RWJF Commission to Build a
Healthier America
Place Matters Presentation

David R. Williams, PhD
October 3, 2013
In 2009,
the Commission was
charged broadly with
identifying actions to
improve the nation’s health
outside of the doctor’...
Progress since 2009 Recommendations
• The Patient Protect and Affordable Care Act (ACA) established funding
for Maternal, ...
Progress since 2009 Recommendations
• The Healthy Hunger-Free Kids Act creates an opportunity for the
USDA to improve the ...
This year,
the Commission is
focusing its deliberations
on recommendations to
support health in
communities and during
ear...
Meet the 2013 Commissioners
Site Visit to Educare Center, D.C. Promise
Neighborhood and Marvin Gaye Park
Public Meeting with Expert Testimony
Preview of Commission Recommendations:
Early Childhood
Early childhood is critical for
lifelong health
• Children most often in need of early childhood

programs are least likel...
Science Has Evolved, Our
Approaches Have Not
Jack P. Shonkoff, Director, Center on the Developing Child, Harvard Universit...
Science Has Evolved, Our
Approaches Have Not
Jack P. Shonkoff, Director, Center on the Developing Child, Harvard Universit...
Helping Children by
Transforming Adults

Elisabeth D. Babcock, President and CEO, Crittenton Women’s Union

Mobility Mento...
Helping Children by Transforming Adults

CWU’s unique business model combines direct
services to over 1,400 clients per ye...
Helping Children by
Transforming Adults

Elisabeth D. Babcock, President and CEO, Crittenton Women’s Union

“Poor families...
Helping Children by Transforming Adults

40% of our clients report at least one significant mental
health diagnosis such a...
Helping Children by Transforming Adults

Career Family Opportunity (CFO) Program
From the outset, CFO had the express inte...
Helping Children by Transforming Adults

Key Aspects of Career Family Opportunity Program:
Mobility mentor

Personal goals...
Helping Children by Transforming Adults

Sample Outcomes:
99% of families exiting homeless shelters had retained
their hou...
Done Right, Early Childhood
Development Programs Can
Change Communities
Jessie Rasmussen, President, Buffett Early Childho...
Done Right, Early Childhood Development Programs Can Change Communities

In the past five years, the local partners in Neb...
Investments in Young Children
= Economic Development
Arthur J. Rolnick, Senior Fellow and Co-Director, Human Capital Resea...
Investments in Young Children = Economic Development

Children served by these programs are more likely to:

Stay in the r...
Investments in Young Children = Economic Development

“In Minnesota, we estimate that to ensure
that all 3- and 4-year-old...
Preview of Commission Recommendations:
Healthy Communities
ZIP Code vs. Genetic Code
New Partners in the “ZIP CodeImproving” Business
David Erickson, Federal Reserve Bank of San Francisco

There is an entire...
New Partners in the “ZIP Code-Improving” Business

Community development and health are working side-byside in the same ne...
New Partners in the “ZIP Code-Improving” Business

A “Wet Cement” Moment
“In the next 18 months we will build the new inst...
“Quarterbacks and Silo-Busters”
Nancy O. Andrews, President and CEO, Low Income Investment Fund

Community Development Fin...
“Quarterbacks and Silo-Busters”

People and Places: LIIF Projects Come to Life

Booth Memorial Child Development Center

B...
“Quarterbacks and Silo-Busters”

People and Places: LIIF Projects Come to Life

Transit Oriented Development
In 2011, LIIF...
“Quarterbacks and Silo-Busters”

People and Places: LIIF Projects Come to Life

Purpose Built Communities

Based on effort...
“Quarterbacks and Silo-Busters”

People and Places: LIIF Projects Come to Life

Refresh

In New Orleans, one of the worst ...
“Quarterbacks and Silo-Busters”

Community development field + health field
Break down silos
Evidence-based investment
Ada...
Investing in Poor Neighborhoods
Makes Good Business Sense
David W. Fleming, Director and Health Officer, Public Health—Sea...
Investing in Poor Neighborhoods Makes Good Business Sense

