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LISC in U.S. News & World Report: Taking Action on Health

U.S. News & World Report interviewed San Francisco Fed’s director of community development, David Erickson, about how investments in neighborhoods improve community health. A longtime LISC partner, Erickson described our teamwork with the healthcare sector as a frontline approach to viewing neighborhoods as patients, and helping boost health outcomes through holistic development and revitalization.

The excerpt below is from:
Investment: An Rx for Community Health
By Steve Sternberg, U.S. News & World Report

Many people know the purpose of the Federal Reserve banking system is to assure the stability, integrity and efficiency of the nation's economic system. But they may not realize the system's 12 district banks also have a much broader obligation, under the Community Reinvestment Act of 1977, to make sure that banks offering federally insured loans treat customers equitably.

The purpose of the law was to counter discriminatory lending practices, called neighborhood redlining, that once made it hard for minorities to obtain loans on the same terms as more privileged populations. The San Francisco Federal Reserve Bank has ingrained this notion of equal opportunity into a community development mission statement: "Our economy can only reach its full potential when everyone is educated, healthy, and has an affordable place to call home." 

It's the job of David J. Erickson, director of community development at the San Francisco Fed branch and community development officer for the Federal Reserve's 12th District, to accomplish that mission – but he hasn't stopped there. He's led a collaboration between the Federal Reserve and the Robert Wood Johnson Foundation to bring together health and community development leaders from across the country, which has resulted in dozens of conferences and multiple publications. His book "The Housing Policy Revolution: Networks and Neighborhoods" was published in 2009 by Urban Institute Press.

U.S. News spoke with Erickson about the role he's played in reframing efforts to build communities beyond housing to health. The interview has been edited for length and clarity.

You got your start studying issues relating to housing. What prompted you to tackle health, too?

I was never interested in health. I was always interested in finding ways to help markets achieve better social outcomes. Then I happened to marry a pediatrician who's a public health professor at Berkeley. As he was reading my dissertation – which became my first book on urban revitalization strategies – he said, "You know this has health implications, right?" When people feel a sense of control over their future they tend to be healthier. It was out of that kernel that the idea began to take shape.

What did you do next?

We started some conversations. We got his friends together with my friends and the San Francisco (Federal Reserve Bank) held the first Healthy Communities Conference in partnership with the Robert Wood Johnson Foundation in 2010 in Washington, D.C. We've had 40 of these meetings since then at Federal Reserve banks around the country. We bring people who care about urban revitalization, affordable housing and anti-poverty together with people who focus on public health, population health and even medical care. We find a lot of overlap in the populations we work with.

We often will start these meetings with heat maps that show areas that are of concern to the anti-poverty people, places with overcrowded housing, unemployment and poverty. Then we do heat maps for the health folks, looking at childhood obesity, violence and chronic disease. When you put these maps together, they're always the same map. That's the core of it. We're working side by side, often with the same populations, but we're not coordinated.

That's the genesis of this work, to say, "Hey, you guys care about these neighborhoods and these families, too. Can we work together to be more effective, giving them the tools and opportunities they need to lead a healthier life?"

Once you've identified the communities on the map, how do you leverage your collective efforts to help them?

That's the problem. The intellectual part of this everybody gets instantly. The hard part is figuring out what to do about it. For a long time it was just kind of getting to know each other and learn how to communicate. We use different vocabularies. For example, in our world, a "CDC" is a community development corporation. There are now 4,000 CDCs across the country. The first was the Bedford Stuyvesant Restoration Corporation in New York, championed by Robert Kennedy. The public health people hear CDC and they're thinking about the Centers for Disease Control and Prevention. So language has been an obstacle. Just getting a common understanding of how we could possibly work together has been a challenge.

When you do work together, what do you focus on?

In the beginning when people mentioned health, I thought of medical care, and that's just not right. That took me a long time to unlearn. The things that determine your health are much simpler: Do you feel some control over your future? Do you feel connected to your community? When you're in a bind, do you have someone to turn to? These are the things that really contribute to your health and lower your stress. Another way of defining health is to think of your body as the living record of your challenges and opportunities. A person who has a lot of challenges just lives a shorter and less healthy life.

What we're trying to do is create as many opportunities as possible in places that don't have them. That can mean making sure residents have a job, maybe through a small-business loan. Making sure they have stable housing, by assuring that there's affordable housing in their neighborhood. Maybe they need access to transportation, recreational opportunities or community-building activities that make neighborhoods a little bit safer and more connected. We've been doing this for 50 years, but now we're sharing a common purpose with the health sector. Billions of dollars are being co-invested by health and community development all across the country.

Can you give some examples?

The Build Healthy Places Network has a lot of great case studies. Dignity Health, which was formerly Catholic Healthcare West, has a $140 million loan fund that they co-invest with nonprofit banks to create jobs, build affordable housing and make communities more viable. Morgan Stanley has a $300 million fund that is really intended to focus on community clinics, but the price of (using that) capital has been driven down by The Kresge Foundation and a nonprofit bank, the Local Initiatives Support Corporation. The Kresge Foundation uses grant dollars to cover part of the cost of the loan; in essence, they are donating their own resources to bring down the interest rate charged to the borrower who is building the clinic and housing. Any clinic that wants access to that cheaper money will have to adopt the whole neighborhood as the patient. It means more than providing health care – it's also case management, job training, affordable housing and the things that make a neighborhood thrive.

The (Local Initiatives Support Corporation) has just created a blended fund with ProMedica in northwest Ohio, where they're making investments cooperatively to improve health by revitalizing neighborhoods in Toledo. That's one of the first times you've seen a nonprofit bank, funded mostly by for-profit banks – which get credit for their Community Reinvestment Act participation – investing with a hospital.

The head of the Local Initiatives Support Corporation says that in five years he expects to deploy more money from hospitals than from banks, which were his main source of funding for 40 years.

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