt foods,” reported Nick Freudenberg, director of the CUNY Urban Food Policy Institute, the CfHF initiative’s evaluation partner.
Freudenberg’s takeaway: CDCs do well to leverage the public-sector food supply (SNAP, schools, senior centers, etc.) and community food offerings (farmers markets, community gardens) as both an alternative to the dominant sector and a competitor that may influence it to sell healthier, less expensive products.
One of the most positive achievements of the program was residents’ increased ability to navigate available food choices in a way that serves their own health. In 2017 compared with 2014, for example, more residents said they compared food prices, read nutrition labels, planned meals ahead, and cooked more meals at home.
Healthy Affordable Homes
Next up, panelists shared insights from Two Shades of Green, a leading-edge partnership across health, housing, and community development sectors. So far it has made 1,100 New York City affordable-housing units healthier for people and the planet (that’s one shade of green) while also saving money (that’s the other shade).
The project, a joint effort of LISC NYC, the New York City Department of Health and Mental Hygiene, the city’s Department of Housing Preservation and Development, and a host of CDCs, introduces water- and energy-conserving alterations such as new plumbing fixtures and LED lighting, along with integrated pest management, green cleaning products, design adaptations to promote physical activity, and smoke-free policies.
When the program launched in 2013, health department officials were most concerned about sky-high rates of emergency-room admissions for asthma in high-poverty areas—“a tale of two cities,” said Deborah Nagin, director of the department’s Healthy Homes Program, that they knew correlated with building issues such as rats, roaches, leaks, mold, and wafting tobacco smoke. LISC NYC, meanwhile, had an eye on rising water costs that were threatening buildings’ affordability, another important consideration for low-income families.
Ellen Tohn, a prominent expert on healthy housing and a lead consultant on the project, presented findings documenting cost savings in nearly every category of intervention in Two Shades. Smoke-free policies, for example, led to lower costs for cleaning apartments between tenants.
It’s much harder to document impacts on health, because the number of tenants affected isn’t big enough to produce a statistically valid study of, say, asthma reduction. Public health officials are confident that changes in conditions are a proxy for health effects, but that doesn’t always persuade building owners, said Nagin. “They just really want to see, ‘I reduced someone’s asthma.’”
Going green has also required a lot of organizing and culture change among those who live and work in the buildings. Michelle Pryce-Screen, director of resident services at Hope Community Inc., which owns or manages some 1,250 affordable units in East Harlem, said building staff were especially skeptical that a holistic pest control system relying less on toxic pesticides would actually work. “But once we got them on board,” she said, “we were able to work with the tenants to get them to understand that this could be effective—and that it could impact the health of their families.”
New Directions in Collaboration
Despite formidable funding and administrative complexities, players in the healthcare field have linked with community development groups to influence the social determinants of health in struggling neighborhoods. The convening’s final panel brought forward projects that make that linkage, raising the possibility of rich new directions for public health.
• New York State’s Delivery System Reform Incentive (DSRIP) program is a major initiative to enhance preventive care and trim costs in Medicaid. It establishes local provider networks (called performing provider systems or PPSs) joining hospitals and clinics with social-service agencies that can help residents stay healthy and avoid hospitalization. For example, as part of the Staten Island PPS, the nonprofit Make the Road New York is training community health workers to liaise between doctors and their patients, meeting with patients in their homes to help them eliminate asthma triggers and follow treatment plans.
• The Bedford Stuyvesant Restoration Corporation, using a foundation grant and city department of health funds, has drawn two local hospitals into a campaign to promote bike sharing as a cheap, physically active transportation alternative. “They’ve got their employees to adopt bike share through their wellness program. They’ve also led the way for the community by leading bike rides that are very visible. And they’ve worked with the health department to actually prescribe bikes to patients—with tremendous success,” Restoration vice president Tracey Capers explained.
• LISC and ProMedica, an Ohio integrated health system, recently announced a groundbreaking partnership deploying $45 million in loans and grants to address the social determinants of health in part of Toledo’s urban core.
According to LISC Toledo’s Sarah Allan, in addition to its investment, LISC brings to the revitalization project an understanding that residents must take part in shaping the effort from the get-go. Said Allan, “We need to have this conversation with the community first.”
LISC NYC resources on health equity
Special thanks to our philanthropic partners
Laurie M. Tisch Illumination Fund
New York State Health Foundation