Like Politics, All Health is Local
U.S. life expectancy by coun...
o
tries

rics and Evaluation,

Investing in Poor Neighborhoods Makes Good Business Sense

Like Politics, All Health is Loc...
We’re all in this Together –
the Need for Collective Action
Laura J. Trudeau, Senior Program Director, Community Developme...
We’re all in this Together –
the Need for Collective Action
Laura J. Trudeau, Senior Program Director, Community Developme...
What’s Next?
Get Involved
• Visit RWJF.org/goto/commission
• Visit buildhealthyplaces.org
• Follow @RWJFCommission on Twitter
• Tune in...
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Place Matters Presentation by David Williams

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At the recent Place Matters conference in Washington, D.C., David Williams, PhD, the Norman Professor of Public Health at the Harvard School of Public Health and staff director of the reconvened Robert Wood Johnson Foundation Commission to Build a Healthier America, talked about the need for cooperation between the community development industry and health leaders.
“Community development and health are working side by side in the same neighborhoods and often with the same residents but often don’t know each other or coordinate efforts.”

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  • GENERAL PROGRESSIncreased awareness of the social factors that impact health Decreasing childhood obesity ratesInitiatives to bring healthy food options to underserved urban and rural communitiesIncreased focus on the importance of early educationIncreased number of health impact assessments to make communities healthierSPECIFIC LEGISLATION1. Increasing focus on Early ChildhoodThe Patient Protect and Affordable Care Act (ACA) established funding for Maternal, Infant and Early Childhood Home Visiting programs, one of which, Nurse Family Partnership, an RWJF grantee, presented to the Commission. The ACA authorized $1.5 billion for these programs, with the amount of authorized funds increasing each year.2.Expanding Access to Healthy FoodsIn November 2010, the White House established the Healthy Food Financing Initiative (HFFI) as a multi-million-dollar public and private investment to improve access to healthy foods. HFFI brings grocery stores and other healthy food retailers to underserved urban and rural communities across the United States. In 2012, Congress provided funding to increase the number of farmers markets participating in the Supplemental Nutrition Assistance Program (SNAP)
  • 2.Expanding Access to Healthy Foods (cont’d)The Healthy Hunger-Free Kids Act, signed into law in December 2010, creates an opportunity for the USDA to improve the nutrition and hunger safety net for millions of children by making real reforms to school lunch and breakfast programs. In February 2013, the USDA proposed updated nutrition standards aimed at providing healthier foods and beverages in school vending machines, cafeteria a la carte lines, and other places where foods and beverages are offered outside of school meals programs.3. Creating Healthy CommunitiesThe use of health impact assessments (HIAs)—flexible, data-driven tools that help decision-makers identify and address the health impacts of a non-health policy decision or project—has gained traction, and built directly on the Commission’s recommendation to develop health impact ratings of infrastructure projects. To date, more than 200 HIAs focusing on policies and programs across multiple issues have been completed or are in progress across the country, informing decisions on new housing projects, transportation plans, community improvements, and a range of policies.At the federal level, the Centers for Disease Control and Prevention (CDC) has launched the Community Transformation Grant Program. Grantees design and implement community-level programs that prevent chronic diseases such as cancer, diabetes, and heart disease, and promote health.
  • An unstable and poorly regulated environment triggers excessive activation of stress response systems that increase the risk for lifelong impairments in both physical and mental healthCWU’s unique business model combines direct services to over 1,400 clients per year, with research, and advocacy, to create new program and public policy approaches designed to overcome obstacles to family stability and self-sufficiency
  • At CWU, we see this distinct poverty imprint on the 1,400 women and children we serve each year. When we perform client intake and annual assessments we find:
  • Armed with the Bridge to Self-Sufficiency™ Theory of Change and the basic assumptions listed above, CWU created Mobility Mentoring and first deployed it in a very intensive five-year model known as the Career Family Opportunity (CFO) Program. With private philanthropic funding, CFO opened in 2009 with 21 families from South Boston public housing developments who voluntarily applied to join the program. From the outset, the program had the express intent of proving that within five years they could attain jobs that would fully support their families without public subsidies (for most families this was a target salary of approximately $50,000 per year) and that they would also have each saved $10,000 (of which $3,600 would come from their own savings and $6,400 from matching funds if they completed their other goals).
