Sidebar: The Healthy Communities Movement
Today's definition of community reinvestment has expanded beyond jobs
creation and the development of affordable housing. Successful community
reinvestment programs approach community development using holistic
applications that take into account, in addition to jobs and housing,
other components of healthy communities which include education, transportation
and health care. These reinvestment programs are successful because
community participants with diverse interests and skills work together
to identify issues, seek solutions and measure progress. They do this
to foster an improved quality of life within a geographically defined
area. Participants in these "healthy community" partnerships
may include financial institutions, community-based organizations, local
governments, hospitals, businesses, academic institutions and local
Through their CRA and community development strategies, financial institutions
play a critical role in improving the overall health of their communities.
By building long-term partnerships with local organizations, banks can
leverage their efforts and ensure the creation of community initiatives
which have measurable, tangible results. Partnerships among financial
institutions, community-based organizations and local governments are
already addressing the need for safe, affordable housing and adequate
employment, both of which are components of healthy communities. Success
in these areas can be tracked and demonstrated through the establishment
and review of specific benchmarks. Developing "community benchmarks"
is essential to ensuring that participants with diverse ideas agree
on common goals and share the responsibility for attaining these goals.
Tyler Norris, executive director of the Coalition for Healthier Cities
and Communities, defines health as "the product of both individual
genetic factors and factors related to people's living and working environments."
The factors that create health, and therefore healthy communities, include
education, adequate housing, meaningful employment, job-skills training,
efficient public transportation, recreational opportunities, clean physical
environments, and health education and prevention services.
To effectively build healthy communities, Norris says communities must
continually develop ways to link information streams, establish priorities
and assess resources. For example, in Columbus, Ohio, the Together 2000
Healthy Communities Initiative established a set of long- and short-term
community priorities and then sponsored more than 30 community-based
initiatives to address the identified local and regional issues. Similarly,
the Healthy Detroit Initiative brought together leaders from health
care, government, business and neighborhood groups to identify community
health issues and develop a plan for improving Detroit's quality of
Several major healthy cities initiatives, including most notably those
in Jacksonville, Pasadena and Seattle have developed quality of life
benchmarks that measure changes affecting these communities. These benchmark
indicators vary depending on the focus of each initiative and on the
needs of each community. For example, Seattle's "sustainable indicators"
track everything from population shifts to the number of salmon spawning
in their native beds. Each indicator has a different community health
implication, but each is vital to the ongoing health status of the city
and residents of Seattle.
Healthy community initiatives are not limited to cities, since "community"
may be defined in numerous ways. Initiatives might occur on the neighborhood
level, as in Oakland, California, where activity is focused on improving
the health status of the San Antonio neighborhood in east Oakland. Initiatives
can be broad, as in Oklahoma City, where a collaborative has been formed
which includes four counties and 30 municipalities. A healthy community
might even result from the initiative of only one organization, such
as Riverside Hospital in Columbus, which has developed a menu of over
150 diverse indicators for measuring the overall health of the communities
Norris also notes that increased consolidation within the health care
industry has accelerated the process of building healthy communities.
Recent partnerships among hospitals, HMOs and other insurance providers
are resulting in integrated delivery systems which merge diverse interests
and require greater consensus within the health care industry. Insurance
providers, who traditionally focus on long-term prevention and investment
are now partnering with health care providers, who tend to focus on
short-term critical care issues. To stay competitive, hospitals and
insurance providers are increasingly seeking competitive advantages
including an emphasis on preventative measures to improve the health
of community members and therefore reduce health care costs. These measures
increasingly include the improvement of a community's economic health
as an integral part of this prevention process.
Consolidation within the banking industry has also created opportunities
to improve banking services and reduce costs, with an eye toward improving
the economic health of the communities in which they do business. Tom
Mitrano, communications and community services manager for Bank of Hawaii,
believes financial institutions can benefit by combining a focus on
long-term investment in the economic health of their communities with
the flexibility to meet short-term needs. Mitrano introduced an "assets
planning" strategy at the bank which brought him to the attention
of the Coalition for Healthier Cities and Communities. This strategy
insists that community reinvestment activities produce measurable economic
results. Mitrano says "the key to success is to agree on specific,
measurable ways a community can be better off, then to structure lending,
service, and investment opportunities to deliver those results."