  • Sample Mobility Mentoring Outcomes for Non-CFO (Career Family Opportunity) Participants
  • Jessie Rasmussen, President, Buffett Early Childhood FundAbout 60,000 infants, toddlers, and preschoolers in Nebraska are growing up at risk of failing school. Eleven counties account for 64 percent of all at-risk children between the ages of birth and 5 years.
  • Jessie Rasmussen, President, Buffett Early Childhood FundIn the past five years, the local partners working in Nebraska have: expanded funding for pre-Kinstitutionalized funding for at-risk four-year-olds through education state aid fundingestablished a $60 million dollar public-private endowment to create, support, and enhance birth-to-three services for children at riskprotected existing early childhood funding during the lean years of state cuttingpassed legislation to expand the Sixpence endowment cash fund, initiate a quality rating and improvement system for child care, and raise the eligibility standard for the child care subsidy
  • Minnesota approach is one example of this approach
  • . Before LIIF’s renovations, Booth’s facilities were outdated, old, and caused health problems in children and staff alike. Asthma attacks were a common problem among Booth staff and children, thanks to the aging condition of the facility. However, a $70,000 investment arranged from LIIF along with matching contributions from philanthropy brought the total investment to $159,000.
  • In 2011, LIIF helped create the Bay Area Transit-Oriented Affordable Housing Fund, a $50 million capital pool formed in collaboration with several other community capital partners—Enterprise, LISC, the Opportunity Fund, and others. Private capital investors included Morgan Stanley and Citibank. The idea behind the TOD fund is to create not only more affordable housing but healthy, mixed-income, walkable communities, located near major transit nodes. Public transportation is crucial in urban areas, because one of the biggest barriers to jobs for low income people is literally being able to get to them. Good transportation is a key to jobs, employment, and opportunities.
  • A prime example of the type of “quarterback” we envision, Purpose Built’s results are stunning; East Lake in Atlanta has empirically demonstrated a 95 percent reduction in crime since its launch in 1995, a six-fold increase in employment and extraordinary improvement in school achievement—96 percent of Purpose Built students now perform at or above grade level, compared to 5 percent at the start. Purpose Built Communities is active in communities in Atlanta, New Orleans, Indianapolis, and Charlotte, among others. LIIF has committed $10 million in New Markets Tax Credits to the Drew Charter School in East Lake.
  • In New Orleans, one of the worst “food deserts” in the country, LIIF worked with Goldman Sachs, JPMorgan Chase, and L+M Development partners to fund an $18 million “healthy food hub.” This is a mixed-use commercial facility with a small-format Whole Foods offering lower prices, kitchens and facilities for local healthy food enterprises and culinary educational institutions, office space for a local charter school, and 10,200 square feet of retail space. Tulane University’s Medical School will use the ReFresh facility for nutrition education.
  • Although disquieting, it turns out that focusing on our average national life expectancy masks the real underlying problem. IHME next imagined that each county in the United States was its own country and calculated how each county would fare relative to the top 10 performing countries
  • However, even regional remedies may not be local enough. For example, take King County, Washington, home of Seattle and Starbucks. In IHME’s county-level analysis, King County fares well, only a couple years behind the top performing countries, reinforcing the region’s reputation as a place of great recreation opportunities, plentiful local food and a relatively robust economy. But, if we repeat the IHME county analysis at the census tract—if we imagine that each census tract in King County is its own country and calculate how each is doing relative to the best performing countries—it turns out that the county’s overall “good” average hides huge underlying disparities. While some census tracts in King County are as much as 40 years ahead of the best performing countries’ average life expectancy, there are others, not further than a bicycle ride away, that are almost 60 years behind. In fact, there is substantially more variation by census tract within King County than there is by county within the U.S. At the pace of best performing nations, it would take 100 years for the census tract with lowest life expectancy in King County to catch up to where the highest ones already are today.
  • Place Matters Presentation by David Williams

    1. 1. RWJF Commission to Build a Healthier America Place Matters Presentation David R. Williams, PhD October 3, 2013
    2. 2. In 2009, the Commission was charged broadly with identifying actions to improve the nation’s health outside of the doctor’s office.
    3. 3. Progress since 2009 Recommendations • The Patient Protect and Affordable Care Act (ACA) established funding for Maternal, Infant and Early Childhood Home Visiting programs. • Healthy Food Financing Initiative (HFFI) brings grocery stores and other healthy food retailers to underserved urban and rural communities. • Congress provided funding to increase the number of farmers markets participating in the Supplemental Nutrition Assistance Program (SNAP).
    4. 4. Progress since 2009 Recommendations • The Healthy Hunger-Free Kids Act creates an opportunity for the USDA to improve the nutrition and hunger safety net for millions of children. • To date, more than 200 Health Impact Assessments (HIAs) have been completed or are in progress across the country. • At the federal level, the Centers for Disease Control and Prevention (CDC) has launched the Community Transformation Grant Program.
    5. 5. This year, the Commission is focusing its deliberations on recommendations to support health in communities and during early childhood.
    6. 6. Meet the 2013 Commissioners
    7. 7. Site Visit to Educare Center, D.C. Promise Neighborhood and Marvin Gaye Park
    8. 8. Public Meeting with Expert Testimony
    9. 9. Preview of Commission Recommendations: Early Childhood
    10. 10. Early childhood is critical for lifelong health • Children most often in need of early childhood programs are least likely to have access to them. • Compared with their counterparts who participate in high-quality early childhood interventions, at-risk children without such services are 25 percent more likely to drop out of school. • Graduation from high school is the leading health indicator for adults, even when controlling for race and income.
    11. 11. Science Has Evolved, Our Approaches Have Not Jack P. Shonkoff, Director, Center on the Developing Child, Harvard University Creative, new approaches in early childhood policy and practice that are grounded in rigorous science and not driven by personal belief More explicit attention to transforming the lives of the adults who care for vulnerable, young children
    12. 12. Science Has Evolved, Our Approaches Have Not Jack P. Shonkoff, Director, Center on the Developing Child, Harvard University A flexible investment strategy and a culture of innovation that support the value of strategic risk-taking, fast-cycle sharing, and a commitment to learn from strategies that don’t work
    13. 13. Helping Children by Transforming Adults Elisabeth D. Babcock, President and CEO, Crittenton Women’s Union Mobility Mentoring is the professional practice of partnering with clients so that over time they may acquire the resources, skills, and sustained behavior changes necessary to attain and preserve their economic independence.
    14. 14. Helping Children by Transforming Adults CWU’s unique business model combines direct services to over 1,400 clients per year, with research, and advocacy, to create new program and public policy approaches designed to overcome obstacles to family stability and self-sufficiency.
    15. 15. Helping Children by Transforming Adults Elisabeth D. Babcock, President and CEO, Crittenton Women’s Union “Poor families lurch between jobs that don’t pay the rent, to subsidies that do, but don’t last, to homelessness and temporary shelters, to work, but no child care, to job loss, to borrowing on credit, to not being able to get an apartment because they have credit card debt or have been evicted.”
    16. 16. Helping Children by Transforming Adults 40% of our clients report at least one significant mental health diagnosis such as bi-polar, anxiety, and/or depressive disorders 40% report a history of trauma 35% report a physical, cognitive, and/or mental health disability that serves as a barrier to work or school 37% report that when they turn to family or friends for support, their social networks are either non-existent or worse, create a drain on their own families 50% of families in our longer-term programs have at least one child with diagnosed special needs (including behavioral, mental health, learning, and physical disabilities)