An example of Mitrano's assets planning approach is demonstrated through
an agreement that was structured with a local nonprofit to provide job
training and life skills for unemployed Hawaiians. In addition to helping
the non-profit launch this particular program, the Bank of Hawaii stayed
committed to the organization and its long-term goals. It lent bank
staff to help the non-profit develop sound financial practices and reduce
their reliance on public and private grants. To complete the process,
the bank provided targeted investment funds to support these newly created
This results-oriented approach has also worked in the Sunnyslope neighborhood
of northern Phoenix, where financial institutions have relied on Joel
McCabe to help define measurable goals and identify investment opportunities
in the area. McCabe, who heads a community development corporation called
Sunnyslope Village Revitalization, Inc., has an interest in building
a healthy community in part due to his dual role as CDC director and
as community development coordinator for John C. Lincoln Hospital, which
is located in Sunnyslope. McCabe says the hospital hasn't promoted good
health "if it treats someone in its emergency room or outpatient
clinic, just to return that person to unhealthy living conditions in
the surrounding community. The hospital believes in preventive medicine
for people and neighborhoods."
As director of the CDC, McCabe initially commissioned an Arizona State
University community needs assessment for Sunnyslope. Using this document
as a blueprint, and through its support of the CDC, the hospital has
subsequently been instrumental in the acquisition and development of
vacant properties for both commercial and multi-family use. The CDC
has partnered with local nonprofits to create a home rehabilitation
program in the area, and with the City of Phoenix, local banks, and
the Arizona Department of Commerce, has created an in-fill housing program.
The Local Initiatives Support Corporation has also been a significant
supporter of the CDC's efforts, which are now focused on bringing a
supermarket and new businesses into the area.
As a hospital employee, McCabe focuses on community organizations including
the development of block-watch groups which have reduced crime in the
neighborhoods surrounding the hospital. He points out that there are
economic considerations for creating healthier communities. "Hospitals
can't stay in business, no matter how good their clinical capabilities,
if patients are too fearful to travel to them for services."
As people are increasingly concerned with the health of their communities,
"creating the building blocks of good health, such as strong families,
good jobs and education, lies largely outside the health care system,"
according to Norris. "In healthy communities, the health status
of community residents is not the sole responsibility of health care
The Healthy Communities Movement
The healthy communities movement can be traced to a 1974 Canadian
government report which concluded that environment and lifestyle
improvements would make a greater contribution to the health of
Canadians than would improvements to the health care system. This
report led to a full-scale effort by the World Health Organization
(WHO) to support an effort to improve quality of life in 34 European
cities in the mid-1980s. The movement has since spread to more
than 1,500 communities in more than 50 countries around the world.
The U.S. Department of Health and Human Services embraced the
concept in 1989 when it asked the National Civic League to help
launch the U.S. Healthy Communities Initiative, which served as
a resource for communities nationwide.
Support for healthy communities projects is available from the
WHO Healthy Cities Collaborating Center at Indiana University
in Indianapolis as well as from organizations including the American
Hospital Association's Hospital Research Trust in Chicago and
the Healthcare Forum in San Francisco.
For more information on the Coalition for Healthier Cities and
Communities, call Tyler Norris at (303) 444-3366. Information about
Sunnyslope Village Revitalization, Inc. is available by calling Joel
McCabe at (602) 997-4310.
|| Jack Richards is Community Affairs Manager for the Federal
Reserve Bank of San Francisco. As manager, Jack oversees Community
Affairs staff working with financial institutions and communities
in the nine western states that comprise the Federal Reserve's Twelfth
District. Previously, Jack worked as a commercial lender, a CRA
and fair lending consultant, and as a CRA officer. He is a fellow
of the W.K. Kellogg Foundation National Fellowship Program.
Tyler Norris conducts community-based planning and capacity-building
processes around the world as Executive Director of the Coalition for
Healthier Cities and Communities and as President of Tyler Norris Associates,
a consulting firm. Previously, he directed the Civic Assistance and United
States Healthy Community Programs for the National Civic League in Denver
and the Connections Program for the Windstar Foundation in Snowmass, Colorado.
He is also a fellow of the W.K. Kellogg Foundation National Fellowship
Tom Mitrano is Vice President and Manager of Communications and Community
Services for Bank of Hawaii. Tom has worked as a legislative advocate
and heads the strategic planning committee of the Hawaii Community Foundation.
Joel McCabe is Community Development Coordinator for John C. Lincoln
Hospital and Executive Director for Sunnyslope Village Revitalization,
Inc. His role is to serve as the hospital's liaison in the immediate
vicinity of the hospital and to improve the economic health and well-being
of residents in the Sunnyslope Village Revitalization area.