    17. 17. Helping Children by Transforming Adults Career Family Opportunity (CFO) Program From the outset, CFO had the express intent of proving that within five years they could attain jobs that would fully support their families without public subsidies (for most families this was a target salary of approximately $50,000 per year) and that they would also have each saved $10,000 (of which $3,600 would come from their own savings and $6,400 from matching funds if they completed their other goals).
    18. 18. Helping Children by Transforming Adults Key Aspects of Career Family Opportunity Program: Mobility mentor Personal goals Feedback and evaluation Cash incentives Social networks Hanging on to the bridge
    19. 19. Helping Children by Transforming Adults Sample Outcomes: 99% of families exiting homeless shelters had retained their housing for more than one year Working adults exiting CWU job-readiness, housing, and education programs experienced an average 85% increase in wages compared to intake 100% of high-risk mothers in supported transitional housing were on-time with rent payments 77% of GED graduates, 80% of job-readiness training graduates, and 100% of supported housing residents were working and/or in school within six months of program completion
    20. 20. Done Right, Early Childhood Development Programs Can Change Communities Jessie Rasmussen, President, Buffett Early Childhood Fund About 60,000 infants, toddlers, and preschoolers in Nebraska are growing up at risk of failing school. Eleven counties account for 64 percent of all at-risk children between the ages of birth and 5 years.
    21. 21. Done Right, Early Childhood Development Programs Can Change Communities In the past five years, the local partners in Nebraska have: Expanded funding for pre-K Institutionalized funding for at-risk four-year-olds through education state aid funding Established a $60 million dollar public-private endowment to create, support, and enhance birth-to-three services for children at risk Protected existing early childhood funding during the lean years of state cutting Passed legislation to expand the Sixpence endowment cash fund, initiate a quality rating and improvement system for child care, and raise the eligibility standard for the child care subsidy
    22. 22. Investments in Young Children = Economic Development Arthur J. Rolnick, Senior Fellow and Co-Director, Human Capital Research Collaborative, University of Minnesota Humphrey School of Public Affairs • Cost-benefit analyses of the Perry Preschool Program, the Abecedarian Project, and the Chicago Child-Parent Centers showed returns ranging from $3 to $17 for every dollar invested • Intensive preschool interventions targeting disadvantaged children have been shown to yield significant gains that may last well into adulthood.
    23. 23. Investments in Young Children = Economic Development Children served by these programs are more likely to: Stay in the regular classroom and out of special education Go through school without repeating a grade Complete high school without dropping out Be employed and have higher earnings as adults
    24. 24. Investments in Young Children = Economic Development “In Minnesota, we estimate that to ensure that all 3- and 4-year-olds living below the poverty line receive high-quality early childhood development, the state needs about an additional $90 million annually. For children who aren’t already involved in an early childhood program, the scholarship would provide access. For children who are enrolled in a child care center or preschool, the scholarship would ensure that the quality is at the necessary level to meet school readiness goals.”
    25. 25. Preview of Commission Recommendations: Healthy Communities
    26. 26. ZIP Code vs. Genetic Code
    27. 27. New Partners in the “ZIP CodeImproving” Business David Erickson, Federal Reserve Bank of San Francisco There is an entire industry— community development—with annual resources in the tens of billions of dollars, that is in the zip code-improving business.
    28. 28. New Partners in the “ZIP Code-Improving” Business Community development and health are working side-byside in the same neighborhoods and often with the same residents, but we do not know each other or coordinate our efforts.
    29. 29. New Partners in the “ZIP Code-Improving” Business A “Wet Cement” Moment “In the next 18 months we will build the new institutions and create new practices that will define the community development industry (and many of its allied sectors) for the next 20 years. Kimberlee Cornett from the Kresge Foundation has been calling this time a “wet cement” moment, when we have the opportunity to create a new way of serving the needs of low-income Americans that can radically improve their life chances. In my opinion, we have never been closer to being able to fix zip codes. But the cement is drying and creating these new systems will require leadership.”
    30. 30. “Quarterbacks and Silo-Busters” Nancy O. Andrews, President and CEO, Low Income Investment Fund Community Development Financial Institutions (CDFIs): Bringing Wall Street to Main Street Mission driven Provides part of financial package that more traditional sources don’t cover First responders
    31. 31. “Quarterbacks and Silo-Busters” People and Places: LIIF Projects Come to Life Booth Memorial Child Development Center Before LIIF’s renovations, Booth’s facilities were outdated, old, and caused health problems. Asthma attacks were a common problem among Booth staff and children. A $70,000 investment from LIIF along with matching contributions from philanthropy brought the total investment to $159,000.
    32. 32. “Quarterbacks and Silo-Busters” People and Places: LIIF Projects Come to Life Transit Oriented Development In 2011, LIIF helped create the Bay Area Transit-Oriented Affordable Housing Fund, a $50 million capital pool formed in collaboration with several other community capital partners to create not only more affordable housing but healthy, mixed-income, walkable communities, located near major transit nodes.
    33. 33. “Quarterbacks and Silo-Busters” People and Places: LIIF Projects Come to Life Purpose Built Communities Based on efforts in Atlanta’s East Lake district, Purpose Built Communities uses integrative strategies including cradle-to-college educational opportunities, mixedincome housing, early child development programs, and recreational opportunities. East Lake in Atlanta has empirically demonstrated a 95 percent reduction in crime since its launch in 1995, a six-fold increase in employment and extraordinary improvement in school achievement.
    34. 34. “Quarterbacks and Silo-Busters” People and Places: LIIF Projects Come to Life Refresh In New Orleans, one of the worst “food deserts” in the country, LIIF worked with partners to fund an $18 million “healthy food hub.” This is a mixed-use commercial facility.
    35. 35. “Quarterbacks and Silo-Busters” Community development field + health field Break down silos Evidence-based investment Adaptive, entrepreneurial networks across divergent fields Scaling up investments in what works
    36. 36. Investing in Poor Neighborhoods Makes Good Business Sense David W. Fleming, Director and Health Officer, Public Health—Seattle & King County Going beyond the walls of the clinic to improve health: Invest in proportion to need Use proven global health strategies Leverage the Health Care Financing Reform and Community Benefit Provisions of the ACA
    37. 37. Investing in Poor Neighborhoods Makes Good Business Sense Like Politics, All Health is Local U.S. life expectancy by county compared to average of top 10 countries, 2007 Red counties are 60 years behind blue counties.
    38. 38. o tries rics and Evaluation, Investing in Poor Neighborhoods Makes Good Business Sense Like Politics, All Health is Local King County life expectancy by census tract compared to average of top 10 countries, 2010 Lake Shoreline Forest Park Bothell Dark red census tracts are 100 years behind dark blue ones. Duvall Kirkland Redmond Carnation Medina Seattle Bellevue Sammamish Mercer Island Issaquah Newcastle Burien Normandy Park Snoqualmie North Bend Renton Tukwila SeaTac Des Moines Kent Maple Valley Covington Federal Way Auburn of Health, pment & Evaluation, Woodinville Kenmore Black Diamond Algona Milton Pacific luation ovisional: Subject to Revision Enumclaw Number of years ahead or behind best performing countries:
    39. 39. We’re all in this Together – the Need for Collective Action Laura J. Trudeau, Senior Program Director, Community Development/Detroit Programs, The Kresge Foundation Detroit Future City: New job opportunities Stabilization of neighborhoods and employment centers Improving city systems and infrastructure
    40. 40. We’re all in this Together – the Need for Collective Action Laura J. Trudeau, Senior Program Director, Community Development/Detroit Programs, The Kresge Foundation Detroit Future City: Zoning reforms that accommodate modern and innovative land uses Putting public land assets into more strategic and productive use Civic engagement
    41. 41. What’s Next?
    42. 42. Get Involved • Visit RWJF.org/goto/commission • Visit buildhealthyplaces.org • Follow @RWJFCommission on Twitter • Tune into the webcast of the recommendations release on January 13

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